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Quincy Area EMS System
STUDY GUIDE
ECRNs and Paramedics
2008 Version
QAEMS Policy & Procedure Manuel.
blessinghealthsystem.org
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(located in the column under the apple sitting on the desk) 1. Which statement regarding patient refusal is correct? REFUSALS
Who May Refuse Care: A patient may refuse medical care and/or transportation if he/she does not
appear to be a threat to himself or others and meets the following criteria:
A.
A competent, conscious adult over the age of 18 A minor (under age 18) who meets one or more of the following criteria: 1) Has been granted legal emancipation and provides documentation C. A Durable Power of Attorney for Health Care may request to limit or refuse medical care. D. The legal guardian or parent of a minor 2. If a patient is found pulseless and apneic and does not meet the criteria for initiation of resuscitative measures, emergency personnel at the scene should: before CONTACTING CORONER
Communicate pertinent medical history (use cell phone if possible) Notify the coroner on all prehospital deaths (after contact with Medical Control) Contact dispatch and advise of need for coroner 3. Which person would not be a member of a Local System Review Board?
Board Make-up
One Emergency Department physician with knowledge of EMS Two persons of the same professional category as the suspended individual, individual provider or participant requesting the hearing. 4. An adult patient is being transported to you via ground EMS with severe nausea and vomiting. You know that the correct drug/dose for the active vomiting patient in the pre-hospital setting is:
VOMITING
Historical Findings: Patient complains of nausea/vomiting Physical Findings: Patient actively vomiting Protocol: If the patient has a complaint of nausea or vomiting (See II A) A. Administer: 1. Adults: Phenergan 12.5 mg (diluted in 10 cc NS) slow IVP. Repeat dose X (1) if 2. Pediatrics: Must contact Medical Control prior to administration Phenergan 0.25 mg/kg (diluted in 10 cc NS) slow IVP. No Repeat Dosage.
Max dose 12.5mg - not to be used in patient under 2 years of age.
5. The minimum emergency department staffing criteria for a Resource and/or an Associate Hospital is: Minimum Staffing Criteria For Program Participation
At least 1 ECRN nurse and 1 EMS physician in-house 24 hours. At least 1 ECRN nurse and 1 EMS physician in-house 24 hours 6. The minimum staffing requirement for a BLS transport ambulance is: Staffing-BLS Non-transport
Staffing is the responsibility of the (agency) and will include a minimum of two EMT-B’s. 7. Prior to expiration of a current license, a provider may request to be placed on inactive status if all relicensure requirements have been met at that time. During inactive status: Request for Inactive Status
During inactive status, the EMT shall not function as an EMT, at any level. 8. What medication may be given in the pre-hospital setting to control severe pain prior to any contact
MORPHINE:
a) Adult: Initial dose of 2 mg IVP may be given prior to contacting Medical Control. Contact Medical Control for additional doses. b) Pediatric: Must call Medical Control prior to administration 0.1 mg/kg IVP Make sure to document vital signs including a pain assessment and O2 saturation. Reassess and document vital signs every 10 minutes. Record before and after medication. Notify receiving facility/physician of meds given. 9. While transferring a patient with a Nitroglycerin drip, the patient becomes hypotensive. The patient has a history of ACS without pulmonary edema. You should first: Nitroglycerin and hypotension
1. Lower the head of the stretcher and administer a 200 ml fluid bolus if not contraindicated 2. If the blood pressure does not return to the minimum systolic parameter listed in the transfer orders (or 90 systolic if no minimum indicated), stop the infusion and contact Medical Control or the receiving facility. 10. You have been called to transport a fifty-six year old male patient who has experienced an acute MI. The patient becomes unresponsive, no carotid pulse detected and you note the following rhythm on the cardiac monitor. You identify this rhythm as: ACLS RHYTHM IDENTIFICATION
11. You are transporting a 55 y/o male patient who was diagnosed with anterior MI. Your patient has a rhythm change which you identify as ventricular tachycardia. The patient is now restless and confused. His skin color is ashen and feels cool and clammy. BP is 68mmHg systolic. Your next action should be: TREATMENT OF SYMPTOMATIC V-TACH WITH PULSE
• If ventricular rate > 150 with serious signs and symptoms related to the tachycardia, prepare for • S&S may include chest pain, dyspnea, decreased level of consciousness, low blood pressure, 12. You are transporting a 60 female patient who was diagnosed with AMI. Minutes after transport began, your patient has a rhythm change which you identify as ventricular tachycardia. She is alert and
oriented, color is pale with warm and dry skin without dyspnea or chest pain. BP140/90 P 120. Your
initial treatment of this patient should include:
STABLE WIDE COMPLEX TACHYCARDIA

Assure airway patency and administer O2 at high flow, cardiac monitoring, IV Administer Lidocaine 1-1.5 mg/kg IV push 13. You are transporting a cardiac patient. Suddenly, the monitor shows asystole. Your first step in caring
ACLS SKILLS
14. The correct initial dosage for the drug Adenosine is: Administration of Adenosine
Administer Adenosine 6 mg per the following method: A syringe of Adenosine and a second syringe of 10-20 ml of normal saline should be prepared. The Adenosine is given rapid IV push followed immediately by the flush of normal saline. If the tachycardia persists after 1-2 minutes and the rhythm is still thought to be PSVT, then consider Adenosine 12 mg, rapid IV push by the method outlined above. The 12 mg dose may be repeated once more if PSVT persists in 1-2 minutes. 15. What is the initial energy dose for defibrillation of the pediatric patient? Treatment of V-Tach/V-Fib
May repeat immediately X2 @ 4J/kg as indicated 16. ALS treatment protocols may be initiated prior to contact with Medical Control: INITIATION OF ALS PROTOCOLS
Treatment, procedures, and standing orders may be initiated prior to establishing contact with the treating when radio/cell phone/telephone contact cannot be established and/or a delay in immediate livesaving treatment would be detrimental to the patient. 17. In the case of a prolapsed umbilical cord, you should: Emergency Delivery with Cord Prolapse
A.
