Emergency Medical Services Guidelines for Patient Destination and Transport, Exams of Computer Network Management and Protocols

Download Emergency Medical Services Guidelines for Patient Destination and Transport and more Exams Computer Network Management and Protocols in PDF only on Docsity! LA County Protocols Exam 114 Questions and Answers. Ref. 304 Purpose of base hospital Base hospital is? - ANS responsible for providing medical direction and destination to pre- hospital care personnel within LA County EMS system according to standard procedures consistent with statewide guidelines Ref. 304 Purpose of base hospital MICN is what? - ANS registered nurse who has been authorized by the medical director, qualified to provide prehospital advanced life support or to issue instructions to EMS personnel within LA County Ref. 304 Purpose of base hospital Base hospital shall: - ANS 1. Be lick. By CA state dept. of public health 2. Special permit for basic or comprehensive emergency service 3. Be accredited, deemed acceptable for Medicare and Medicaid 4. Meet or exceed standards for PEDS unless exempted 5. Have a written contractual agreement with EMS agency 6. Implement and monitor LA County policies ***7. Designate a base hospital medical director who shall be responsible of the base hospital. Base hospital medical director shall be a physician on the hospital****** And a lot of more shit to remember Ref. 408 ALS Unit Staffing ALL ALS units shall - ANS both public and private Shall be staffed at least two state licensed paramedics accredited in Los Angeles County Ref. 409 Procedure for reporting ALS unit staffing exceptions - ANS 1. Complete a report for each calendar month where an ALS unit operates with less than the minimum staff. 2. The report must be submitted no later than 10 days after the close of the calendar month to DHS Ref. 502 Patient Destination MAR defined as - ANS the most accessible receiving (MAR) may or may not be the closest facility geographically. Consider traffic, weather conditions, that may influence transport time Ref. 502 Patient Destination pts. Shall not be transported? - ANS pt. shall not be transported to a medical facility that is on diversion due to internal disaster Ref. 502 Patient Destination P a g e 1 | 15 Pt. should be transported to the MAR unless - ANS 1. The base hospital determines that another facility is more appropriate to meet the needs of the pt. or 2. The patient meets criteria or guidelines to a specialty care center Ref. 503 Guidelines for hospital requesting Diversion of ALS Pt. ALS pt. defined as - ANS ALS patient is any patient who requires paramedic assessment or intervention, including not limited to patient meeting the criteria outlined in ref. 808 Ref. 503 Guidelines for hospital requesting diversion Who is responsible maintaining Redline - ANS Receiving hospital are responsible for maintaining and updating Redline Ref. 503 Guidelines for hospital requesting diversion ED Saturation defined as - ANS ED resources (beds, equipment and staff) are fully committed or are not sufficient to care for addle incoming ALS patients. Hospitals may request ED diversion via the Redline for up to one hour at a time. At the end of the hour Reddened will automatically re-open the hospital Only one hour increments Ref. 503 guidelines for hospital requesting diversion CT scanner - ANS hospital is unable to provide essential diagnostic procedures due to lack of a functioning CT scanner Ref. 503 guidelines for hospital requesting diversion Trauma centers requesting diversion - ANS hospital is unable to care for additional trauma patients because trauma team is fully committed caring for trauma patients A. critical equipment unavailable B. operating room unavailable C. trauma team encumbered Ref. 503 guidelines for hospital requesting diversion Pediatric Medical Center (PMC) - ANS diversion may be requested only when critical equipment essential to definitive diagnosis or treatment of critical medical pediatric patients is unavailable Lack of available PICU beds alone is not sufficient cause to request PMC Diversion Ref. 503 guidelines hospital requesting diversion STEMI - ANS diversion may be requested only when all cardiac catch labs are fully encumbered caring for STEMI pt. ED sat. Not sufficient cause to request SRC diversion Ref. 503 guidelines hospital requesting diversion Internal Disaster defined as - ANS Hospital must request diversion to MAC by phone 1. Power outage P a g e 2 | 15 Ref 510 PEDS Pt. Destination Patients meeting medical guidelines for transport to a PMC? - ANS 1. Shall be transported to the most accessible PMC if ground transport is 30 mines. Or less 2. If transport to a PMC is greater than 30 mines, transport to most accessible EDAP Ref 510 PEDS Pt. Destination Patients meeting trauma criteria / guidelines for transport to PTC - ANS 1. Shall be transported to the most accessible PTC if transport does not exceed 30 mines 2. IF a PTC cannot be accessed but a trauma center can, patient may be transported to the trauma center 3. IF a PTC or trauma center cannot be accessed, the patient may be transported to an EDAP Ref 510 PEDS Pt. Destination PEDS with uncontrollable, life threatening situation, Poor airway or uncontrollable