General Protocols Quiz

Questions and Answers

What should happen if a patient refuses medical care or transport?

The refusal of care procedure should be utilized, ensuring assessment of competency and providing necessary information about the risks of refusal.

Which groups of individuals may refuse medical care and/or transport?

Competent Adult Patient

Competent emancipated minor

Legal representative such as a guardian

All of the above (correct)

A person under the age of eighteen (18) can always refuse medical care.

False

What is implied consent in the context of medical emergencies?

Implied consent is when a patient is deemed incompetent to refuse treatment, allowing EMS to treat and transport them regardless of their refusal. Signup and view all the answers

Patients who refuse to be transported should be considered to be refusing _____ .

transport Signup and view all the answers

In what scenario should medical direction be contacted in high-risk refusals?

All of the above Signup and view all the answers

What is the Behavioral Health Access Program (BHAP)?

A multicomponent program for firefighter mental health/wellness and crisis intervention. Signup and view all the answers

Which of the following organizations recognizes the BHAP model?

National Fallen Firefighter's Foundation Signup and view all the answers

Which of the following is NOT a benefit of BHAP?

Higher insurance premiums Signup and view all the answers

What are Debilitating Critical Incidents (DCI)?

Types of incidents that prompt BHAP response, such as serious injury or death of a department member. Signup and view all the answers

What is CISM?

Crisis Intervention Stress Management Signup and view all the answers

CISM discussions are confidential and privileged under Florida law.

True Signup and view all the answers

What must accompany a live patient during transport according to the DNRO regulations?

A copy of the DNRO form or the patient identification device. Signup and view all the answers

What color paper is the Florida Do Not Resuscitate Order Form printed on?

Yellow Signup and view all the answers

Which entities are likely to provide effective insurance coverage for first responders?

First responder specific providers Signup and view all the answers

What tasks can the Rescue Task Force (RTF) provide? (Select all that apply)

Extracting victims Signup and view all the answers

Law enforcement officers (LEO) should separate from fire and EMS personnel during an incident.

False Signup and view all the answers

In what zone can RTFs operate?

Warm Zone Signup and view all the answers

What does the acronym THREAT stand for?

Threat suppression, Hemorrhage Control, Rapid Extrication to safety, Assessment by medical providers, Transport to definitive care Signup and view all the answers

The _____ is established by the first-arriving officer.

Command Signup and view all the answers

What is the designation for the area where there is known hazard or direct threat?

Hot Zone Signup and view all the answers

What must be requested for an active shooter event with unknown victims?

MCI level 2 response Signup and view all the answers

The Cold Zone is where there is a significant threat from an assailant.

False Signup and view all the answers

Unified Command consists of representatives from law enforcement, fire, and EMS working together to develop a single _____ action plan.

incident Signup and view all the answers

What should the Transport Officer do?

Supervise the medical communication coordinator Signup and view all the answers

Match the following MCI Levels with their corresponding number of victims:

MCI Level 1 = 5-10 victims MCI Level 2 = 11-20 victims MCI Level 3 = 21-100 victims MCI Level 4 = 101-1000 victims MCI Level 5 = More than 1000 victims Signup and view all the answers

What should be documented during an incident?

Hospital Capability Worksheet Signup and view all the answers

What is the purpose of the Medical Resource Coordination Center (MRCC)?

To maintain status information, coordinate transportation, and direct patients to appropriate hospitals. Signup and view all the answers

The transporting unit should contact the individual hospital directly.

False Signup and view all the answers

What are the priority categories for victims during transport?

Red, Yellow, Green Signup and view all the answers

What should pediatric patients who have reached puberty be treated like?

As adults. Signup and view all the answers

The adult IM injections are administered in the _____ thigh.

lateral Signup and view all the answers

Which of the following is NOT a component of the six rights of drug administration?

Frequency Signup and view all the answers

What equipment should be assured for transport?

Necessary medical equipment and supplies. Signup and view all the answers

In pediatric cardiac arrest, the preferred method of vascular access is _____ infusion.