A prolapsed cord occurs when the umbilical cord is compressed between the fetus and the pelvis. If the umbilical cord is noted to be protruding from the vagina: 1. Administer oxygen at 15 LPM per non-rebreather mask to the mother Place the mother in knee-chest or Trendelenberg position Insert two fingers of a gloved hand into the vagina to raise the presenting part off the cord. This position will need to be maintained until instructed otherwise at the hospital. At the same time check the cord for pulsations. Cover the exposed cord with a moist sterile dressing. Do not compress, palpate or handle the cord more than necessary 18. After normal delivery of an infant and placenta, you note that the mother is bleeding heavily from the vagina. You should do all of the following EXCEPT: Severe Post-Partum Hemorrhage
• Administer oxygen at 12-15 LPM per non-rebreather mask. • Initiate an IV of Normal Saline and administer a fluid bolus to maintain systolic blood pressure at a minimum of 100 systolic. (ALS). • Oxytocin 10 units – add to 500 or 1000 ml of Normal Saline and infuse slowly at the rate indicated by Medical Control. You must be certain that the placenta has delivered and there are no other fetuses present. • Consider the use of PASG (MAST) leg sections only* *(Note: BLS to contact Medical Control before inflating.) 19. Which of the following is a duty of the Emergency Communications RN (ECRN)?
ECRN DUTIES AND RESPONSIBILITIES
Give voice orders to system participants via radio in accordance with System approved protocols. Document calls for which direction was given completely and accurately recording information as required on the emergency department Radio Log. Sign the patient report form of the transporting unit indicating transfer of patient care to the Monitor, supervise, and assist hospital personnel fulfilling educational requirements in the clinical Perform other duties as may be assigned by the EMS Medical Director. Monitor conformance to system policy and procedure 20. Recertification at the end of a four-year license period for an EMT-P includes: PARAMEDIC RELICENSURE REQUIREMENTS
I. Participation in 30 hours of approved continuing medical education per year. (120 hrs/4 year period)
A. 8 hours must be obtained by attendance at Quincy Area EMS System monthly Continuing Medical Education classes per year. (These are offered at Blessing Hospital each month). B. 16 hours/4 year period MUST be pediatric related programs. C. Other hours may be obtained by attendance at approved seminars, courses, or other educational programs, i.e., ACLS, BTLS, PALS. (See Policy CET-1) D. No more than 25% of total hours may be in the same subject. E. At least 50% of the total hours required should be earned through system taught/approved 21. The final designated medical authority in the EMS System is the: EMS MEDICAL DIRECTOR
The EMS Medical Director is the designated final medical authority. The first arriving EMS team on the scene is responsible under the direct authority of the EMS Medical Director and will assume responsibility for carrying out appropriate patient care at the scene. Responsibility and authority for patient care management will be transferred to the team providing the highest level of care at the scene upon their arrival. 22. Treatment goals for the patient with pulmonary edema are to prevent hypoxemia and subsequent respiratory failure. Therefore, maintenance of an airway and oxygenation is very important. Other medications should be considered in the treatment regimen EXCEPT: First Line Action
23. A reason for withholding baby aspirin to a patient with chest pain would include: CONTRAINDICATION TO ASA
Active ulcer disease (relative contraindication) Known hypersensitivity to the drug, bleeding disorders 24. The START program is used to triage patients. It consist of three basic components which are: START TRIAGE - ADULT
STEP 1: Respiration’s (breathing) STEP 2: Perfusion check (radial pulse) or use capillary refill test STEP 25. The Resource Hospital can be asked to intervene or override orders from an Associate Hospital when: Intervention Policy
No radio response by the receiving hospital after 3 attempts by the prehospital unit. Deviation from Quincy System defined treatment protocols, disposition, or communication C. Undue delay in initiation of treatment or delayed transport of critically ill or injured patients (greater than 25 minutes) without reasonable cause. When the Associate Hospital requests the intervention. When an ALS crew requests the intervention. 26. All of the following may refuse treatment EXCEPT: REFUSALS
Who May Refuse Care: A patient may refuse medical care and/or transportation if he/she does not appear to be a threat to himself or others and meets the following criteria: A. A competent, conscious adult over the age of 18 B. A minor (under age 18) who meets one or more of the following criteria: 1. Has been granted legal emancipation and provides documentation 2. Is pregnant 3. Is a parent C. A Durable Power of Attorney for Health Care may request to limit or refuse medical care. D. The legal guardian or parent of a minor 27. The disaster tag system used in the QAEMS System in the event of a major EMS Incident is called the:
QAEMS SYSTEM USES SMART TAG
28. Which situation does not require an EMS physician to be present at Medical Control radio/phone? PHYSICIAN TO THE OPERATIONAL CONTROL POINT (RADIO)
A decision regarding where a patient is to be transported needs to be made by the resource hospital. (see policy O-4) Intervention by the resource hospital is indicated. (see policy O-5) When a Quincy ALS unit is requesting permission to respond to a second and simultaneous dual response. When an ALS crew is requesting an infield service level downgrade. 29. The Cincinnati stroke scale includes all of the following parameters EXCEPT: CINCINNATI STROKE SCALE – 3 COMPONENTS.
