• Shuffle
    Toggle On
    Toggle Off
  • Alphabetize
    Toggle On
    Toggle Off
  • Front First
    Toggle On
    Toggle Off
  • Both Sides
    Toggle On
    Toggle Off
  • Read
    Toggle On
    Toggle Off
Reading...
Front

Card Range To Study

through

image

Play button

image

Play button

image

Progress

1/130

Click to flip

Use LEFT and RIGHT arrow keys to navigate between flashcards;

Use UP and DOWN arrow keys to flip the card;

H to show hint;

A reads text to speech;

130 Cards in this Set

  • Front
  • Back
What are the 5 elements referred to as the chain of survival?
-immediate recognition of cardiac arrest and activation of the emergency response system
-early CPR with emphasis on chest compressions
-rapid defibrillation
-effective advanced life support
-integrated post-cardiac arrest care
What are the different levels of EMS providers in Canada?
-Emergency Medical Respnders (First responders)
-Primary Care Paramedics
-Advanced Care Paramedics
-Critical Care Paramedics
What skills are done by First Responders?
-Initial scene and patient assessment
-Basic airway skills (OPA, NPA and BVMV)
-Spinal immobilization
+/- defibrillation using an AED
-Hemorrhage control
-Use of epinephrine auto-injectors for anaphylaxis
What skills are done by Primary Care Paramedics?
First responder skills plus:
-Triage and detailed patient assessment
-Blind insertion of airway control devices in certain systems
-May administer medications in certain systems: glucagon, ASA, nitroglycerin, epinephrine, salbutamol (GANES)
What skills are done by Advanced Care Paramedics?
PCP skills plus:
-Advanced airway interventions including endotracheal intubation
-Cardiac monitoring
-Manual defibrillation
-Intravenous line placement
-Administration of certain medications
What skills are done by Critical Care Paramedics?
ACP skills plus:
-Needle or surgical cricothyrotomy
-Needle decompression of a tension pneumothorax
-Cardiac rhythm recognition
-Transthoracic cardiac pacing
-Expanded pharmacologic treatments
Describe a single-tiered EMS system and its advantages?
Every response regardless of the call type receives the same level of personnel expertise and equipment.

Advantages: cost effective, ensures the capability of providing a consistent level of care to all patients, no potential for under or over triage by 9-1-1 telecommunicators
Descrive a multi-tiered EMS system and its advantages?
These systems use a combination of ALS and BLS levels depending on the nature of the call

Advantages: employee satisfaction, potential to preserve ALS resources for higher priority calls, in that BLS transport of nonurgent patients allows for ALS ambulances to be available for potential critical responses
What is the standard symbol for EMS?
Six pointed blue star surrounding the staff of Aesclapius
Give examples of online medical control?
-Real time interaction between a physician or designee and the field provider by radio or telephone communications
-Direct scene observation
What are the challenges to the provision of EMS in rural environments?
-decreased likelihood of witnessed emergency due to the low population density
-911 may not be available
-long distances to access and transport patients
-road access not always available, special rescue capabilities may be required
-Difficult recruitment and retention of EMS personnel
-Often part-time, less experienced EMS personnel due to low response volume
-EMS personnel may have fewer opportunities for training and skill maintenance
-Lack of medical leadership to support the system with adequate knowledge and experience
Explain Boyle's law and its significance in air medical transport?
At a constant temperature the absolute pressure and volume of gas are inversely proportional

As altitude increases (decreased atmospheric pressure) the molecules of gas grow apart and the volume of gas expands. With descent the molecules are condensed and gas volume contracts. Explains barotitis and barosinusitis
Explain Charles' law and its significance in air medical transport?
At a constant pressure, the volume of a gas is directly proportional to the change in the absolute temperature

The molecular dispersion seen with increases in gas volume at altitude means there is less chance of molecular collision with resulting generation of heat. This explains why the ambient temperature decreases with increased altitude
Explain Dalton's law and its significance in air medical transport?
The total pressure exerted by a mixture of gases is equal to the sum of the partial pressures of each of the different gases

