Patient Refusal and ALS to BLS Protocols
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Questions and Answers

Who is authorized to purchase and wear the navy blue military-style sweater?

  • Only administrative staff
  • All firefighters regardless of rank
  • All employees of Montgomery County Fire and Rescue Service
  • Only Battalion Chiefs and above (correct)

    • What feature is required on the left side of the chest of the navy blue sweater?

  • A specialty team patch
  • An embroidered rank insignia
  • A gold nameplate
  • A badge holder (correct)

    • What type of uniform shirt must be worn underneath the navy blue sweater?

  • A Class A uniform shirt
  • A Class B or Class C uniform shirt (correct)
  • A tactical shirt
  • Any standard t-shirt

    • When is a sweatshirt permitted to be worn as the outermost garment?

    <p>Only for the Class E Uniform</p> Signup and view all the answers

    What does a patch or emblem indicate on a uniform jacket?

    <p>An employee’s specialty team membership or certification</p> Signup and view all the answers

    What is the primary purpose of the document shared by station personnel between shifts?

    <p>To communicate issues affecting the station and community</p> Signup and view all the answers

    Who is referred to as the 'Station Officer' in the context of this policy?

    <p>The senior MCFRS officer on duty at the station</p> Signup and view all the answers

    What must be done if there are changes to scheduled activities due to operational demands?

    <p>Document the changes in the logbook</p> Signup and view all the answers

    What is the role of the Station Commander?

    <p>To facilitate readiness and support of the station and apparatus</p> Signup and view all the answers

    Which of the following statements is NOT true as per the policy outlined?

    <p>Exceptions to scheduled activities can be made at any time.</p> Signup and view all the answers

    What must a provider obtain if a patient refuses treatment and/or transport?

    <p>A complete patient assessment, risks explanation, and advice about condition changes</p> Signup and view all the answers

    Which of the following is NOT a requirement when a patient refuses transportation?

    <p>Contacting the patient's family for consent</p> Signup and view all the answers

    In the case of ALS to BLS patient downgrade, what must be included in the ePCR?

    <p>A detailed narrative explaining the downgrade reason</p> Signup and view all the answers

    What should a provider document regarding potential risks when a patient refuses care?

    <p>An explanation of the potential risks must be provided to the patient</p> Signup and view all the answers

    If an EMS provider advises a patient of a changing medical condition, what should the patient do?

    <p>Call 911 immediately</p> Signup and view all the answers

    What action should a provider take if there's a hardware failure affecting RMS?

    <p>Call IT Help Desk and start completing paper reports</p> Signup and view all the answers

    Which of the following must NOT be included in the narrative when downgrading from ALS to BLS?

    <p>The exact time of the downgrade</p> Signup and view all the answers

    What protocol should providers refer to for further direction regarding patient refusal?

    <p>Maryland Medical Protocol: Patient Initiated Refusal of EMS</p> Signup and view all the answers

    What is included in the clean copy of a draft document sent for comments?

    <p>Proposed changes without brackets and underlines</p> Signup and view all the answers

    What may be indicated if a marked-up version of a document is omitted?

    <p>All parts should be considered changed</p> Signup and view all the answers

    Who is responsible for preparing the final copy of the draft document for the Fire Chief’s signature?

    <p>The Document Control Officer or designee</p> Signup and view all the answers

    What action is taken with signed FCGOs, Directives, and Information Bulletins after their approval?

    <p>Published on the Webpage and notifications are sent</p> Signup and view all the answers

    What is indicated on the front page of rescinded documents?

    <p>Bold markings indicating rescission</p> Signup and view all the answers

    How often does the Fire Chief review all MCFRS policies?

    <p>Every three years</p> Signup and view all the answers

    What is the role of the Fire and Emergency Services Commission (FESC) regarding policies and procedures?

    <p>To approve or disapprove policies and procedures</p> Signup and view all the answers

    What documents does the Fire Chief or designee send to the FESC for review?

    <p>Executive Regulations and MCFRS Policies and Procedures</p> Signup and view all the answers

    What must personnel do with their personal protective equipment upon reporting for duty?

    <p>Place it in their assigned riding position</p> Signup and view all the answers

    Which of the following responsibilities falls to the Station Commander?

    <p>Coordinate with LFRD on facility issues</p> Signup and view all the answers

    What should be reported in accordance with current MCFRS procedures?

    <p>Apparatus defects</p> Signup and view all the answers

    What is one of the initial actions to be taken when the Station Officer reports for duty?