1. Facial droop (Ask the patient to smile) 2. Speech (Ask the patient to repeat a simple sentence.) 3. Arm drift (Ask patient to close eyes and hold arms straight out in front of them.) 30. The objective of physical restraint for a patient demonstrating a behavioral emergency is to: NEED FOR RESTRAINT
Physical restraint may be necessary when EMS personnel have a reasonable belief that the patient may
harm himself or others.
31. The ten-codes used for medical communications in the QAEMS system include all EXCEPT: Five 10 signals that shall be used for medical communications to the hospital:
10-33 Run Emergent (HOT)
10-40 Run Non-Emergent (COLD)
10-56 Intoxicated
10-79 Dead
32. Examples of possible System-wide crises that might necessitate activation of the System Wide Crisis plan includes all of the following EXCEPT:
Examples of possible System-wide crises:
Terrorist act involving a nuclear, biological or chemical agent 33. What is the purpose of a local system review board? Purpose:
The Resource Hospital shall designate a Local System Review Board for the purpose of reviewing a
decision of the EMS Medical Director to suspend an individual, individual provider or participant from
participation in the Quincy Area EMS System.
34. Any participant in the EMS System may be suspended by the EMS Medical Director for any of the Any such suspension may be based on one or more of the following:
Failure to meet the educational and training requirements of the State or by the EMS Medical Director. Violation of the EMS act or any rule promulgated under it. Failure to maintain proficiency in the provision of basic or advanced life support services. Failure to comply with System Policies and Procedures. Intoxication or personal misuse of any drugs or the use of intoxicating liquors, narcotics, controlled substances, or other drugs or stimulants in such manner as to adversely affect the delivery, performance, or activities in the care of patients. Falsification of any reports or orders, or making misrepresentations involving pt. care. Abandoning or neglecting a patient requiring emergency care. Unauthorized use or removal of narcotics, drugs, supplies or equipment from any ambulance, health care facility, institution, or other work place location. Performing or attempting emergency care, techniques or procedures without proper permission, certification, training, or suspension. Discriminating in rendering care due to race, sex, creed, religion, national origin or ability to pay. Physical impairment to the extent that emergency care and life support functions for which the provider is certified, cannot be physically performed. Mental impairment to the extent that the appropriate judgment, skill and safety required for performing the emergency care and life support functions for which the provider is certified cannot be exercised. The EMS Medical Director believes that the continuation in practice by the provider would constitute an imminent danger to the public. Committing a felony act while on or off duty. Definition: A person who has successfully completed a dispatching course that meets or exceeds the National Curriculum of the United States Department of Transportation. Accepts calls from the public for emergency medical services Dispatches designated emergency medical services personnel and vehicles Provides pre-arrival medical instructions to the caller in accordance with protocols 36. Medications indicated for the prehospital treatment of asthma include: Asthma
Administer O2 12-15 LPM non-rebreather mask
Administer epinephrine 1:1,000 solution, 0.3 ml subcutaneously and/or administer 2.5 mg of albuterol
via nebulizer
37. For the patient with signs and symptoms of acute pulmonary edema and a heart rate of 90, prehospital treatment may include all of the following EXCEPT: First Line Action
38. Your patient is experiencing chest pain, dyspnea, confusion and hypotension. You attach the monitor and identify sinus bradycardia with a rate of 40. Proper treatment would include: INTERVENTION
SEQUENCE
Atropine 0.5-1.0 mg IVP every 3-5 minutes up to max of 0.03-0.04 mg/Kg If low blood pressure after rate increases: * Epinephrine IV drip at 2-10 mcg/minute 39. Appropriate treatment for a patient experiencing supraventricular tachycardia might include all of the
Supraventricular
Tachycardia
-Vagal Maneuvers (Have patient cough or valsalva) -Adenosine 6 mg rapid IV push over 1-3 seconds. -If no change in 1-2 minutes give Adenosine 12 mg rapid IVP over 1-3 second. Followed by bolus/flush normal saline and elevating the extremity. -May repeat 12 mg dose once more if no change in 1-2 min. -If at any time the patient becomes unstable, consider synchronized cardioversion. 40. Your patient is complaining of severe chest pain and dyspnea. During your assessment, the patient becomes confused and is diaphoretic. The monitor is showing a tachycardic rhythm with a rate greater than 150 beats per min. You should: UNSTABLE
TACHYCARDIA
Synchronized Cardioversion (100J, 200J, 300J, 360J) 41. Your patient is unresponsive. During your assessment, you palpate a carotid pulse. The monitor shows a rhythm resembling ventricular fibrillation. You should: ACLS SKILLS