As pressure is reduced, expansion of gases creates increasing distances between molecules and the quantity of oxygen available for respiration decreases. Although oxygen still constitutes 21% of the atmospheric pressure each breath brings fewer oxygen molecules to the lungs and hypoxia results.
Explain Henry's law and its significant in air medical transport?
The amount of gas that will dissolve in a liquid at a given temperature is directly proportional to the partial pressure of that gas

This doesn't carry the same weight in aviation as it does in diving because the degree of change in atmospheric pressure per unit distance is considerably less but it may apply in cases of sudden decompression at high altitude
What injuries occur upon ascent in air medical transport?
-reverse squeeze injuries
-barometric pressure decreases and volume of air trapped within a space increases exertomg [ressire pm structures

Barotitis, barosinusitis, conversion of a simple PTX into tension PTX, rupture of a hollow viscus, increased volume of medical equipment containing air space
What injuries occur upon descent in air medical transport?
Squeeze injuries

Air trapped within the sinus or middle ear cavities cannot be equalized with ambient pressure and the air within the space contracts, pulling mucosal and neurovascular elements with it. Barotitis and barosinusitis
Name the stresses of flight?
Noise
Vibration
Temperature fluctuations
Prolonged exposure (motion sickness, disorientation, fatigue, decrease in task performance)
Long term exposure (nausea, visual or vestibular disturbances, ear damage, fatigue, decreased task performance)
What are 2 types of air medical missions?
Primary responses (scene flights)
Secondary responses (interfacility transport)
In what position should a supine patient be placed in an aircraft?
Head towards the front of the aircraft
What are advantages of rotor-wing transport?
Shorter transport time (75% less than for an equivalent distance by ground)
Can fly to a radius of 150-200 miles from its base
Can avoid traffic delays and ground obstables
Can fly into locations inaccessible to other modes of travel
Helicopter landing zone requirements allow more flexibility than the landing requirements for fixed wing aircrafts
What are disadvantages of rotor-wing transport?
Noise and turbulance
Weather considerations may limit the availability of HEMS
Cramped patient compartment
Weight, equipment and number of transport personnel are limited
No cabin pressurization
Safety issues
What are advantages of fixed wing transport?
Greater range, speed, patient/crew/equipment capacity than rotor-wing
Less noise and turbulence than HEMS
Cabin pressurization
What are disadvantages of fixed-wing transport?
Operations limited to areas that have airports and runways of appropriate length and refueling facilities
Patient tranfers require multiple vehicles
What are landing zone requirements for air medical transport?
LZ should be as close as possible to the scene or hospital entrance but not so close that it may interfere with ground operations
LZ should be at least 100x100ft
LZ should be as flat and level as possible
LZ must be clear of debris
What are the criteria for air medical transport
Distance to the closest appropriate facility is too great for safe and timely transport by ground ambulance
Patient's clinical condition requires that the time spent in transport be as short as possible
Patient's condition is time critical requiring specific or timely treatment not available at the referring hospital
Potential for transport delay associated with ground transport is likely to worsen the patient's clinical condition
Patient requires critical care life support during transport that is not available from the local ground ambulance service
Patient is located in an area inaccessible to regular ground traffic, impeding ambulance egress or access
Local ground units are not available for long-distance transport
Use of local ground transport services would leave the local area without adequate EMS coverage
For interfacility medical transport where the requesting physician based on his/her best judgement and information available determined the need for air medical transport
For scene medical transport, the requesting authorised OOH provider based on applicable policy, his medical judgment and information available determined the need for AMT
Describe the effects of altitude on oxygenation
There is half the pressure at 18,000ft so someone who is saturating at 98% will saturate at 72%
What is tactical EMS?
It is a specialty of EMS established to maintain safety, health and welfare for combat medical units and special operations civilian law enforcement units such as special weapons and tactics (SWAT teams), hostage rescue and special emergency rescue teams
What are the goals of tactical emergency medical support
Enhance mission accomplishment
Prepare medical threat assessment
Monitor the medical effects of environmental conditions
Reduce death, injury and illness and related effects among team members, innocents and perpetrators
Reduce lost work time
Maintain good team morale
Maintain health of team and provide preventative medicine
Coordinate with surrounding agencies and hospitals
Decrease liability
Possess basic forensic knowledge and crime scene preservation
What are the leading preventable causes of battlefield death that are at the basis of the development of the Tactical Combat Casualty Care guidelines
Airway compromise
Tension pneumothorax
Hemorrhage from a compressible site
What are the phases of tactical combat care?
Care under fire
Tactical field care
Casualty evacuation care
What is care under fire
In the hot zone (possible direct exposure to hostile fire)
Airway management and c-spine immobilizatino are deferred
No CPR
Interventions: hemostasis (tourniquet), rescue position, evacuation
What is tactical field care?
In the warm zone (still under threat of injury but no direct exposure to hostile fire)
Interventions provided : airway management, needle decompression of a tension pneumothorax, placing a dressing on an open PTX wound, CPR, advanced hemostasis, IV/IO fluids, hypothermia prevention, analgesia, antibiotics
What is casualty evacuation care?
In the cold zone and while the victim is evacuated to definitive medical ALS care
What is urban search and rescue?
The science of responding to, locating, reaching, medically treating and safely extricating victims entrapped by collapsed structures
What clinical problems occur with greater frequency in urban search and rescue environments?
Blast injuries
Crush syndrome
Compartment syndrome
Hazardous material exposures
Respiratory problems due to dust inhalation (airway obstruction, asphyxia, pulmonary edema, exacerbation of pre-existing medical conditions)
What is crush syndrome?
Systemic manifestations caused by crushed muscle tissue (hypotension secondary to hypovolemia, ARF, electrolyte imbalances, cardiac dysrhythmias, compartment syndrome)
Typically occurs when blood flow is restored to the crushed tissue and the toxins are released systemically
Usually develops in 4-6 hours but can occur in 1 hour if the pressure is severe
Assume all victims with obvious crush injury or immobilized for 4 hours to have crush injury
What are the causes of death in crush syndrome?
Early
Hypovolemia due to third spacing
Dysrhythmias due to severe metabolic acidosis and hyperkalemia