hemorrhage - ANS shall be transported to the most accessible EDAP Ref 510 PEDS Pt. Destination PEDS may be transported to non-EDAP when? - ANS 1. The patient, family, or private physician request transport to a non EDAP facility 2. You tell the patient, family or private physician that the facility is not an EDAP 3. The base hospital concurs and contact the requested facility and ensure that the facility will agreed to accept the patient 4. Document all of the above on EMS report form Ref 510 PEDS Pt. Destination Guidelines for critically ill PEDS patients? - ANS 1. Cardiac dysrhythmia 2. Severe Respiratory distress 3. Cyanosis 4. Persistent ALOC 5. Status epileptics 6. ALTE less than 12 months of age ALTE - ANS Apparent Life Threatening Event 1. Transient apnea 2. Color change (cyanotic, pallid, erythematous, and plethoric) 3. Marked changes in muscle tone 4. Choking 5. Gagging ALTE Includes but not limited to - ANS 1. Gastrointestinal reflux 2. Infection 3. Seizures 4. Airway abnormally 5. Hypoglycemia 6. Metabolic problems 7. impaired regulation of breathing during sleep or feeding Ref 511 Perinatal Pt. Destination Perinatal is what? - ANS refers to patients who are at least 20 weeks pregnant P a g e 5 | 15 Ref 511 Perinatal Pt. Destination Perinatal Center? - ANS refers to a general acute care hospital with a basic emergency department permit and obstetrical service Ref 511 Perinatal Pt., Destination Birth before hospital - ANS delivery occurs prior to arrival at a hospital, the mother and newborn should be transported to the same facility Ref 511 Perinatal Pt. Destination The following should be transported to the most accessible perinatal center? - ANS 1. Pt. in active labor, whether or not delivery appears imminent 2. pt. whose c/c appears to related to the pregnancy, pt. who appear to be having perinatal complications 3. Injured pt. who do not meet trauma criteria or guidelines Ref 511 Perinatal Pt. destination Perinatal pt. who delivered prior to arriving at a health facility should be transported to? - ANS the most accessible perinatal center which is also an EDAP, consider perinatal center with a NICU Ref 511 Perinatal Pt. Destination Perinatal pt. and trauma? - ANS meets trauma criteria / guidelines, transport to a trauma center Ref. 511 Perinatal Pt. Destination Perinatal pt. whom transport would exceed 30 mines to perinatal center, shall be transport where - ANS transport to a receiving facility with an EDAP Ref. 511 Perinatal Pt. Destination Perinatal pt. should be transported to the MAR when? - ANS 1. Acute respiratory distress 2. Full arrest 3. c/c is clearly not related to the pregnancy Ref 511 Perinatal Pt. Destination Consideration may be given by the base hospital to? - ANS 1. 34 weeks or less, whose c/c appears to be related to pregnancy, to a perinatal center with a NICU, regardless of service are consideration/rules 2. Honor the pt. destination request depending on the condition of patient and transport time doesn't exceed 30 mines Ref 512 Burn patient Destination Base contact - ANS medics should make base contact whenever any patient sustaining burn injuries meet the guidelines of 808 Ref 512 Burn patient destination Determine the destination of burn - injured patients as follows? - ANS 1. Pt. who meet trauma or PMC criteria/guidelines should be transport to the appropriate trauma center or PMC 2. pt. who don't meet trauma or PMC criteria/guidelines should be transported to the closest, MAR appropriate for their age Ref 512 burn patient destination P a g e 6 | 15 Receiving hospital should? - ANS 1. Stabilize the pt. 2. Arrange with MAC, for transfer of pt. and include A. status of airway b. %, degree and location of burns C. type of burn D. level of care pt. requires E. circulatory status F. level of consciousness G. other injuries H. past medical history I. treatment in progress Ref 513 STEMI ST- Elevation Myocardial Infraction (STEMI) is? - ANS an acute myocardial infarction that generates ST-segment elevation on the pre-hospital 12-lead electrocardiogram Ref 513 STEMI STEMI receiving Center (SRC) is? - ANS hospital that has a cardiac catheterization lab. And cardiovascular surgery. Ref 513 STEMI Pt. is stem do? - ANS contact the assigned base hospital for medical direction/notification/destination for all pt. with STEMI 12 LEAD Ref 513 STEMI In general, pt. with STEMI (including hypotensive, s/s of cardio shock) shall be transported to? - ANS the most accessible open SRC, if ground transport is 30 mines. Or less regardless of service boundaries Ref 513 STEMI SRC may request diversion of a STEMI pt. when? - ANS 1. Hospital staff is fully committed to caring for STEMI patients in catch lab 2. SRC experiences critical mechanical failure of essential catch lab 3, SRC is on diversion due to internal disaster Ref 516 ROSC pt. destination Do ROSC pt. get a 12 lead? - ANS as time allows, get a 12 lead A. if the 12 lead, shows STEMI, transport to SRC B. label it with pt. name and sequence number C. document finding on EPCOR Ref 516 ROSC Patient gets ROSC do what? - ANS establish base hospital contact for medical direction and destination Ref 516 ROSC Transport to SRC when pt. have the following and transport time is less than 30 mines - ANS 1. All