    <p>Exchange relevant information with the off-going Station Officer</p> Signup and view all the answers

    In terms of timekeeping, what is the Station Commander's responsibility regarding subordinates?

    <p>Ensure that timecards are up-to-date and overtime is approved</p> Signup and view all the answers

    What should be done when any significant damage or failure is noted at an LFRD owned or managed station?

    <p>Notify the LFRD based on the Station Reference Manual</p> Signup and view all the answers

    What is part of the station management procedures regarding apparatus and equipment?

    <p>Conducting daily checks as agreed upon</p> Signup and view all the answers

    Who is responsible for completing electronic incident and unit reports?

    <p>The Station Commander</p> Signup and view all the answers

    What is the primary responsibility of the Station Officer concerning personnel?

    <p>To oversee the daily operation and document personnel attendance</p> Signup and view all the answers

    Which of the following supplies is NOT specifically mentioned as part of the station's supply management?

    <p>Personal protective equipment</p> Signup and view all the answers

    What action must the Station Officer take if they do not have access to the electronic Battalion Line-up?

    <p>Provide riding assignments to the Battalion Chief using an alternative method</p> Signup and view all the answers

    What is a key responsibility of the Station Commander regarding station supplies?

    <p>To ensure the supply levels directly support operations</p> Signup and view all the answers

    In case of a facilities failure, what is the immediate action the Station Officer should take?

    <p>Take actions to limit damage caused by the failure</p> Signup and view all the answers

    What is the primary focus of the MCFRS Critical Illness and Injury policy?

    <p>To define actions for work-related critical illnesses and injuries.</p> Signup and view all the answers

    Which personnel does the MCFRS Critical Illness and Injury policy apply to?

    <p>All MCFRS personnel.</p> Signup and view all the answers

    What qualifies as a Critical Illness/Injury under the MCFRS policy?

    <p>An illness or injury necessitating hospitalization and extensive recuperation.</p> Signup and view all the answers

    What role does the Family Liaison Officer play according to the MCFRS policy?

    <p>To provide support to the family of critically ill/injured personnel.</p> Signup and view all the answers

    What action does MCFRS commit to regarding the families of personnel who suffer work-related critical illnesses/injuries?

    <p>Making resources available to meet their needs.</p> Signup and view all the answers

    What existing policy does the MCFRS Critical Illness and Injury policy update?

    <p>DFRS Policy &amp; Procedure #525</p> Signup and view all the answers

    Which of the following best describes a key component of the policy's objectives?

    <p>To enhance support for families during crises.</p> Signup and view all the answers

    What is NOT included in the MCFRS Critical Illness and Injury policy?

    <p>Protocols for routine medical examinations.</p> Signup and view all the answers

    Who must be notified immediately when personnel sustain a critical non-work-related illness or injury?

    <p>The Fire Chief, Division Chiefs, and Safety Officer</p> Signup and view all the answers

    What is the responsibility of all MCFRS personnel regarding emergency notification information?

    <p>They must maintain and update it immediately upon any changes.</p> Signup and view all the answers

    If an individual sustains a critical work-related illness or injury and is unable to contact their family, who is responsible for notifying the family?

    <p>A Department designee</p> Signup and view all the answers

    What kind of assistance does MCFRS offer for personnel sustaining a critical non-work-related illness/injury?

    <p>Support for the family or significant other</p> Signup and view all the answers

    What must MCFRS personnel do upon learning of someone sustaining a critical non-work-related illness/injury?

    <p>Notify their supervisor immediately</p> Signup and view all the answers

    In what circumstance would a Family Liaison Officer be assigned?

    <p>When personnel sustain a critical work-related illness/injury</p> Signup and view all the answers

    What is a required procedure for personnel following a critical work-related illness or injury?

    <p>Follow procedures outlined in MCFRS Policy &amp; Procedure 04-01</p> Signup and view all the answers

    Which statement regarding up-to-date next of kin information is true for MCFRS personnel?

    <p>It should be maintained in the designated staff database.</p> Signup and view all the answers

    What must a provider do when using the Short Form to document a patient refusal on the scene?

    <p>Enter patient refusal information into the ePCR system as soon as possible.</p> Signup and view all the answers

    Which of the following is a requirement for the original Short Form after documenting a patient refusal?

    <p>It should be sent to the Records Custodian at PSHQ via sealed interoffice mail.</p> Signup and view all the answers

    Which component is included on the reverse side of the Short Form for patient refusals?