When your assessment and monitor readings do not “match”, always recheck patient and equipment. 42. Cardiac care for patient with chest pain includes: PATIENTS WITH CHEST PAIN AND/OR POSSIBLE AMI
-Administer oxygen at 2-4 LPM (increase as needed) -Start IV normal saline to keep vein open -Monitor cardiac rhythm (ALS) -Administer four 81 mg aspirin tablets. Instruct the patient to chew and swallow. 43. Prehospital orders/care for the diabetic patient may include all of the following EXCEPT: Determine blood glucose level with a Glucometer (ALS)
If blood glucose level is less than 60 mg/dl: a) Establish IV of Normal Saline, TKO rate (ALS) Administer 50 ml. of 50% Dextrose IV push (ALS) Administer 1 mg Glucagon IM, if IV is not obtainable and patient is unresponsive or unable to swallow (ALS) 44. Of the following, which drug is used for suspected or known narcotic overdose? Medications (ALS)
Naloxone if suspected or known narcotic abuse/overdose. a) Adult: 1-2 mg IV, ET, IM. May repeat in 2-3 minute intervals for 2-3 doses if no response. 45. Dopamine is the drug of choice in the prehospital setting to treat: CARDIOGENIC SHOCK
46. Of the following conditions, which would NOT indicate the emergent use of a Central Venous Access Devices (CVAD’s) in the pre-hospital setting? Purpose:
-Previously established central lines and other access ports may be utilized during an emergency in the event that a peripheral IV line cannot be established. 1. Cardiac arrest 2. Major trauma 3. Life-threatening situation requiring immediate need for medication or fluid therapy (A-7.1) 47. Which statement about Glucagon is NOT true?
GLUCAGON
48. All of the following are true regarding Lidocaine EXCEPT:
CONTRAINDICATIONS
High degree heart blocks
PVC's in conjunction with bradycardia
49. Which is NOT a potential complication of IV therapy? COMPLICATIONS
50. Atropine is an antidote for organophosphate poisoning including Malathion and Diazinon. The correct dose for treatment of organophosphate poisoning is: Atropine 2-5 mg every 10-15 minutes
A. Organophosphate poisoning – insecticides 1. Parathion 2. Malathion 3. Diazinon 4. TEEP 51. A key side effect to assess for in the patient receiving an Aggrastat, Integrilin or Reopro drip while Procedure for transfer
A. Obtain patient report from the RN caring for the patient in the transferring facility with special 1. Patient condition including recent vital signs 2. All drugs being infused – know rate of infusion for each 3. Transfer orders – including measures to be taken if bleeding occurs which cannot be B. Assess the patient for any signs of bleeding 52. Appropriate care of uninjured students involved in a Category II bus accident include: Category II or III bus accident/incident.
1. Contact Medical Control, advise of the existence of Category II or III bus accident/incident and determine if a scene discharge of uninjured children/students by the ER Physician in charge of the call is appropriate. 2. Injured children/students by exam and/or complaint are treated and transported as deemed necessary and appropriate by EMS personnel or at the request of the student. 3. Implement provider procedures for contacting school officials or parent/legal guardians to receive custody of the uninjured students consistent with region III policy. Procedure may include option of ambulance service provider escorting bus, if operable, back to school of origin or other appropriate destination. 4. Medical Control, after consulting with scene personnel, will discharge the uninjured students to the custody of the ambulance service provider who then will transfer the custody of the students, consistent with appropriate department and regional policies and procedures, to parent/legal guardians or school officials. 5. Authorized school representatives will sign the log sheet indicating acceptance of responsibility for the students after medical clearance by the EMS personnel finding NO evidence of injury. The school representative will then follow their own policies to include informing the parents/legal guardians as regards to the accident/incident. 6. Any student having reached the age of 18 or older and any adult non-student present on the bus will initial the log sheet adjacent to their name and address when in agreement that they have suffered no injury and are not requesting medical care and/or transport to the hospital. 7. Complete one Prehospital Care Report Form in addition to the School Bus Incident From. 53. Which medication may be administered for a patient with overdose of tricyclic antidepressants exhibiting ventricular tachycardia or other dysrhythmias? Sodium Bicarbonate-Indications
Severe acidosis, Cardiac arrest with prolonged downtime 54. Adenosine (Adenocard) IV is given to:
ADENOSINE
ACTION - Slows conduction time through the AV node. Blocks reentry pathways through the
AV node in supraventricular tachydysrhythmia that have been previously resistant to other
antidysrhythmic drugs.
INDICATION - PSVT, narrow complex tachycardias
55. Which of the following statements is true about nitroglycerin tablets?
PRECAUTIONS-NITRO
1.
Monitor blood pressure prior to administration and at frequent intervals after 56. All of the following medications may be administered via the endotracheal route EXCEPT:
ENDOTRACHEAL ROUTE
A.
