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?

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

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

    <p>Emergency physicians appointed for on-line supervision</p> 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?

    <p>To improve patient outcomes</p> Signup and view all the answers

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

    <p>Accompanying the patient in the rescue unit to the hospital</p> Signup and view all the answers

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

    <p>Fire Rescue Medical Director</p> 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?

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

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

    <p>To ensure efficient evaluation and transport of traumatic injury patients</p> 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?

    <p>St. Johns County Fire Rescue</p> Signup and view all the answers

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

    <p>Using a CAD system and response zones assignments</p> Signup and view all the answers

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

    <p>In all emergency medical assistance requests</p> Signup and view all the answers

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

    <p>Relaying doubts about relinquishment responsibilities</p> Signup and view all the answers

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

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

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

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

    Who is authorized to change the trauma alert status?

    <p>Fire Rescue Medical Director or physician at the receiving facility</p> Signup and view all the answers

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

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

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

    <p>Inform Fire Rescue Communications</p> Signup and view all the answers

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

    <p>Patient goes to the nearest hospital for stabilization</p> Signup and view all the answers

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

    <p>Fire Rescue personnel</p> Signup and view all the answers

    How are pediatric trauma alert patients transported?

    <p>To the nearest pediatric trauma center or trauma center with pediatric services</p> Signup and view all the answers

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

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

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

    <p>Transporting provider along with written documentation in ePCR</p> Signup and view all the answers

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

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

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

    <p>Fire Rescue Communications</p> Signup and view all the answers

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

    <p>Assessing the condition of each patient using the Trauma Scorecard Methodology</p> Signup and view all the answers

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

    <p>Notify Fire Rescue Communications</p> Signup and view all the answers

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

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

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

    <p>If their normal GCS score is 12 or less</p> 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?

    <p>If the victim's condition warrants it based on their judgement</p> 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?

    <p>The reason for not calling a Trauma Alert</p> Signup and view all the answers

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

    <p>55 years or older</p> Signup and view all the answers

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

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

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

    <p>$30$ breaths per minute</p> Signup and view all the answers

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

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

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

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

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

    <p>The wave-off procedure should be followed</p> Signup and view all the answers

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

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

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

    <p>Consider having the LZ wet down by engine personnel</p> Signup and view all the answers

    How should the LZ be illuminated at night?

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

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

    <p>Face the LZ with arms extended upward and palms facing the LZ</p> Signup and view all the answers

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

    <p>Move away from the LZ to avoid rotor wash</p> Signup and view all the answers

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

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

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

    <p>Secure the LZ while the patient is being loaded</p> Signup and view all the answers

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

    <p>Assist with traffic duties</p> Signup and view all the answers

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

    <p>Isolated wrist or ankle fracture</p> Signup and view all the answers

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

    <p>Less than 50 mmHg</p> 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?

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

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

    <p>11 kg or less</p> Signup and view all the answers

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

    <p>33 inches or less</p> 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?

    <p>If the patient's condition warrants it, in the EMT or Paramedic's judgment</p> 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?

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

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

    <p>UF Health Shands Hospital</p> Signup and view all the answers

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

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

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

    <p>The deviation will be fully documented and justified on the ePCR</p> Signup and view all the answers

    What is the primary purpose of this policy?

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

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

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

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

    <p>Respond to the landing zone if practical</p> Signup and view all the answers

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

    <p>The Incident Commander on scene</p> Signup and view all the answers

    What is the responsibility of the Landing Zone Supervisor?

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

    When is a second helicopter considered for transport?

    <p>When there is more than 1 critical patient</p> Signup and view all the answers

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

    <p>Establish the landing zone and supervise its safety</p> Signup and view all the answers

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

    <p>The Landing Zone Supervisor</p> Signup and view all the answers

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

    <p>The closest pre-designated landing zone</p> Signup and view all the answers

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

    <p>All of the above</p> 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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    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.

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