Delayed deaths
Renal failure
Severe electrolyte derangements
Ischemic organ injury
Sepsis
ARDS
DIC
What is the management crush syndrome?
Early aggressive fluid therapy that should begin before extrication (1.5L/h)
Treatment of hyperkalemia and hypocalcemia
Continuous monitoring of VS and urine output (300cc/hr) during extrication
What is a disaster?
An event that overwhelms response capabilities
What factors indicate an increasing probability of mass casualty incidents?
-Terrorist activities
-Increasing population density in floodplains, seismic zones and areas susceptible to hurricanes
-Production and transportation of thousands of toxic and hazardous materials
-Risks associated with fixed-site nuclear and chemical facilities
-The possibility of catastrophic fires and explosions
-Global warming
Define surge capacity
Surge capacity is a way to manage an event that produces a sudden influx of casualties with medical and health needs that exceed current hospital resources

There are 3 components
(3Ss)
Staff (hospital personnel)
Stuff (supplies and pharmaceuticals)
Structure (physical location and management infrastructure)
What are the disaster levels?
Level I: Situation in which local resources are adequate to care for casualties (Collision between a freight train and commuter train in California)

Level II Regional mutual aid is required to respond to the event (Hyatt Regency hotel in Kansas 1981 when two skywalks collapsed killing 114 people and injuring hundreds)

Level III Incidents that require state and federal aid (World trade center attack in 2001 and Hurricane Katrina in 2005)
What is PICE?
Potential Injury Creating Event
What does the first prefix of PICE describe?
Potential for additional casualties

Static: Number of victims known and little potential for further harm exists

Dynamic: Evolving situation in which it is too soon after incident to determine the numbers and types of casualties and the impact on the hospital
What does the second prefix of PICE describe?
Whether local resources are overwhelmed and it so, whether they must simply be augmented (disruptive) or whether they must first be totally reconstituted (paralytic)
What does the 3rd prefix of PICE describe?
The extent of geographic involvement
Local, regional, national or international
What does the stage rating in PICE define?
The likelihood that outside medical assistance will be needed either to augment or to completely reconstitute resources