IO Signup and view all the answers

What is a key role of the Medical Supply Coordinator?

Managing all medical supplies and acquiring necessary equipment Signup and view all the answers

Which of the following programs or forms are used by several states?

All of the above Signup and view all the answers

What must occur for an EMT or paramedic to determine a patient is dead?

All of the above Signup and view all the answers

What does DNRO stand for?

Do Not Resuscitate Order Signup and view all the answers

Resuscitation should be attempted on a TRAUMA victim if all three presumptive signs of death are present.

False Signup and view all the answers

What should EMS personnel do if law enforcement denies access to a crime scene?

Notify the EMS Agency Supervisor Signup and view all the answers

What is a Casualty Collection Point (CCP)?

A temporary location for gathering, triage, medical stabilization, and subsequent evacuation of casualties. Signup and view all the answers

Air Rescue is unnecessary for a level 1 trauma patient with a ground transport time of greater than 20 minutes.

False Signup and view all the answers

Which of the following is true about an Improvised Explosive Device (IED)?

It is designed to destroy or incapacitate Signup and view all the answers

What is the responsibility of the local law enforcement agency once death has been determined?

Control the body until disposition is made Signup and view all the answers

What should be confirmed with a manual blood pressure reading?

Any abnormal or significant changes of an automatic blood pressure cuff reading Signup and view all the answers

Hypotension for adults is defined as Systolic BP < 90 mm Hg.

True Signup and view all the answers

Which of the following patients should be monitored with ETA O2?

Patients who have been sedated Signup and view all the answers

A BGL shall be documented for patients with a history of ______.

diabetes Signup and view all the answers

What conditions warrant a 12 lead ECG?

Palpitations Signup and view all the answers

What should be done for patients with inadequate air exchange with suspicion of foreign body airway obstruction?

Follow the FBAO protocol. Signup and view all the answers

Oxygen should be withheld if the patient is dyspneic or hypoxic.

False Signup and view all the answers

Which patients are to receive 15 LPM via NRB regardless of SpO2?

All 3rd trimester pregnancy trauma patients Signup and view all the answers

What is the recommended SpO2 level for all patients?

Maintain SpO2 of 94% Signup and view all the answers

Study Notes

General Protocols

Refusal of Care & Transport: Procedure for patients with the right to decline evaluation and treatment, considering competency.
BHAP & CISM Activation: Mental health support program recognized by major firefighting associations emphasizing first responders' wellness.
Do Not Resuscitate (DNR) Order: Guidelines regarding patient preferences for resuscitation.
Determination of Death: Protocols for assessing and confirming death in emergency settings.
Crime Scene Considerations: Procedures to follow when on scene of a potential crime.
Helicopter Safety: Safety guidelines for air transport situations.
Mass Casualty Incident: Protocols for responding to large scale emergencies involving multiple victims.

Standing Orders

General Information: Overview of standing orders for EMS personnel.
Patient Assessment: Guidelines for evaluating patient conditions.
Ventilatory Assistance: Protocols for providing respiratory support.
Transport Destinations: Criteria for determining appropriate areas for patient transport.
Helicopter Transport Criteria: Guidelines specifying when helicopter transport is warranted.

ALS Medical Emergencies

Acute Adrenal Insufficiency: Critical care procedures for adrenal failure incidents.
Allergic Reaction: Management strategies for acute allergic responses.
Diabetic Emergencies: Protocols for handling various diabetic crises.
Dystonic Reaction: Treatment instructions for patients exhibiting muscular spasms.
Fluid Resuscitation/Dehydration: Approaches to restore hydration and address fluid loss.
Hyperkalemia: Management of elevated potassium levels in patients.
Nausea/Vomiting: Care strategies for patients experiencing gastrointestinal distress.
Respiratory Distress: Emergency response protocols for breathing difficulties.
Seizure: Guidelines for the assessment and management of seizure activity.
Sepsis: Critical interventions for suspected septic patients.
Stroke: Identification and treatment protocol for stroke victims.

