SOP 95-97

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Questions and Answers

Who has the ultimate responsibility for patient care according to the policy?

Fire Rescue personnel (correct)

On-scene health care professionals

Fire Rescue Medical Director

On-scene physicians

What must an on-scene physician possess to be delegated on-line control?

Valid Florida licensure only

Valid licensure to practice medicine (correct)

Minimum of 5 years of experience

Certification in emergency medicine

In what circumstances can the quality of patient care be improved by delegating medical control functions to on-scene physicians?

When the Fire Rescue Medical Director is present

In all clinical problems

Urgent clinical situations only

Depending on the clinical problem and expertise of the on-scene physician (correct)

Why are information cards made available for presentation to on-scene physicians?

To provide a reference to clarify policy regarding on-line medical control Signup and view all the answers

Who may be delegated on-line control according to the policy?

Emergency physicians appointed for on-line supervision Signup and view all the answers

What is the main purpose of promoting cooperation between St. Johns County Fire Rescue and on-scene health care professionals?

To improve patient outcomes Signup and view all the answers

What is required for an on-scene physician to assume on-line medical control?

Accompanying the patient in the rescue unit to the hospital Signup and view all the answers

Who has the final decision on whether an on-scene physician can assume on-line medical control?

Fire Rescue Medical Director Signup and view all the answers

When does a Fire Rescue Medical Director or receiving hospital emergency department physician absolve further responsibility for a patient?

After delegating on-line medical control to an on-scene physician based on clinical information Signup and view all the answers

What is the purpose of the policy regarding on-line medical control as mentioned in the text?

To ensure efficient evaluation and transport of traumatic injury patients Signup and view all the answers

Which department is the sole provider of Class A-Certificate of Public Convenience and Necessity (COPCN) prehospital EMS in St. Johns County?

St. Johns County Fire Rescue Signup and view all the answers

How does St. Johns County Fire Rescue dispatch rescue units to incidents?

Using a CAD system and response zones assignments Signup and view all the answers

In what situations would Fire Rescue Communications gather information regarding real or suspected trauma?

In all emergency medical assistance requests Signup and view all the answers

What is required from Department personnel if they doubt relinquishing on-line medical control?

Relaying doubts about relinquishment responsibilities Signup and view all the answers

Why might there be no relinquishing of on-line medical control according to the text?

If there are doubts about on-scene physician's qualifications or licensure status Signup and view all the answers

Who can request assistance from other agencies in case of an emergency?

Any Fire Rescue unit on the scene or enroute to an incident Signup and view all the answers

Who is authorized to change the trauma alert status?

Fire Rescue Medical Director or physician at the receiving facility Signup and view all the answers

When must a complete and accurate patient care record be available to the hospital upon request?

Within 24 hours of dispatch Signup and view all the answers

What is the first step after determining that a trauma victim meets the criteria for a Trauma Alert?

Inform Fire Rescue Communications Signup and view all the answers

What happens if ground transport time to a trauma center exceeds twenty minutes?

Patient goes to the nearest hospital for stabilization Signup and view all the answers

Who will issue a trauma alert if a trauma alert patient is to be transported by ground ambulance?

Fire Rescue personnel Signup and view all the answers

How are pediatric trauma alert patients transported?

To the nearest pediatric trauma center or trauma center with pediatric services Signup and view all the answers

When is an exception made for transporting a patient to a hospital instead of a trauma center?

When ground transport time exceeds 20 minutes and patient's condition is deteriorating Signup and view all the answers

Who provides information about patient care to the receiving trauma center or hospital?

Transporting provider along with written documentation in ePCR Signup and view all the answers

What must ALS non-transporting personnel provide to transporting personnel upon transferring responsibility for a patient?

Complete information including patient's identity, initial assessment, and pre-transport care provided Signup and view all the answers

Who notifies the air transport unit (ATU) to be enroute upon issuance of a Trauma Alert?