Stage 0 - little or no chance
Stage I means there is a small cahnce and requires placing outside medical help on alert
Stage II means there is a moderate cahnce and outside help should be placed on standby
Stage III means local resources are clearly overwhelmed and requires the dispatch of outside resources and commitment of personnel
What are the six critical substrates for hospital operations
Physical plant
Personnel
Supplies and Equipment
Communication
Transportation
Supervisory managerial support

If one or more of these resources are compromised they must be reconstituted or a substitute must be implemented
What is the START triage method
Quick assessment of respiration, perfusion and mental status
The only interventions provided are opening obstructed airway and direct pressure on obvious external hemorrhage then transport
What are the 4 categories of the START triage system
Minor (green)
Delayed (yellow)
Immediate (red)
Deceased (black)
How do you identify START triage green patients?
Victims who can walk are identified first and triaged into the minor category
How do you identify START triage red patients?
-breath with re-positioning of airway
-breathing over 30/min
-Breathing <30/min, No radial pulse and capillary refill >2secs
-Breathing <30/min, No radial pulse, capillary refill <2 secs but can't follow simple commands
How do you identify START yellow patients?
-Breathing <30/min
-Radial pulse present
-Can follow simple commands
HOw do you identify START black patients?
Not breathing and no respirations with repositioning of the airway
Outline the Jump start triage system for paediatric MCI patients?
Able to walk -> minor
Assess breathing and reposition airway if not breathing (if breathing with repositioning then immediate)
Assess respiratory rate (if <15 or >45) then triage as immediate
If breathing 15-45 but no palpable pulse then immediate
If Breathing 15-45, palpable pulse and A, V or appropriate P on AVPU then delayed
If brething 15-45, palpable pulse and inappropriate P, posturing or U then immediate
What is the phenomenon of convergenc in a disaster?
Hospitals close to the disaster scene are overwhelmed, whereas hospitals located only a few miles away may receive few if any patients
What are the 5 functional elements in the organizational structure of the Out of hospital Incident command system?
Incident command
Operations
Planning
Logistics
Finance
Describe the organization of the OOH disaster scene
Command post
Staging area for incoming personnel and equipment (outer perimeter)
Safe landing zone (if air evac needed)
Casualty collection point and morgue
What is the most important and most vulnerable component of a disaster plan
Communication systems
What are the phases of comprehensive emergency management all-hazard approach to disaster preparedness?
Mitigation -> taking actions to reduce the impact of identified hazards
Preparedness -> training, drills and cataloguing resources
Response -> assessing the disaster situation and coordinating resources
Recovery -> return to normal operations and debriefing to critique the response and provide psychological support to the rescuers
What are the 8 basic components of a hospital comprehensive disaster response planning process?
Interdepartmental planning group
Resource management
(full inventory of resources, potential support for outside the hospital sought, develop contingency plans to compensate for lost resources, relationships with community agencies - fire, EMS)
Command structure (designate a command center, create a clear chain of command, must contain sufficient equipment to operate even if moved as a result of hospital damage
Media
Communication
Personnel (roster of critical positions and reliable method for their mobilization), management of volunteers)
Patient Management (protocols for decontamination, triage, patient prioritization, evacuation, control of patient's families)
Training exercises 2 drills/year
What are the components of the hospital emergency operations plan?
Activate operations plan
Set up emergency operations center
Assess hospital capacity
Create surge capacity
Establish communication systems
Provide supplies and equipment
Establish support areas
Establish decontamination, triage and treatment areas
Terminate disaster response and provide for remediation
Why are children particularly vulnerable to weapons of mass destruction?
-Faster respiratory rate than adults (increased relative exposure to aerosolized agents
-More likely to inhale certain chemicals that are heavier than air such as sarin
-Greater surface area to volume ratio and thinner skin (more susceptible to agents that act through the skin)
-Smaller fluid reserves and higher metabolic rates (more vulnerable to dehydration due to intoxication with agents causing vomiting and diarrhea
What agents could potentially be used as weapons of mass destruction?
Chemical
Sarin
soman
Tabun
VX
Mustard agen