pt. with ROSC, who are greater than 14 and don’t meet trauma criteria or guideline 2. Patients who have progressed into cardiopulmonary arrest while en route and had a pre- arrest STEMI 12 lead 3. pt. with ROSC who re-arrest en route P a g e 7 | 15 Protected health information may be disclosed by pre-hospital personnel when? - ANS A. healthcare providers involved in the care of the patient B. EMS agency C. base hospital D. Patient, legal guardian or others authorized by the patient E. Law enforcement F. provider agency billing G. response to a subpoena Ref 606 Documentation of prehospital care An EMS report form must be completed for every EMS response and - ANS Canceled calls No patient found False alarms Ref 702 Controlled drugs carried on ALS units How much Fentanyl can be carried? - ANS 100mcg unit dose, min. amount 500mcg not to exceed 1500mcg Ref 702 Controlled drugs carried on ALS units How much morphine can you carry - ANS 4mg unit dose, min. amount is 32mg not to exceed 60mg Ref 702 controlled drugs carried on ALS units How much Midazolam (Versed) can you carry - ANS 5mg unit dose, min. amount 20mg not to exceed 40mg Ref 702 controlled drugs Provider may obtain controlled drugs through - ANS a county operated hospital pharmacy with approval from EMS agency or Provider medical director who meets the qualifications Ref 702 controlled drugs Controlled drugs security? - ANS paramedics assigned to ALS unit shall be responsible for maintain the correct controlled drug inventory and security of narcotic keys at all times Controlled drugs shall not be stored in any location other than the ALS units Fentanyl, morphine, midazolam shall be secured on the ALS units under double lock Ref 702 controlled drugs Daily inventory procedures - ANS controlled drugs shall be inventoried by 2 medics daily and anytime there is a change in personnel Errors shall be corrected by drawing a single line through the incorrect wording, initial next to change Ref 702 controlled drugs Daily controlled drug and key inventory form, maintained for how long? - ANS min. of 3 years An entry shall be made on this form for each of the following: A. Change of shift B. any change to narcotic inventory P a g e 10 | 15 C. any time there is a change of responsible personnel If you are 1:1 staffing Required to inventory controlled drugs at the end of shift, when two paramedics are available to count and co-sign the drugs Ref 803 Paramedic scope of practice includes met scope Patient assessment - ANS 1. Use capnometry and measuring devices to measure scenography waveforms 2. Utilize ECG and 12 lead 3. Obtain venous or capillary blood samples 4. Use electronic devices to measure glucose Ref 803 paramedic scope of practice Airway management and o2 admin. - ANS u1. Use a laryngoscope to visualize the airway and remove a foreign body with Magill forceps 2. Insert a pulmonary ventilation by use of: a. King airway in adults and pads over 12 and at least 4 ft. tall b. ET tube in adults and PEDS over 12 and height is greater than the length of pads resuscitation tape C. stoma intubation 3. CPAP Ref 803 paramedic scope of practice Rescue and emergency care - ANS 1. Perform needle T via 2nd intercostal space, mid-clavicle line 2. Perform defy 3. Perform sync cardio version 4. TCP for symptomatic bradycardia 5. Use hemostatic dressings 6. Use Valhalla maneuver 7. Monitor thoracotomy tubes Ref 803 paramedic scope of practice IV and IO access - ANS 1. Institute IV catheters, saline locks, or needles in peripheral veins 2. Monitor and admin. Meds and IV fluids through various external per-existing vascular access for the following cardiac arrest, extremis due to shock, base station order 3. Perform adult and PEDS IO during cardiac arrest 4. Obtain venous or capillary blood samples Ref 803 paramedic scope of practice Meds Admin. - ANS admin meds through the following: Oral Intranasal Sublingual Transcutaneous Topical Inhalation Rectal IV IO P a g e 11 | 15 IM Subcutaneous Ref 803 paramedic scope of practice Meds we can give, prepackaged dose - ANS 10%, 25%, 50% dextrose Adenosine Albuterol Amiodarone As a Atropine Calcium chloride Diazepam (disaster caches only) Diphenhydramine Dopamine Epic Fentanyl Glucagon Midazolam Morphine Arcane Nitro Ondansetron Potassium Sodium biker Total perinatal nutrition Ref 803 paramedic scope of practice Trial studies - ANS procedures or meds may be implemented on a trial basis when approved by medical director of the EMS agency Ref 806.1 General ALS is what - ANS 1. Basic airway/o2prn-BVM and adv. airway prn 2. Cardiac monitor/document rhythm 3. Venus access, 250 ml fluid challenge 4. If indicated blood glucose <60mg admin Dextrose 50%50ml slow IVP PEDS 1 month to 2yrs= 25% 2ml/kg >2 years 50%1ml/kg up top 50ml 5. PEDS resuscitation tape 6. Ondansetron may give 4mg IV, IM, ODT one time for nausea/vomiting/morphine admin Ref 806.1 General ALS Respiratory distress Arrest/hypoventilation (RR<8/min) - ANS 1.General ALS then 2. Suspect narcotic OD with hypoventilation Naloxone 2mg IM/IN prior to venous access or adv. airway Adult IV= 0.8-2mg IVP, titrate to RR PEDS= 0.1 mg/kg IV, IM, IN Ref 806.1 General ALS Respiratory distress Bronchospasm/wheezing - ANS 1. General ALS 2. Albuterol P a g e 12 | 15