Medical Protocols for EMS and ALS Personnel

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Questions and Answers

What is required from EMS agencies when restocking controlled substances from a hospital?

Verify the identity of the hospital's pharmacy staff.

Receive verbal confirmations from hospital staff.

Provide a labeled syringe and original drug package for exchange. (correct)

Complete a CSA order form before receiving replacements.

For how long must EMS agencies retain documentation of controlled substance exchanges?

3 years

2 years

1 year

5 years (correct)

Which of the following must be verified by two ALS personnel before placing controlled substances into the EMS CS container?

Authorization for the exchange from the hospital.

The time stamp on the original packaging.

Medication type, concentration, amount, and expiration date. (correct)

The hospital's policy regarding waste management.

What procedure must be followed when wasting a controlled substance?

At least two authorized medical professionals must witness the wastage. Signup and view all the answers

What is the purpose of the limited-access waste containers mentioned in the procedure?

To ensure waste is irretrievable. Signup and view all the answers

What documentation is required from the hospital when they provide controlled substances to the agency?

Written documentation of the transaction. Signup and view all the answers

Which of the following individuals must witness the wastage of a controlled substance?

One RN and one ALS practitioner. Signup and view all the answers

What action must be taken after the controlled substances are restocked into the EMS CS container?

Verify counts against the CS Log. Signup and view all the answers

What is the maximum duration for which controlled substance logs must be archived in Illinois?

5 years Signup and view all the answers

What must ALS personnel do immediately upon discovering a count discrepancy involving controlled substances?

Notify the Provider EMSC, EMS MD, and EMS Administrative Director Signup and view all the answers

Which of the following is a best practice model for resolving discrepancies with controlled substances?

Within the same shift Signup and view all the answers

What is involved in the initiation of an RFC when a controlled substance is missing?

Collecting signed statements from EMS personnel Signup and view all the answers

How soon must a registrant notify the DEA in writing about the theft or significant loss of controlled substances?

Within 1 business day Signup and view all the answers

What form is required to report theft or loss of controlled substances to the DEA?

DEA Form 106 Signup and view all the answers

Who may assist in filling out the DEA Form 106 report when there is theft or significant loss?

EMS MD Signup and view all the answers

What must be included in the internal investigation after a missing controlled substance is reported?

Documentation supporting the chain of custody Signup and view all the answers

What action should be taken with the CS container combinations upon an employee's termination?

Change the lock combinations immediately. Signup and view all the answers

Which scenario does NOT require the removal and secure storage of CS?

The crew is unavailable as they are on a lunch break. Signup and view all the answers

What is prohibited in personal or Agency non-EMS vehicles?

Controlled substances. Signup and view all the answers

What is one of the basic requirements defined by the DEA regarding CS records?

Records must be readily retrievable. Signup and view all the answers

Which of the following statements about incidental contact by EMTs is true?

ALS personnel must have complete control over CS at all times. Signup and view all the answers

How long should CS records be kept according to the requirements mentioned?

For two years. Signup and view all the answers

Why is daily accountability for CS inspections important?

To prevent unauthorized access and diversion. Signup and view all the answers

What type of drugs are allowed in 'jump bags' carried by personnel?

Over-the-counter drugs. Signup and view all the answers

Which of the following substances is classified as a Schedule I controlled substance?

Heroin Signup and view all the answers

What distinguishes Schedule II substances from Schedule I substances?

Schedule II substances can be prescribed. Signup and view all the answers

Which of the following drugs falls under Schedule III controlled substances?

Anabolic steroids Signup and view all the answers

What is the primary characteristic of Schedule IV substances compared to Schedule III substances?

Schedule IV substances have a lower potential for abuse. Signup and view all the answers

Which of the following medications is considered to have the least potential for abuse?

Robitussin AC Signup and view all the answers

Which of the following statements is true regarding Schedule V controlled substances?

They have the least abuse potential among controlled substances. Signup and view all the answers

Which class of controlled substances is primarily associated with severe physical dependence?

Schedule II Signup and view all the answers

Which of the following is a characteristic of Schedule III substances?

They can lead to moderate to low physical dependence. Signup and view all the answers

Which of the following behaviors would NOT lead to disciplinary action according to the guidelines?