Anthrax
Plague
Smallpox

Radiologic
Simple device (like those used in hospitals for radiation therapy)
Dispersal device (conventional explosive)
What are the features of weapons of mass destruction?
Fear of unknown or unfamiliar
Lack of training for hospital personnel
Lack of equipment, including personal protection and diagnostic aids
Potential for mass casulaties
Psychological casualties
Crime scene requiring evidence collection and interaction with law enforcement
Potential for ongoing morbidity and mortality (dynamic situation)
What signs suggest biological weapon deployment
Pulmonary symptoms
Rashes
Sepsis syndrome
Influenza

Epidemioogy
Multiple simultaneous events
Dead animals
Large patient numbers with high toxicity and death rate
What are the recommendations for prevention of in-hospital transmission of contagious agents?
-isolate patient in single room with adjoining anteroom
-have handwashing facilities and PPE available in anteroom
-negative air pressure if possible
-use strict barrier precautions: PPE, gowns, gloves, HEPA filter respirators, shoe covers, protective eyewear
-alert hospital departments that generate aerosols (laboratory, pathology)
What is the etiology of anthrax?
bacillus anthracis
(gram positive bacilli)
What is the pathophysiology of anthraces?
Spores are inhaled, ingested or inoculated
The spores germinate into bacilli inside macrophages
The bacteria produce disease by releasing toxin
What is the presentation of anthrax?
Inhalational
Initially flulike illness with malaise
24-48 hours later septic shock, hemorrhagic mediastinities, dyspnea, stridor

Gastrointestinal
bloody diarrhea, hematemesis, ascities

Cutaneous anthrax
papule-> large vesicle -> rupture -> black eschar
Severe edema and regional lymphadenitis. Antibiotics prevent transmission but do not affect the course
What is the treatment for anthrax?
Cutaneous without toxicity
Cipro or doxy or amoxicillin PO
(even in children) 7-10 days

Inhalational, cutaneous, GI with toxicity
Cipro or Doxy or Pen G IV
Give until toxicity resolves then treat for 60days or until all 3 doses of vaccine given
What is PEP for anthrax?
Cipro or doxy or amoxicillin PO for 60 days or until the patient receives 3 doses of vaccine 0, 14, 28
What is the etiology of plague?
Yersinia pestis
gram negative bacillus

Transmitted to humans through the bite of an infected flea or inhalational route
What is the presentation of plague
Bubonic
large, tender nodes in the groin, axilla or cervical region. Dissemination occurs in 50% leading to secondary pulmonic or septicaemia plague

Septicemic plague
Shock, DIC and coma

Pulmonic
Sudden onset flulike illness followed by a fulminant pneumonia with hemoptysis, systemic toxicity, respiratory failure. There is also an associated coagulopathy with DIC and acral gangrene (black death)
Only pulmonic plague is transmissable human to human
What is the treatment of plague?
Resp isolation for 48 hours (bubonic, septicaemia) or 4 days (pulmonic)
Antibiotics x 10 days (streptomycin, alt: cipro, doxy, gent, chloramphenicol)
What is important about the treatment of septicaemia or pneumonic plague?
The treatment must be started within 24 hours of symptom onset to improve outcome
What is the etiology of smallpox?
Variola virus
What is the pathophysiology of smallpox?
The virus is inhaled, replicates in lymph nodes then spreads to the spleen, bone marrow and liver
What is the presentation of smallpox?
Variola major (classic form, 30% mortality)

Variola minor(mortality 1%)

Fever, prostration, HA, AMS x 2-3 days
Classic rash maculopapular rash which becomes vesicular and finally pustular. Rash begins on face and forearms and later spreads to the legs and trunk
All lesions are in the sam stage of development

Hemorrhagic
rash characterized by petechiae and hemorrhage

Malignant
rash of flat, soft lesions that don't progress to pustules
What is the treatment for smallpox
Isolate at home or nonhospital facility
No effective treatment
Vaccination may prevent death if given up to 7 days post exposure and will prevent or significantly ameliorate illness if given within 3 days
VIG has no role in active disease
The role of VIG is to prevent complications from vaccination in pregnant, immunocompromised, HIV patients and those with eczema
Differentiate the rash of chicken pox from small pox with regards to prodrome, illness severity, lesion development, lesion location, contagiousness?
In chicken pox
-prodromal signs are absent or mild
-illness is usually not severe unless complications/immunosuppressed
-superficial vesicles developing rapidly and in multiple stages
-commonly on face and trunk and not palms and soles
-contagious until all lesions are crusted over