    <p>A checklist for Patient Refusals from the Maryland Medical Protocols.</p> Signup and view all the answers

    What should a provider note in the narrative of the ePCR when the Short Form is used?

    <p>That there are no patient signatures due to the use of the Short Form.</p> Signup and view all the answers

    How are copies of the Short Form being utilized by Montgomery County hospitals?

    <p>As a guide for pre-hospital consults.</p> Signup and view all the answers

    When should the original Short Form be mailed to the Records Custodian?

    <p>Immediately after the documentation has been completed.</p> Signup and view all the answers

    What is the primary purpose of the checklist included on the Short Form?

    <p>To guide providers to obtain properly-informed patient refusals.</p> Signup and view all the answers

    What types of records are referenced as attachments in the document?

    <p>NFIRS forms for different types of incidents.</p> Signup and view all the answers

    What is the primary responsibility of supervisory personnel in regard to policies and procedures?

    <p>To ensure subordinate personnel are aware and comply with applicable documents</p> Signup and view all the answers

    What is required on all FCGOs, Directives, and Bulletins that are designed for limited duration scenarios?

    <p>An automatic expiration date</p> Signup and view all the answers

    What is a responsibility of the Document Control Officer or designee?

    <p>To maintain master files of issued documents in editable and protected formats</p> Signup and view all the answers

    What process must any MCFRS personnel follow to propose a change to a current policy or procedure?

    <p>Forward the proposal through the chain-of-command to the Division Chief</p> Signup and view all the answers

    Which action is NOT part of the Division Chiefs' responsibilities regarding Policies and Procedures?

    <p>Ensuring all personnel adopt their changes immediately</p> Signup and view all the answers

    What happens automatically upon the distribution of a new or revised document?

    <p>The previous version of the document is cancelled</p> Signup and view all the answers

    Which of the following is NOT a responsibility of the Division Chiefs in MCFRS?

    <p>Developing personal opinions on policy matters</p> Signup and view all the answers

    What characteristic must all distributed documents possess to ensure clarity and control?

    <p>A clear cancellation section indicating previous versions</p> Signup and view all the answers

    Study Notes

    Patient Refusal of Treatment and Transport

    • EMS providers must document patient refusal of treatment and transport by obtaining the patient's signature and documenting details on the ePCR.
    • Before a patient refuses treatment and transport, EMS providers must thoroughly assess the patient, including vital signs, and inform the patient of potential risks associated with refusing treatment and/or transport.
    • The EMS provider must also advise the patient to call 911 immediately if their medical condition changes.

    ALS Downgrade to BLS Transport

    • If an ALS provider determines a patient is appropriate for BLS transport only, they must complete an ePCR with certain details.
    • The ePCR must include a narrative explaining the patient assessment and reason for the downgrade.
    • This narrative must include more than a single sentence without elaboration.
    • The ALS provider should refer to the General Patient Care Protocol within the Maryland Medical Protocols for information on transitioning care from ALS to BLS.

    Montgomery County Fire and Rescue Service (MCFRS) RMS Contingency Plan

    • If the RMS (other than the EMS ePCR system) fails, MCFRS personnel should call the IT Help Desk.
    • If all stations are affected, the MCFRS IT Section will send an email and the ECC will make an announcement.

    MCFRS Document Policy

    • The Document Control Officer will distribute a clean copy of a document with proposed changes and a marked-up version showing changes.
    • Final copies of signed FCGO's, Directives, and Information Bulletins will be published on the MCFRS website and sent to all MCFRS County email addresses.
    • MCFRS Policies and Procedures are sent to the Fire and Emergency Services Commission (FESC) for approval.
    • Once approved, MCFRS Policies and Procedures are published on the MCFRS website and sent to all MCFRS personnel with County email addresses.
    • Cancellation or rescission of documents is done in writing by the Fire Chief.
    • MCFRS policies are reviewed every three years by the Fire Chief and amended as needed.

    Apparel Policy

    • All MCFRS personnel, both career and volunteer, must comply with the Apparel Policy.
    • Battalion Chiefs and above may only wear a specific navy blue military-style V-neck sweater with specific features.