Accurate inventory checks Signup and view all the answers

What must be verified by two ALS personnel before placing restocked controlled substances back into the EMS container?

Medication, concentration, amount, and expiration date Signup and view all the answers

Which statement regarding intra-agency controlled substance exchanges is correct?

The original opened CS and labeled syringes must be brought to the receiving hospital for wasting. Signup and view all the answers

What is a necessary action if an equal and appropriate exchange of controlled substances cannot be completed on scene?

Bring the original open packaging to the receiving hospital for wasting/exchange. Signup and view all the answers

In the case of peer-to-peer exchanges between ALS clinicians, what must they ensure regarding the exchanged controlled substances?

The packaging, concentration, and dosing specifications must meet specific guidelines. Signup and view all the answers

Which of the following is an example of behavior that could result in disciplinary action?

Failing to perform an inventory check Signup and view all the answers

What must ALS clinicians do when a patient is not transported but controlled substances are opened?

Restock from another ALS vehicle on scene, ensuring responsibility is assumed. Signup and view all the answers

Which of the following is a consequence of a break in the chain of custody of controlled substances?

Disciplinary action by the EMS Agency Signup and view all the answers

Study Notes

Controlled Substance Management in EMS

Authorized individuals are permitted to pick up and transport controlled substances (CS) as per the agency’s regulations.
ALS personnel must maintain strict control over access to CS, even during incidental contact with EMTs at the scene.
Security recommendation: Change lock combinations or passcodes for CS containers upon employee termination to enhance security.

Out-of-Service (OOS) Regulations

OOS EMS vehicles must have their CS removed and secured according to medication management plans.
Temporary OOS status due to crew breaks or non-emergency duties does not require immediate CS removal.

Storage Restrictions

Controlled substances are prohibited in non-EMS vehicles; personal "jump bags" may only contain over-the-counter drugs.

Monitoring and Record-Keeping

The EMS System is obligated to conduct audits for inventory discrepancies and potential CS diversion.
Key DEA recordkeeping requirements include:
- Records must be easily retrievable and kept for at least two years.
- Original logs and explanations should be archived electronically for five years.

Incident Reporting

ALS personnel must report any discrepancies, theft, or loss of controlled substances to relevant authorities immediately.
Discrepancies must be resolved within 24 hours, preferably during the same shift.
A Request for Clarification (RFC) is necessary if discrepancies cannot be immediately explained.

Federal Regulations on Theft Reporting

Registrants are required to notify the DEA in writing about theft or significant loss of CS within one business day.
Completion and submission of DEA Form 106 is mandatory, and assistance from the EMS medical director may be needed.

Disciplinary Actions

Breaches in the chain of custody, dishonesty in inventory checks, and drug diversion are grounds for disciplinary actions against EMS personnel.

Peer-to-Peer CS Exchanges

ALS clinicians may replenish CS from other ALS vehicles at the scene if they assume patient responsibility.
Verification of correct medication, concentration, and expiration date is required before restocking.
Intra-agency exchanges do not require a form but must be documented in ePCR.

Emergency Restocking from Hospitals

EMS may receive CS from hospitals for restocking without forms, provided proper documentation of the exchange is maintained for five years.
All CS wasting must be witnessed and documented according to hospital policies.

Wasting Controlled Substances

Remaining CS after preparation must be wasted in the presence of an ED nurse, documented in ePCR, and must include the nurse’s signature.

Schedules of Controlled Substances

Schedule I: High abuse, no medical use (e.g., heroin, marijuana).
Schedule II: High abuse, accepted medical use (e.g., morphine, oxycodone).
Schedule III: Intermediate abuse potential (e.g., anabolic steroids).
Schedule IV: Less abuse potential (e.g., alprazolam, diazepam).
Schedule V: Least potential for abuse (e.g., Robitussin AC).

Important Notes

Documentation of all CS transactions must adhere to organizational and regulatory standards.
Compliance is crucial to prevent loss, ensure accountability, and mitigate potential legal consequences.

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Description

This quiz covers the protocols and security measures related to the handling and transport of controlled substances by EMS personnel. It emphasizes the importance of ALS practitioners maintaining control during incidental contact. Understand the recommendations for best practices in compliance with federal regulations.