Small pox
-1-4 days of systemic symptoms before the rash
-very ill from onset, may be toxic
-hard circumscribed pustules developing slowly (over days) all in the same stage
-Commonly on the face and extremities including palms and soles
-contagious until all scabs have fallen off
What are the major criteria for small pox
febrile prodrome
classic small pox lesions
lesions in the same stage of development
What are the minor criteria for smallpox
centrifugal distribution of pustules
first lesions on oral mucosa, face/forearms
toxic appearance
slow evolution of lesions
pustues on palms and soles
What is the CDC algorithm for assessing the probability of smallpox
3 major criteria = high risk = isolation and report

febrile prodrome and 1 major or 4 minor criteria = moderate probablity, consult ID/derm
What are the 4 classes of chemical terrorism agents?
Nerve agents (acetylcholinesterase inhibitors)
Vesicants
Pulmonary agents
Blood agents
What are the nerve agents?
Tabun
Sarin
Soman
VX
What are the clinical features of nerve agents?
Cholinergic toxidrome

Sarin - inhalational and liquid threat
VX - only liquid threat
What is the treatment for nerve agent toxicity
atropine (endpoint is drying secretions)
pralidoxime
BZD
What are examples of vesicants
Mustard agents
Organic arsenical agents (lewisite)
Halogenated oxime agents (phosgene oxime)
What is the mechanism of action of vesicants?
alkylating agents that damage DNA and cause bone marrow suppression
What are the clinical features of vesicants?
Latent period of up to 24 hours, resemble 2nd degree burns with vesicles and erythema.
Myelosuppression 3-5 days later
What is the treatment for vesicants?
Hydrotherapy
Moist dressing on blisters
Supportive if wbc <200 survival rare.
What are examples of pulmonary agents?
Phosgene
Chlorine
Chloropicrin
Pepper spray
What is the mechanism of action of pulmonary agents?
Airway irritation
Non cardiogenic pulmonary edema
What is the treatment for pulmonary agent toxicity?
Supportive care
What is an example of a blood agent (chemical toxins)
Hydrogen cyanide
What are clinical features of HCN poisoning?
High AG metabolic acidosis
High lactate
Hypotension
AMS
Death
What is the treatment for HCN
Amyl and sodium nitrite
Sodium thiosulfate
Hydroxycobalamin
What does the MARK 1 kit contain?
2 autoinjectors (atropine 2mg and 2 PAM 600mg)
An autoinjector containing diazepam is also available
What are the degrees of sarin exposure?
mild: rhinorrhea and miosis
moderate: mild symptoms, increase in secretions, wheezing and dyspnea,
severe: apnea, seizures, flaccid paralysis
What are the degrees of VX exposure?
mild: localized sweating and fasciculations where a drop touches -> may be delayed 18 hours
moderate: GI effects
severe: apnea, seizures, loss of conciouness
What is the treatment for vapour nerve agent exposure?
Mild: observe and release after 1 hour
Moderate: 1-2 Mark kilts IM or atropine 2-4mg and 2 PAM 1g IV
Severe: atropine 6mg, 2 PAM, diazepam
What is the treatement for liquid agent exposure
Mild: Mark I kit
Same as vapor
Same as vapor
What are the elements of ED preparedness for chemical weapons of mass destruction
Community based hospital planning
Personnel trained in recognition, mass casualty triage and treatment
Decontamination facility with protocols
PPE readily accessible and compliant with regulations
Rapid access to antidotes, cyanide kits and anticonvulsants
Hospital incident management system in place
Knowledge of how to access experts quickly
List VS warranting EMS transfer to a trauma center?
GCS<14
SBP <90mmHg
RR <10/min or >29/min
List injury patterns warranting transfer to a trauma centre?
-Penetrating injury to the head, neck, torso or extremity above the elbow or knee
->/= 2 proximal long bone fractures
-open or depressed skull fracture
-flail chest
-pelvic fracture
-crush/mangeled extremity/degloving
-amputation proximal to the wrist or ankle
paralysis
List mechanisms of injury warranting transfer to a trauma centre
-Adults fall >20ft
-peds fall >10ft
-intrusion of vehicle >12inches into occupant site or >18inches into any site
-ejection (any)
-death in same passenger compartment
-vehicle telemetry data consistent with high risk of injury
-Auto v pedestrian/bicyclist thrown, runover or significant impact (>20mph)
-Motorcycle crash >20mph
List comorbidities warranting transfer to a trauma centre
Adult >55years
children