Fire Rescue Communications Signup and view all the answers

What is the protocol for determining the transport destination of trauma alert patients?

Assessing the condition of each patient using the Trauma Scorecard Methodology Signup and view all the answers

What will Fire Rescue personnel do if there are deceased victims at the incident scene?

Notify Fire Rescue Communications Signup and view all the answers

When is a patient considered a trauma alert patient based on the criteria outlined?

If sustained heart rate is over 120 beats per minute Signup and view all the answers

What criteria must be met for a victim to be evaluated using the Glascow Coma Score (GCS)?

If their normal GCS score is 12 or less Signup and view all the answers

Under what circumstance can an EMT or paramedic call a Trauma Alert, even if the victim does not meet the Trauma Alert criteria?

If the victim's condition warrants it based on their judgement Signup and view all the answers

What will be documented on the patient care report (ePCR) if the victim's condition does not meet any Trauma Alert criteria?

The reason for not calling a Trauma Alert Signup and view all the answers

What age qualifies a victim to be considered for trauma alert status based on the provided criteria?

55 years or older Signup and view all the answers

Which of the following conditions would NOT classify a victim as a trauma alert patient?

$2^{nd}$ or $3^{rd}$ degree burns to 10% of body surface area Signup and view all the answers

When would a victim be considered a trauma alert patient based on airway assistance needs?

$30$ breaths per minute Signup and view all the answers

What is one of the signs that would qualify as an indication for calling a Trauma Alert?

A motor response score of $4$ on Glascow Coma Scale Signup and view all the answers

What is the primary responsibility of law enforcement regarding the landing zone (LZ)?

To provide LZ information to the air transport unit (ATU) personnel Signup and view all the answers

What should be done if unforeseen circumstances arise during the ATU's final approach, making landing unsafe?

The wave-off procedure should be followed Signup and view all the answers

What are the minimum requirements for the size and condition of the landing zone (LZ)?

100' x 100' area, clear and free from all obstructions, level ground with no more than a 10-degree slope Signup and view all the answers

What should be done if the LZ is located in a sandy area?

Consider having the LZ wet down by engine personnel Signup and view all the answers

How should the LZ be illuminated at night?

Place a light at each corner of the LZ, shining across the LZ Signup and view all the answers

What should the ground guide do on the initial ATU approach?

Face the LZ with arms extended upward and palms facing the LZ Signup and view all the answers

What should the ground guide do once the ATU is on final approach?

Move away from the LZ to avoid rotor wash Signup and view all the answers

What should the ground guide do if the landing is conducted at night or in decreased visibility?

Use a flashlight with a red traffic cone attached to guide the ATU Signup and view all the answers

What is the responsibility of law enforcement personnel after the ATU has landed?

Secure the LZ while the patient is being loaded Signup and view all the answers

What should the ground guide do after the patient is loaded and the ATU lifts off?

Assist with traffic duties Signup and view all the answers

Which of the following is not considered a criteria for a Trauma Alert?

Isolated wrist or ankle fracture Signup and view all the answers

What is the systolic blood pressure threshold for a Trauma Alert under the Circulation criteria?

Less than 50 mmHg Signup and view all the answers

Which of the following is not considered a component for determining a Trauma Alert based on 2 or more criteria?

Cutaneous Signup and view all the answers

What is the weight threshold for a Trauma Alert under the Size criteria?

11 kg or less Signup and view all the answers

What is the length threshold for a Trauma Alert under the Size criteria?

33 inches or less Signup and view all the answers

Under what circumstances can an EMT or Paramedic call a Trauma Alert if the patient does not meet the stated criteria?

If the patient's condition warrants it, in the EMT or Paramedic's judgment Signup and view all the answers

Which information is the referring hospital required to provide to the transporting unit when arranging an emergency interhospital transfer?

All of the above Signup and view all the answers

Which hospital is not considered a designated Receiving Hospital utilized by St. Johns County Fire Rescue?