Only specific drugs may be given this route 1. Usual dose via endotracheal tube is 2-2.5 times the usual dose diluted in 10 cc of saline. 57. External pacing (transcutaneous pacing) is indicated in all of the following EXCEPT: INDICATIONS:
Symptomatic and hemodynamically unstable bradycardias: 1. Pulseless electrical activity (PEA) with a ventricular rate < 60. CONTRAINDICATIONS:
58. Appropriate prehospital care for the OB/GYN patient exhibiting a prolapsed umbilical cord may include If the umbilical cord is noted to be protruding from the vagina:
Administer oxygen at 15 LPM per non-rebreather mask to the mother Place the mother in knee-chest or Trendelenberg position Insert two fingers of a gloved hand into the vagina to raise the presenting part off the cord. This position will need to be maintained until instructed otherwise at the hospital. At the same time check the cord for pulsations. Cover the exposed cord with a moist sterile dressing. Do not compress, palpate or handle the cord more than necessary 59. For the normal spontaneous emergency delivery in the field, an APGAR score (appearance, pulse, grimace, activity, respirations) should be done:
APGAR SCORING
Note APGAR score at 1 minute and 5 minutes post delivery.
60. Prehospital care of the unconscious patient of undetermined cause may include all EXCEPT:
Other-UNCONSCIOUS UNDETERMINED CAUSE
1. Finger stick glucose to rule out hypoglycemia. (ALS) a. If hypoglycemic, treat per protocol MP-7 2. Administer Naloxone in the patient suspected of having a narcotic overdose (ALS) a. Adult: 1-2 mg IV, ET, IM – may repeat in 2-3 minute intervals for 2-3 doses if no 3. Monitor vital signs, level of consciousness and cardiac rhythm (ALS). 61. When caring for a renal dialysis patient in the prehospital setting, when may a shunt, fistula or graft be Use of shunt, fistula, or graft in an emergency: (ALS)
A.
If the patient has cardiac standstill or ventricular fibrillation or the patient's blood pressure is very low and venipuncture is not possible, the shunt, fistula or AV graft can then be used to administer life saving drugs or IV fluids. If the patient has a shunt -- disconnect the two small tubes, apply copper clip or any clamp on the arterial line; (arterial line is mostly on the radial side of the wrist). Attach IV line or syringe directly to the venous line. In patients with fistulas a regular butterfly needle or IV needle can be inserted in any of the prominent veins. In patients with AV grafts -- IV needle can be inserted to the venous side of the graft (ulnar side). 62. Prior to accepting a refusal from a patient, you must: Procedure
A. Assess the patient and obtain vital signs. If the patient refuses assessment, document this in the B. Explain to the patient or legal guardian the risks associated with their decision to refuse C. Medical Control MUST be contacted via radio or phone to verify the refusal. D. After concurrence of Medical Control to accept the refusal, obtain signatures of the patient or legal guardian and the EMS provider obtaining the refusal. It is always preferable to have two witnesses if possible. If the patient or legal guardian refuses treatment and/or transport after having been informed of the risks involved and also refuses to sign the refusal form, relay this information to Medical Control 63. What is the correct joule setting for the 2nd and 3rd shocks of a child in ventricular fibrillation? Ventricular Fibrillation or Pulseless Ventricular Tachycardia
Defibrillate 2J/kg (Continue CPR while defibrillator is charging) After 2 min of CPR…Give 1 shock of 4 J/kg or utilize AED
Resume CPR immediately for 2 minutes
Establish vascular access IV/IO

Give epinephrine while continuing CPR
¾ IV/IO: 0.1 ml/kg (0.01 mg/kg) 1:10,000
¾ ET: 0.1 ml/kg (0.1 mg/kg) 1:1000
¾ Repeat every 3 to 5 minutes
64. The pediatric dosage for epinephrine in cardiac arrest is: PEDIATRIC CARDIAC ARREST ALS CARE GUIDELINE
-Secure airway as appropriate
-Establish vascular access IV/IO NS @TKO
-Epinephrine IV/IO 0.01 mg/kg (0.1 ml/kg) 1:10,000 or
ET 0.1 mg/kg (0.1 ml/kg) 1:1,000 May repeat every 3-5 minutes
65. All of the following medications/fluids may be indicated for the unconscious patient of unknown Other-UNCONSCIOUS UNDETERMINED CAUSE

-Finger stick glucose to rule out hypoglycemia. (ALS) If hypoglycemic, treat per protocol MP-7 -Administer Naloxone in the patient suspected of having a narcotic overdose (ALS) Adult: 1-2 mg IV, ET, IM – may repeat in 2-3 minute intervals for 2-3 doses if 1. Administer oxygen 2. Assist ventilations as needed 1. Initiate an IV normal saline TKO (ALS) 66. A STATE EMERGENCY MEDICAL DISASTER PLAN activation may occur when: STATE EMERGENCY MEDICAL DISASTER PLAN ACTIVATION
Purpose: This plan may be put into effect when a state of emergency or medical disaster is declared
in Illinois by the Governor or his delegate. If the disaster occurs outside of Region 3, we may be
activated in order to determine the available resources within the Quincy Area EMS System or to
supply aid to the disaster scene.