    Station Management Policy

    • MCFRS is committed to maintaining operational readiness of personnel, facilities, apparatus, and records while ensuring a safe work environment.
    • All personnel must comply with the Station Management Policy.
    • The Station Officer is responsible for reporting any damage or failure at LFRD owned or managed stations to the LFRD.
    • The Station Officer is responsible for ensuring that apparatus and portable equipment are checked daily.
    • The Station Officer is responsible for ensuring subordinates' timecards are up-to-date and overtime is properly requested and approved.
    • The Station Officer is responsible for ensuring that electronic incident/unit/and EMS reports are completed according to MCFRS procedures.

    Critical Illness and Injury

    • MCFRS must provide support for families or significant others of personnel who sustain critical illness or injury, including those with non-work-related injuries/illnesses
    • MCFRS will make resources available to families of personnel who sustain a work-related critical illness/injury
    • When MCFRS personnel sustain a critical work-related illness/injury, the Fire Chief, Division Chiefs, Duty Operations Chief, or Section Chief, Health & Wellness Chief, affected Battalion Chief, Safety Officer, LFRD Chief and/or President, and affiliated bargaining unit representative must be immediately notified.
    • MCFRS will appoint a Family Liaison Officer to the family or significant other of personnel sustaining a critical illness/injury
    • A Department designee will notify the family or significant other of the individual sustaining a work-related critical illness/injury.
    • MCFRS personnel must maintain current emergency notification information in the designated staff database.
    • When MCFRS personnel sustain a critical non-work-related illness/injury, the Fire Chief, Division Chiefs, Duty Operations Chief or Section Chief, Health & Wellness Chief, affected Battalion Chief, Safety Officer, LFRD Chief and/or President, and affiliated bargaining unit representative must be immediately notified.
    • All MCFRS personnel must immediately notify their supervisor when they, or someone they supervise, sustains a critical work-related illness/injury.
    • All MCFRS personnel must maintain up-to-date next of kin information in the designated staff database.
    • The provider must retain the original Short Form with signatures, and send that original Short Form to the Records Custodian at PSHQ via sealed interoffice mail.
    • When using the Short Form to document a patient refusal on the scene, the provider must enter that information into the ePCR system as soon as possible, and note in the narrative of the ePCR that there are no patient signatures due to the use of the Short Form.
    • The provider must send that original Short Form to the Records Custodian at PSHQ via sealed interoffice mail.
    • The Short Form may also be used as a guide for pre-hospital consults, and copies are being provided to Montgomery County hospitals for this purpose.
    • The reverse side of the Short Form includes a checklist for Patient Refusals from the Maryland Medical Protocols. Providers should use this checklist as a guide to obtain properly-informed patient refusals.

    MCFRS Document Policy

    • All MCFRS personnel are responsible for familiarizing themselves and adhering to all Policies and Procedures, FCGO’s, Directives, and Bulletins.
    • Supervisory personnel ensure that subordinate personnel know and comply with all applicable Policies and Procedures, Orders, Directives, and other controlling documents.
    • Station officers review new Policies and Procedures, FCGO’s, Directives, and other controlling documents with on-duty personnel.
    • Division Chiefs and leaders in all MCFRS organizational elements are responsible for annually reviewing Policies and Procedures, Orders, Directives, and Bulletins that directly affect their Division, Section, or organizational element.
    • Division Chiefs and leaders in all MCFRS organizational elements are responsible for initiating the development, revision, or rescission of documents.
    • Division Chiefs and leaders in all MCFRS organizational elements are responsible for ensuring the continued progress of new and revised documents from start to finish.
    • Division Chiefs and leaders in all MCFRS organizational elements are responsible for considering the comments and feedback received.
    • Division Chiefs and leaders in all MCFRS organizational elements are responsible for reviewing and commenting on all other draft policies and procedures and directives in a timely fashion.
    • The Document Control Officer or designee is responsible for maintaining master files of issued documents in editable and protected formats.
    • The Document Control Officer or designee is responsible for assigning document numbers.
    • The Document Control Officer or designee is responsible for coordinating the distribution and receipt of documents going to and from Notice and Opportunity.
    • The Document Control Officer or designee is responsible for annually reviewing the Policy and Procedure Webpage.
    • Any MCFRS personnel may forward a proposal to their Division Chief via the chain-of-command, to establish, revise, or modify a current policy or procedure.

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    Related Documents

    Montgomery County Fire and Rescue Service Policies PDF

    Description

    This quiz covers essential protocols for EMS providers regarding patient refusal of treatment and the process for downgrading from ALS to BLS transport. Participants will learn about the documentation required and the importance of patient assessment and communication. Understanding these protocols ensures safety and adherence to medical guidelines.

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