UF Health Shands Hospital Signup and view all the answers

What is the first step in the Decision Tree for determining if a patient meets 'Trauma Alert' criteria?

The victim meets one of the red or 'R' criteria Signup and view all the answers

What is the required documentation if there is a deviation from the Trauma Transport Protocols?

The deviation will be fully documented and justified on the ePCR Signup and view all the answers

What is the primary purpose of this policy?

To establish a policy for the safe and efficient use of Air Transport Units (ATUs) Signup and view all the answers

Which of the following is NOT information that Fire Rescue Communications will request when an ATU is needed?

The length of time the patients have been waiting for transport Signup and view all the answers

What is the responsibility of the Patrol Shift Leader when an ATU is requested?

Respond to the landing zone if practical Signup and view all the answers

Who maintains final authority for all decisions relating to ATU transport?

The Incident Commander on scene Signup and view all the answers

What is the responsibility of the Landing Zone Supervisor?

All of the above Signup and view all the answers

When is a second helicopter considered for transport?

When there is more than 1 critical patient Signup and view all the answers

What is the primary responsibility of law enforcement in the ATU landing process?

Establish the landing zone and supervise its safety Signup and view all the answers

Who is responsible for communicating with the ATU during the landing process?

The Landing Zone Supervisor Signup and view all the answers

What is the default location for the ATU to land initially?

The closest pre-designated landing zone Signup and view all the answers

What is the purpose of notifying the Patrol Shift Leader and Watch Commander of an ATU request?

All of the above Signup and view all the answers

Study Notes

St. Johns County Fire Rescue Policy

Purpose: Promote cooperation between Fire Rescue and on-scene healthcare professionals to ensure efficient and respectful patient care.
Scope: Applies to Fire Rescue personnel responsible for patient care decisions.

On-Scene Physicians

Delegating medical control to on-scene physicians may improve patient care, but they must accept full responsibility and possess valid Florida licensure.
Requests for ID and proof of licensure may be made on a selective basis.
On-scene physicians must accompany the patient to the hospital and assume full and continuous care until arrival.

Liability

Fire Rescue Medical Director or receiving hospital emergency department physician is responsible for delegating on-line medical control.
No on-scene physician has the right to assume on-line medical control without express permission.
Liability is absolved once the patient arrives at the receiving hospital.

Trauma Transport Policy

Purpose: Ensure patients with traumatic injuries are efficiently evaluated and transported to the most appropriate facility.
Scope: Applies to all career employees of St. Johns County Fire Rescue who make decisions related to trauma transport.

Service Description

St. Johns County Fire Rescue is a licensed advanced life support provider of prehospital emergency care.
It is the sole provider of Class A-Certificate of Public Convenience and Necessity (COPCN) prehospital EMS in St. Johns County.

Receiving and Dispatching Calls

Fire Rescue Communications gathers information from individuals requesting emergency medical assistance, including number of victims, incident location, type of incident, and patient information.
Rescue units are dispatched based on location and response zones.

Prehospital Procedures

EMTs and Paramedics assess patients using the Adult or Pediatric Trauma Scorecard Methodology.
Transport destination is determined by the assessment.
Patients are evaluated using the Glascow Coma Score (GCS) if they do not meet Trauma Alert criteria.

Trauma Alert Criteria

Adult Trauma Alert criteria:
- Severity of injury measures (airway, circulation, Best Motor Response, cutaneous, long bone fracture)
- Mechanism of injury (e.g., ejection from a motor vehicle, fall from 10 feet or greater)
- Age (55 years or older)
Pediatric Trauma Alert criteria:
- Severity of injury measurements (airway, consciousness, circulation, fracture, cutaneous)
- Size (11 kg or less, or length of 33 inches or less)

Transport Methods

Patients who meet Trauma Alert criteria are considered for transport by Air Transport Unit (ATU) first.
If ATU is unavailable, patients are transported by ground unit to the approved trauma center nearest the incident location.
Exceptions include deteriorating patient condition, ground transport time exceeding 20 minutes, or unavailability of ATU.

