Emergency Response Exam Review

 SHORT ANSWERS

List three types of prehospital care products that should be routinely checked on an ambulance?

• Supplies
• Medication
• Equipment

 

What would be a consequence of the following supply or equipment problems?

1. The batteries aren’t charged on the portable suction unit, and your patient is trapped in a car with a mouth full of blood?m

• The patient may suffer from aspiration or asphyxia

2. The defibrillator doesn’t work, and the patient is in ventricular fibrillation?

• Death could occur due to the fact that VF is a shockable rhythm or the patient may deteriorate.

3. You run out of strips to check blood glucose levels on a call with an elderly man who has an altered LOC and no available Hx?

• Since an altered LOC is a symptom of hypoglycemia the inability to check blood glucose may lead to glycemic coma. Inappropriate administration may also cause harm in the case that it is not hypoglycemia.

4. Someone forgot to replace the OB (Delivery) kit after the last delivery?

• The inability to provide adequate care and Tx if a delivery occurs may increase morbidity and/or mortality

5. You run out of oxygen while on a call for pulmonary edema?

• The need for CPAP and high flow O2 is primordial in the Tx of PE (MONA) If it’s not available, the pt may succumb due to hypoxia or cardiac complications.

 

 EMS and community planners must consider a number of factors when determining ambulance placement to provide acceptable availability and response times. List four of these factors.

• Geographical Area
• Population and patient demand
• Traffic conditions
• National response time standards

 

Explain how you can reduce the risk of vehicle accidents in each of the following situation:

1. You are being led by a police escort

• Keep a reasonable distance and use a different siren sound 

2. It’s 05h00 and driving conditions include a light rain and heavy fog

• Proceed at a safe speed and use the low beams

3. The lights and sirens are on, and you are preparing to proceed through a red light at an intersection

• Stop at the red light and check if there’s any oncoming traffic. Cross the intersection using “yelp” and make eye contact with drivers

 

What patient management procedures should be performed before the helicopter arrives?

• Secure the airway
• Administer O2
• Start two large bore IVs with isotonic fluids 20 ml/kg
• Immobilized with proper tool

 List three safety measures that should be taken as you approach the helicopter to load the patient when it lands

• Always approach in a crouched position
• Carry long objects horizontally, no higher than waist high
• Allow only the necessary personnel to help load the patient

What are the criteria in which triage is based on

• Breathing rate
• Perfusion
• Mental Status or AVPU

What is the difference between adult and pediatric triage?

• Pediatric triage requires that you check for a pulse following upper airway position, if the child is apneic, a pulse check is required. In the case of an adult, no pulse check is needed, he is immediately coded BLACK. Following a pulse check in peds, if the child has a pulse 5 rescue breaths should be given, if he is still apneic he is coded BLACK if he breathes he is coded IMMEDIATE. 
• The breathing rate range for an adult triage is OVER 30/min for IMMEDIATE and UNDER 30/min for normal.  
• The breathing rate range for a pediatric triage is anything between 15 to 45 is considered normal while anything outside of this range is tagged IMMEDIATE

What is the priority of safety?

• Personal safety 
• The crew
• Bystanders, and then,
• Patient

Most common place for an accident

• Dry weather 
• In an intersection

What are two scenarios that are NEVER allowed to cross even with lights and sirens?

• Railroad crossing
• Bus flashing

Seven phases of rescue operation 

1.  Arrival and scene size?up  (What is required?) (Is it a rescue, a search, or a body recovery)
   1. What is required
   2. What type of operation is it? (Rescue, a search, or a body recovery)
   3. What equipment is needed?
   4. Determine whether
   5. Determine the number of patients
2.  Hazard control (IMPORTANT)
   1. Eliminate risk
   2. Reduce risk
   3. Control
3.  Gaining access to patient
4.  Medical treatment  (IMPORTANT)
   1. Spinal Immobile
   2. Team concept = Communication
   3. Rapid primary survey
5.  Disentanglement
6.  Patient packaging
7.  Transportation

What are two important acronyms to remember?

SCUBA = Self-Contained Underwater Breathing Apparatus

HELP = Heat, Escape, Lessening, Posture

OSHA lists six major hazards, what are they?

1. Oxygen-deficient atmospheres
2. Chemical/toxins exposure or explosion
3. Engulfment
4. Machine entrapment
5. Electricity
6. Structural concerns

SCENARIO

At 0800h, you respond to a rollover MVC with a patient ejected. On arrival, you find a 4-year-old girl who was thrown 20 feet from the vehicle. She is unconscious; has rapid respirations, and shows signs of shock. The nearest hospital is 40 minutes away. A peds trauma center is 45 minutes away by ground or 20 minutes by air. Air medical ETA to you 10-20 would be 10 minutes. (Questions 1-3 pertain to this case study)

1. Give two reasons why this is an appropriate situation for use of air medical transport.

• Specialized care for ped is needed
• Time needed by ground would pose a threat to the patient's outcome

2. What information should you give the dispatcher when you call to activate the air medical support?

• Type of emergency response (Rescue or Body recovering)
• Number of patients
• Location of the LZ (Landing Zone)
• Any prominent landmarks and hazards 

3. Described landing zone selection and preparations for this air medical response.

Landing zone should be:

• Flat land
• Free of vertical structures, tall grass or crops
• Measure approx. 100ft x 100ft
• Free of debris and hazardous material

Preparations include:

• Safety shields
• Glasses
• Proper PPE         

 MULTIPLE CHOICE QUESTIONS 

   

         1. Why are routine ambulance equipment checks essential?

• So that accurate patient billing and reimbursement can occur in a timely manner
• So that the disciplinary action will not be necessary if an equipment failure occurs
• So that the essential equipment is available and in working order during patient care
• So that the provincial laws and regulations can be met and licensure can be maintained

 

2. What should determine emergency vehicle placement in a community?

• Average response times that meet national standards
• The number of receiving hospitals in the region
• The projected revenue flow from reimbursement
• Where the citizens would like to have ambulances

 

           3. Which of the following help promote safety when driving an ambulance?

• Drive no faster than 20 km/h over the speed limit of routine calls
• Make sure that only the driver and the patient are always restrained
• Use extreme caution at intersections, especially when using lights and sirens
• Use lights and sirens often so that other drivers will yield the right of way

 

           4. How can a paramedic promote safety when responding to a vehicle crash on the highway?

• Park 100 feet past the crash if NOT first on scene
• Park downhill from hazardous material
• Park on the opposite side of the road
• Turn off emergency lights

 

          5. All air medical crew member should receive specialized training in which area?

• Airway management
• Flight physiology
• Medication administration
• Vascular access techniques

 

          6. Which of the following situations would justify the use of air medical transport by an ACLS unit with an ETS of 40 minutes?

• Possible fractured tibia with good pulses
• A possible aneurysm with absent pedal pulses
• Home delivery with both patients stable
• Asthma patient with pulse: 100/mon; resp 20/min

 

           7. Which of the following safety measures should be used when approaching the helicopter to load patients?

• Approach the aircraft as soon as it lands
• At least six people should help load the aircraft
• Long objects should be carried vertically to maintain control
• The aircraft should be approached from the front

 

          8. Should you risk rescuers for a body recovery?

• Yes
• No

 

 

 

 

 

 

 

 

Works Cites

1.  Sanders M. Mosby's Paramedic Textbook. St. Louis, Missouri: Elsevier Mosby; 2012:1465-1514.