Cardiac Emergencies

Conditions such as Atrial Fibrillation, Bradycardia, and Cardiogenic Shock involve specific protocols to stabilize patients.
Chest Pain: Immediate assessment and intervention protocols for chest pain complaints.
STEMI Alert: Procedures for identifying and responding to ST-Elevation Myocardial Infarction.
CHF (Pulmonary Edema): Management of congestive heart failure cases.
Wide Complex Tachycardia: Treatment Guidelines for dysrhythmias.
Ventricular Assist Device: Management of patients with ventricular assist devices.

Cardiac Arrest

Standing Orders: Standard protocols during cardiac arrest situations.
Differentiation between adult and pediatric cardiac arrest management.
Special considerations for various arrest situations based on clinical assessment.

Overdose Emergencies

Standing Orders: Guidelines for treating overdose cases.
Specific protocols for managing overdoses from substances such as beta blockers, calcium channel blockers, cocaine, narcotics, and tricyclic antidepressants.

Chemical Control

Chemical Restraint: Protocols for safely restraining patients in cases of chemical-induced agitation.
Pain Management: Guidelines to control pain in emergency settings.
Delayed Sequence Intubation: Protocols for securing airway management in critically ill patients.

Environmental Emergencies

Management protocols for conditions like Decompression Sickness, Non-Fatal Drowning, Heat Emergencies, Carbon Monoxide, and Cyanide Exposure.

Trauma

Comprehensive standing orders covering various types of trauma including eye injuries, bites, fractures, bleeding control, and traumatic arrest.
Specific protocols for handling pediatric trauma and trauma in pregnancy.

Obstetrical

Guidelines for managing complications during different trimesters of pregnancy, including pre-eclampsia/eclampsia and meconium staining.

Editors & Contributors

Recognition of key individuals and teams involved in the development and approval of EMS protocols, including Medical Directors and emergency services chiefs.

Refusal of Care & Transport

Established guidelines for patients who refuse evaluation/treatment based on competency.
Emphasis on proper documentation and procedures when minors refuse care without guardian presence.
High-risk refusal situations require direct consultation with Medical Direction for guidance.

BHAP & CISM Activation Process

BHAP’s role in mental health support for firefighters, enhancing work-life balance and reducing PTSD symptoms.
DCI types specified as circumstances warranting BHAP activation, aligning with safety and health standards in emergency services.### Interventions and Events Requiring BHAP & CISM Activation
Serious incidents involving department members, such as injuries or fatalities, necessitate immediate activation of mental health support services.
Pediatric injuries or deaths require special handling due to their severity and emotional impact.
Large-scale events, including natural disasters or mass casualty incidents, pose significant operational challenges and may lead to activation.
Line-of-duty deaths or injuries, as well as officer-involved shootings, trigger critical stress management protocols.
Events generating excessive media coverage or involving known victims are prioritized for mental health intervention to manage public and internal impact.
Serious injuries from fire department operations, including vehicle accidents, also warrant activation.

BHAP Services Overview

CISM (Critical Incident Stress Management) focuses on peer support interventions, maintaining confidentiality in discussions under state law.
Peer Support provides emotional wellness resources and addresses mental health challenges for first responders and their families.
Chaplaincy offers spiritual crisis intervention and grief counseling while ensuring privileged confidentiality.
Clinician Response Team (CRT) consists of professionals trained in first responder culture, offering assessments and crisis interventions.
Evaluated Recovery Centers provide first responders with specialized treatment programs for substance abuse and PTSD, meeting stringent criteria.
Family Support educates caregivers on mental health issues affecting first responders and promotes recovery strategies.

CISM Activation Process

Activation begins with the Officer notifying the Safety and Health Chief to initiate a BHAP response via Broward Regional Communications Centers.
Essential information for activation includes agency name, incident type, number of members involved, and contact details.
The BHAP Team Coordinator organizes a response based on the incident's nature and timing of activation.
Interventions occur in secure locations, ensuring confidentiality and safety for participants.
Follow-up debriefing occurs for the BHAP team post-intervention to discuss responses and processes.