67. Prior to dispatching ALS assistance to an incoming ambulance transporting a patient with a serious injury, Medical Control or the receiving facility should: Prior to dispatching ALS assistance, the receiving hospital should weigh the benefits of the ALS
assistance to the patient against the ETA to the hospital and subsequent delay in transport that would occur. 68. All pulseless and non breathing patients are to receive full resuscitative efforts except in certain circumstances. Reasons NOT to initiate resuscitative efforts include all of the following EXCEPT: All pulseless and non breathing patients are to receive full resuscitative efforts except when any of
the following physical findings can be documented:
A.
69. Which of the following measures should be taken first in a neonatal resuscitation with no signs of NEONATAL RESUSCITATION ALS CARE GUIDELINE
Meconium Absent
RR slow/gasping absent
Position airway Support ventilation with BVM 100% O2 @40-60/min. for 15-30 sec
AIRWAY, TRAUMA and SHOCK

70. All of the following are approved EMT-P level skills in the Quincy Area EMS System EXCEPT:

Approved Procedures

71. For volume expansion in the pediatric patient, a rapid bolus of _______ should be given initially followed by additional boluses if needed. HYPOVOLEMIC
(Suspected dehydration/volume /loss /hemorrhagic shock) -Establish vascular access IV/IO NS @TKO -If no response to initial fluid bolus, repeat at 20 ml/kg as indicated to maximum of 60 ml/kg 72. The preferred site for needle chest decompression is:
Procedure:
a. Attach the 10 cc syringe to the IV catheter
b. Locate the 2nd intercostal space mid-clavicular line
c. Cleanse the site with alcohol or Betadine
d. Insert the IV catheter at the superior border of the 3rd rib
e. Push the needle until you feel a pop as you enter the pleural space
f. The plunger of the syringe will be pushed outward by pressurized air exiting the chest
g. Advance the catheter over the needle until it is flush with the skin
h. Discard the needle
i. Secure the catheter in place with tape
73. You respond to a one-vehicle car crash in a remote area. Upon assessment of the driver, you note the patient to be in acute respiratory distress with absent breath sounds on the right side, jugular vein distention, hyperresonance to percussion on the right chest wall, normal heart tones and tracheal deviation to the left. You suspect: SIGNS OF A TENSION PNEUMOTHORAX
A.
Absent or diminished lung sounds on the affected side Progressive respiratory distress and/or increased resistance to bagging Signs of shock with chest trauma present 74. Which is the first step in the treatment of the child with suspected hypovolemic shock?
First Steps in shock Treatment
-Assess
-Complete initial assessment -Cardiac Monitor -Supine position Second steps
-Establish vascular access IV/IO NS @TKO -If no response to initial fluid bolus, repeat at 20 ml/kg as indicated to max. of 60 ml/kg 75. You are called to the scene of a house fire. A fifty-year-old female is complaining of dyspnea and burns to her face and anterior chest. Upon assessment you note singed eyebrows, sooty deposits in the mouth and nose and hoarseness. There is redness and blistering of her right cheek, forehead and anterior chest. You suspect the patient has a burn involving the respiratory tract. Treatment for this patient should include all of the following EXCEPT: TREATMENT OF BURNS
A. Airway Management - be alert to the possibility of associated pulmonary injuries if the burn occurred in an enclosed space or during an explosion. Note any toxic fumes. 1. Ensure patent airway 2. Suction if necessary 3. Utilize oral or nasal airway as needed 4. Perform endotracheal intubation if necessary (ALS) 1. Administer oxygen 2. Assist ventilations if necessary 3. Monitor O2 saturation if pulse oximetry is available 1. Initiate at least 1 large bore IV line (minimum 16 gauge) as is appropriate depending upon extent of burns/site available (ALS). 76. All of the following are indications for intubation EXCEPT: Indications:
-Comatose patients with inadequate airway 77. The preferred site for intraosseous infusion is the: Procedure
Grasp the thigh and knee above and lateral to the site to stabilize the tibia. DO NOT allow any portion of your hand to rest behind the site. Locate the puncture site 1-3 cm distal to the tibial tuberosity and slightly medial. Angle the needle slightly toward the foot. Insert the needle firmly through the skin, subcutaneous tissue , and periosteum of the bone with a twisting motion. Stop advancing the needle when a sudden decrease in resistance is felt. Withdraw the stylet (may need to unscrew cap). Slowly inject 10 cc of normal saline and observe for patency: 1. the needle can stand upright without support Attach IV tubing and set to desired rate. 78. Indications for Percutaneous Transtracheal Catheter Ventilation include all of the following EXCEPT: Indications for Percutaneous Transtracheal Catheter Ventilation
A. A fully obstructed airway that cannot be cleared by mechanical maneuvers. B. Extensive maxillofacial injury that makes ventilation with a bag valve mask or endotacheal C. Acute lower airway obstruction not removed using Magill forceps. D. Extensive upper airway injury that makes ventilation with a bag valve mask or endotacheal 79. Which is an indication for a nasal intubation?