Hospital List

Designated State approved trauma centers, pediatric trauma referral centers, and receiving hospitals:
- State Approved Trauma Center (SATC): Shands-Jacksonville, Jacksonville Orange Park Medical Center
- State Approved Pediatric Trauma Referral Center (SAPTRC): Shands-Jacksonville, Jacksonville
- Receiving hospitals: Flagler Hospital, St. Augustine Baptist Medical Center, etc.

Protocol Deviation

Any deviation from these protocols must be fully documented and justified on the ePCR.### Adult Criteria
Airway control is a priority over O2
Red flags for airway control: • Paralysis • Amputation proximal to wrist or ankle • HR 120 or higher
Red flags for circulation: • Lack of radial pulse • HR 120 or higher • Suspicion of spinal cord injury • Penetrating injury to head, neck, or torso • BMR 5 or less
Red flags for respiration: • Respiratory rate 30 or higher • GCS 12 or less
Red flags for burns: • 2nd or 3rd degree burns 15% or more of total body surface area
Red flags for miscellaneous: • Age 55 or older • Ejection from a motor vehicle • Multiple long bone fractures • Major degloving injury

Pediatric Criteria

Red flags for airway: • Intubated or maintained by adjuncts • Loss of sensation • Multiple dislocations • Amputations proximal to wrist and ankle • Systolic B/P under 90mmHg
Red flags for circulation: • Faint or non-palpable radial or femoral pulse • Systolic B/P under 50mmHg • Major degloving • Multiple fracture sites • 2nd or 3rd degree burns 10% or more of total body surface area
Red flags for respiration: • Comatose • Loss of consciousness • Weight under 11kg • Pediatric length under 33 inches
Red flags for miscellaneous: • Paralysis • Evidence of open long bone fracture • Major flap avulsion

Air Transport Unit (ATU) Policy

Purpose: Establish policy for safe and efficient use of ATU
Scope: All Fire Rescue personnel responsible for ATU utilization
Determination: Based on airway, circulation, respiration, and miscellaneous criteria

Landing Zone (LZ) Procedure

LZ must be 100’ x 100’ area clear and free from obstructions
Level ground with no more than a 10-degree slope, preferably paved or grassy
Pilot will be informed of hazards such as trees, power lines, etc.
At night, lights should be placed at each corner of the LZ, shining across the LZ
LZ should be located at least 100’ from rescue staging area
Ground guide will always wear eye protection
No hats, caps, or other headgear not attached to the head are to be worn in or near LZ

ATU Landing

Once radio contact is established, only the LZ supervisor should communicate with ATU
LZ supervisor will describe the LZ to the pilot, including location, landmarks, hazards, wires, vehicles, and other obstacles
If ATU is to land on a highway, the LZ supervisor will stop traffic in time to give ATU ample space and time to observe area and make landing decision
In most cases, ATU will circle LZ at least once to observe and communicate with the ground guide
The pilot has the final decision on whether to land or not
On initial ATU approach, the ground guide should face the LZ with arms extended upward and palms facing LZ
Once ground guide makes eye contact with ATU personnel, they should move away from the LZ to avoid rotor wash

Helicopter Safety

Remain clear unless accompanied by an ATU crewmember
Do not assist ATU crew in opening or closing doors
No unauthorized persons within 100’ of the aircraft
No smoking near the aircraft
Never approach ATU from the rear
After ATU lands, law enforcement personnel will be responsible for safety and security of the LZ while patient is being loaded onto the aircraft

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Description

Test your knowledge on the policy that promotes cooperation between St.Johns County Fire Rescue and on-scene healthcare professionals. Questions cover how Fire Rescue personnel should interact with individuals at accident or illness scenes, their responsibilities for patient care decisions, and more.