anticoagulation or bleeding disorder
Burns
Time sensitive extremity injury
Pregnancy >20weeks
EMS provider judgement
ESRD
Discuss situations where helicopter should be considered in EMS?
-difficult to access due to geographical location
-ground access blocked by roads/traffic
-Transport time >15 min
-ground transport to local hospital > helicopter to trauma centre or >20min extrication time
-utilization of local EMS leaves community with inadequate coverage
-mechanism of injury consistent with major trauma
What are benefits of EMS systems on cardiac emergencies
-survival from vfib is directly related to time to defibrillation
-in acute MI time to reperfusion are decreased by pre-hospital 12 lead EKG
-cardiac arrest and CV morbidity are prevented by treatment of dysrhythmias, ischemic pain and heart failure
What are benefits of EMS systems on trauma
-rapid transport to appropriate facilities
-definitive airway control by paramedics
What are benefits of EMS systems in medical emergencies?
-early advanced airway measure for upper airway obstruction
-neuromuscular paralytic agents in the field can be safely used
-treatment of respiratory distress in COPD and asthmatics with beta agonists
-glucose for hypoglycemia
-seizure control with BZD and airway support
list four changes to implement in the EMS system to prevent transmission
Universal precautions with droplets and airborne
N95 implementation and testing
Screening and tracking system for transfers
limit use of nebules
Under what conditions can you accept refusal of transport?
-discover reasons for refusal
-use family and friends to help
-is patient capable (normal mental status)
-informed decision by the patient
-options explained
-advantages and risks associated with decision explained and understood
-document explanation and advice given and record AMA
-offer continued care if needed
What are the essential components of an EMS system
Manpower
training
communications
transportation
facilities
Critical care units
public safety agencies
consumer participation
access to care
transfer of care
standard patient record
public information and education
independent review and evaluation
disaster linkage
mutual aid agreement
What are the components of offline medical control?
protocol development
development of ongoing education
development of medical accountability
What is the role of physicians in EMS
MEdical direction
Educator
Quality assurance
Research
Participation as EMS provider
Considerable physician input required to optimize patient care
Physicians should act as patient advocates
Provide ongoing feedback to EMS providers regardign care
Provision of direct medical orders to personnel in the field
Need to be aware of EMS skill set
Recognize that environment limits patient assessment
Once in communication with crew physician accepts medicolegal responsibility for actions if further orders given
What is priority dispatch
System in which key information is taken by 911 call taker and then appropriate unit for problem is sent
How many physicians are required for mass gatherings
1: 5,000-50,000
What are the phases of a disaster response?
Activation
-notification
-organization of command post

implementation
-search and rescue
-triage, stabilization and transport
-definitive management of scene hazards and victimes

Recovery
-withdrawal from the scene
-return to normal operations
-debriefing
What are 3 types of critical incident stress debriefing
On scene
Defusing session
Formal debriefing
What are the CTAS levels
I-V
What is time to MD in different CTAS levels
I - immediate
II - 15min
III - 30min
IV - 60min
V - 120min
What is the fractile response for time to MD in CTAS levels
I - 98%
II - 95%
III-90%
IV - 85%
V - 80%
What are false positives for esophageal detector devices
gas in the stomach
too much time for re-expansion
incompetent GE junction
What are false negatives for EDD?
Laryngospasm
fluid aspiration
tracheal secretions
inadequate time for re-expansion
endobronchial intubation
bronchospasm
morbid obesity
late pregnancy
What is the Morrison ALS TOR rule
Terminate resuscitation in the field if:
-no ROSC in the field
-no Shock
-no bystander CPR
-not witnessed by bystander or EMS
What is the Marsden TOR?
>15min between collapse and ambulance arrival
no bystander CPR
No pulse or breathing on ambulance arrival
What is the Petrie TOR?
>8min call response interval
asystole on monitor