INDICATIONS-Nasal
Intubation
A. Breathing patients requiring intubation due to airway compromise. B. Examples: 1. Trauma with possible spinal cord injury 2. Pulmonary edema/COPD 3. Clenched jaw 4. Fractured mandible CONTRAINDICATIONS-Nasal
Intubation
Use caution in patients with deviated septum 80. Use of the Combitube airway is contraindicated in which of the following patients?
Contraindications:
A. Patient with an intact gag reflex. B. Patient under age 16 and/or under 5 feet tall. C. Patient with known esophageal disease. D. Patient with a history of esophageal trauma/or ingestion of caustic substance. E. Patient with a tracheostomy or laryngectomy. F. Patient with a foreign body obstruction in the trachea. 81. Which statement is INCORRECT regarding the procedure for nasal intubation? Procedure-Nasal Intubation
Check all equipment, lubricate the tube. Oxygenate/hyperventilate for two minutes if possible. Select larger/clearer nostril for insertion. Stand or kneel to the side of the patient with the tube in one hand. Palpate the anterior neck in the area of Insert the tube into the nostril with the bevel toward the septum. When maximal airflow is heard through the tube, gently and quickly advance it during the next inspiration. You should observe misting/condensation in the tube. The patient may cough or buck the tube. Check the tube placement via auscultation of lung fields, auscultation over the epigastrium and EID. 82. According to Illinois law, as a mandated reporter of child abuse, ECRNs and paramedics must: Report suspicions to ED physician, ED charge nurse and DCFS (1-800-25-ABUSE)
83. Which could be considered a form of child neglect? The following are some common forms of neglect
Environment is dangerous to the child (e.g., weapons within reach, playing near open windows without screen/guards, perilously unsanitary conditions, etc.). Caretaker has not provided, or refuses to permit medical treatment of child’s acute or chronic life-threatening illness, or of chronic illness, or fails to seek necessary and timely medical care for child Child under the age of 10 has been left unattended or unsupervised. (Although in some situations children under 10 years of age may be left alone without endangerment, EMS personnel cannot make such determinations). All instances should be reported for DCFS investigation. Caretaker appears to be incapacitated (e.g., extreme drug/alcohol intoxication, disabling psychiatric symptoms, prostrating illness) and cannot meet child’s care requirements. Child appears inadequately fed (e.g., seriously underweight, emaciated, or dehydrated) inadequately clothes, or inadequately sheltered. Child is found to be intoxicated or under the influence of an illicit substance(s). 84. Pediatric burns that would be an appropriate transfer to a burn center include all EXCEPT: Any patient with a life threatening condition should be treated until stable at the nearest appropriate
facility before being transferred to a burn center.
Listed below is the American Burn Association criteria for pediatrics to be transported to a burn center:
-Second and third degree burns greater than 10% body surface area (BSA) in patients < 10 years of -Second and third degree burns greater than 20% BSA in other age groups. -Second and third degree burns that involve the face, hands, feet, genitalia, perineum and major joints. -Third degree burns greater than 5% BSA in any age group. 85. Patients with serious trauma often need interventions that are not available in the pre-hospital setting. All of the following are considered “load and go” conditions EXCEPT: Certain signs/symptoms require the trauma patient to be immediately loaded onto a spine board, transferred to the ambulance, and transported rapidly with lights and siren. Non-lifesaving procedures (such as splinting and bandaging) may be needed but should be done during transport. Life-saving The following are critical situations that require “load and go”
-Cardiac/respiratory arrest -Obstructed airway -Decreased level of consciousness -Respiratory difficulty -Signs of shock -Injuries that will rapidly lead to shock or respiratory difficulty: *flail chest *open pneumothorax *tender abdomen *unstable pelvis *bilateral femur fractures *poorly controlled major bleeding
86. The only absolute contraindication for use of a pneumatic antishock garment (MAST) is:
CONTRAINDICATIONS
A. Pulmonary Edema B. Evisceration (may use leg compartments) C. Pregnancy (may use leg compartments) 87. Unless delayed by extrication or other mitigating circumstances, the goal is to have an on scene time of ten minutes or less when the patient is seriously injured. Which procedures should be initiated while en route to the hospital? Unless delayed by extrication or other mitigating circumstances, the goal is to have a total on-scene time of 10 minutes or less. A. The following procedures are appropriate to provide on scene in a load and go situation. 1. Airway management 2. Oxygen 3. Stabilize flail chest 4. Seal open pneumothorax 5. Needle chest decompression 6. Stabilize impaled objects 7. Spinal immobilization 8. Control major bleeding B. All other procedures including IV therapy, splints, bandaging should be performed enroute unless the patient is entrapped and the procedures can be done during extrication. 88. Which of the following statements regarding the care of an amputated part is NOT true?
PREHOSPITAL
PROTOCOL FOR AMPUTATED PARTS
Prehospital protocol for handling amputated parts intended for reanastomosis. -Any gross contaminants on the part should be removed by rinsing the part in sterile saline solution. -No attempt should be made to debride or otherwise clean up the amputated part. -The part should be rinsed, wrapped in a moist but not wet sterile dressing, placed in a plastic bag and tightly sealed to prevent direct contact with liquid substances. The sealed bag should then be placed in iced saline or sterile water. -Patient transport should not be delayed by the search for the amputated part. Search can be continued by other personnel (i.e. 2nd ambulance, fire, law enforcement) while patient is transported. 89. Which of the following statements is true regarding the prehospital treatment of serious burns?