Do Not Resuscitate Orders (DNRO)

DNROs are legally recognized in Florida, allowing patients to refuse cardiopulmonary resuscitation in specific circumstances.
EMS personnel must honor valid DNROs issued on the official form or patient identification device.
The DNRO form must be printed on yellow paper, clearly labeled, and signed by a physician.
Patients or authorized representatives can revoke DNROs at any time.
Oral orders or telephonic requests from absent physicians are not valid for DNRO enforcement.

Determination of Death Guidelines

EMTs may declare death under specific conditions, including presence of lividity, rigor mortis, decomposition, or an existing DNRO.
Reevaluation protocols apply when encountering suspected hypothermia, overdose, or electrocution cases.
In trauma situations, resuscitation is not warranted if clear signs of death are present.
Local law enforcement handles the deceased post-determination, with the body remaining on-site until medical examiner disposition.

Crime Scene Considerations

EMS personnel must be cautious when responding to potential crime scenes and adhere to directives from law enforcement to ensure patient care and investigation integrity.### Crime Scene Protocols
Only designated units will respond to calls for crime scenes.
EMS can request entry to assess life status but must avoid confrontation with law enforcement if denied access.
Limit the number of EMS personnel entering a crime scene to preserve its integrity.
Resuscitation is not permitted if the patient has no pulse and no respiration per established protocols for determining death.
Maintain close proximity to the victim while on the scene and avoid disturbing pooled blood or wandering.
Do not touch the victim's personal effects or alter their body or clothing in any way; clothing should remain intact unless specified by protocol.
Medical supplies should not be left scattered at the scene; move victims expeditiously to the vehicle if resuscitation is needed.

Air Rescue Procedures

Standard dispatch for Air Rescue includes one engine company and one rescue unit.
Additional resources may be needed based on incident specifics; only uniformed fire officers can modify assignment dispatch.
Air Rescue response is warranted for various critical situations including severe trauma with extended transport times, inaccessible locations, and life-threatening emergencies.
Weather conditions, safety hazards, and civilian traffic must be accounted for before requesting Air Rescue.
Clear communication with Air Rescue is essential; critical information to relay includes patient status, weight, and airway concerns.

Helicopter Landing Zone Considerations

A safe landing zone should be 100 feet by 100 feet, devoid of hazards and with designated marshaling personnel.
Secure emergency communications during helicopter operations and call “Abort” if any hazards arise.
Ground crews must keep a safe distance until patient loading is complete, and all personnel should exit the landing zone together after loading.

Patient Preparation for Air Transport

Before loading a patient into the helicopter, ensure they are secured on a spine board and warn them about the noise and wind.
Personnel must not approach the helicopter until the flight crew is ready; all coverings must be removed to avoid hazards from rotor wash.
Three personnel, including flight medic, are required to safely move the patient to the helicopter.

Mass Casualty Incident (MCI) Protocol

The purpose of the MCI protocol is to effectively triage, treat, and transport numerous victims beyond the capability of the initial response unit.
Key terms include:
- Active Assailants: Individuals engaged in killing or attempting to kill in populated areas.
- Casualty Collection Point: A temporary area for gathering and treating casualties.
Unified command facilitates coordination between fire, EMS, and law enforcement during tactical incidents.
Triage should prioritize victims using color-coded ribbons for immediate, delayed, ambulatory, or deceased designations.

Incident Command Responsibilities

The first-arriving officer establishes command and performs a size-up to estimate victims and request appropriate levels of response.
Identification of staging areas and establishment of Unified Command are crucial for ensuring effective communication and safety.
As units arrive, designate officers for triage, treatment, transport, and staging to streamline response efforts.
Utilize the THREAT acronym for initial actions: Threat suppression, Hemorrhage control, Rapid Extrication, Assessment by providers, and Transport to care.

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Description

Test your knowledge on essential general protocols related to patient care and transport. This quiz covers critical topics like refusal of care, resuscitation orders, and determination of death. Prepare to evaluate your understanding of these vital healthcare processes.