Burns
A. Airway Management - be alert to the possibility of associated pulmonary injuries if the burn
occurred in an enclosed space or during an explosion. Note any toxic fumes. 1. Ensure patent airway 2. Suction if necessary 3. Utilize oral or nasal airway as needed 4. Perform endotracheal intubation if necessary (ALS) 1. Administer oxygen 2. Assist ventilations if necessary 3. Monitor O2 saturation if pulse oximetry is available 1. Initiate at least 1 large bore IV line (minimum 16 gauge) as is appropriate depending upon extent of burns/site available (ALS). Administer fluids at rate dependent on blood pressure/Medical Control. 90. Criteria to request a scene response by a helicopter air ambulance would include all EXCEPT: Criteria for Helicopter
-Category I trauma or seriously ill patient in remote or off-road locations not easily accessible to ground ambulances, or whose location may cause delay in transport time. -MVC or incident with prolonged extrication time anticipated (> 20 minutes). -Special environmental conditions such as extreme heat or cold which affect potential patient outcome or prohibit ground access to the hospital (road or bridge damage). -No available trauma center within 20 minutes by ground transport time. -Reduction in transport time to a trauma center compared to ground transport for the seriously -Ground transport resources are exhausted or exceeded (multi-casualty or multiple calls). 91. Supine-hypotension syndrome can occur in the pregnant trauma patient over 20 weeks gestation when the enlarged uterus compresses the inferior vena cava.
Supine-Hypotensive
Syndrome
A. May occur in pregnant patients over 20 weeks gestation due to the gravid uterus compressing the inferior vena cava when the patient is supine. 1. Administer oxygen 2. Place the patient on her left side 3. Initiate an IV line and administer a fluid bolus if needed to maintain blood pressure at a 4. Consider use of PASG (MAST) leg sections only* *(Note: BLS to contact Medical Control before inflating.) 5. Monitor vital signs and fetal heart tones 92. Which is not indicated in the care of the adult patient in anaphylactic shock? Medications (ALS)
1. Administer epinephrine 1:1,000 solution a. Adults: 0.3 ml subcutaneously for a mild reaction b. Peds: 10 kg 0.1ml SQ *Maximum dose: 0.3 ml SQ. May be repeated in 15 min. 2. Administer epinephrine 1:10,000 solution, 5.0 ml at 1 ml/min IVP for a severe reaction 3. Administer Benadryl: a. Adults - 50 mg slow IV push b. Peds - 1 mg/kg slow IV push* 4. If patient is conscious, Albuterol 2.5 mg via nebulizer may be considered but must be used with extreme caution if epinephrine has been administered 1. BLS transport and BLS non-transport agencies: (Per protocol AP-24) a. Epi pen 0.3 mg IM b. Epi pen (Pediatric) 0.15 mg IM 2. EMT-B’s working for First Responder agencies can assist the patient with Epi-pen 93. Which of the following assessment findings would indicate decreased perfusion in the 6 month old Circulation
Heart rate – compare to normal rate for age and situation Central/truncal pulses (brachial, femoral, carotid) – strong, weak or absent Distal/peripheral pulses – present/absent, thready, weak, strong Color – pink, pale, flushed, cyanotic, mottled Blood pressure – compare to normal for age of child. Must use appropriately sized cuff Hydration status – anterior fontanel in infants, mucous membranes, skin turgor, crying tears, 94. Upon arrival to the ER, endotracheal tube placement should be checked using more than one method. Which is NOT a valid method of checking placement? Confirming ER Placement
-Check placement of ET tube via ausculation of bilateral breath sounds auscultation over epigastrium
and EID.
-[Other methods instructed per ACLS include EID and CO2 detector.]
95. Which statement is NOT true regarding adult endotracheal intubation? Contraindications:
Comatose patients ventilating adequately Complications:
Precautions:
If not successful after 3 attempts, maintain airway and ventilate with 100% oxygen using. bag-valve-mask or positive pressure; attempt combitube if not contraindicated. 96. Treatment for the victim of a heat related emergency may include: Heat Exhaustion/Heat Stroke

1. Move the patient to a cool environment 2. Remove excessive clothing. 3. If hypotensive or unconscious: a. maintain an open airway b. oxygen per nasal cannula or mask as needed. c. initiate an IV of normal saline and administer an initial fluid bolus of 200 ml. d. monitor cardiac rhythm (ALS). e. perform and transmit 12 lead EKG if possible (ALS). f. initiate cooling of the heat stroke victim with cold packs or cool soaks to the 97. Prehospital treatment of isolated frostbite may include all of the following EXCEPT: Isolated Frostbite
Move the patient to a warm environment. Remove wet, restrictive clothing. Cover affected areas with dry, sterile dressings. Prevent thawing/re-freezing of the affected areas. Rewarming of frostbitten tissue is best performed in the controlled setting of the emergency
98. Which of the following is NOT an absolute indication for spinal immobilization?
INDICATIONS for spinal immobilization
A. All trauma patients with a neurological deficit. B. All trauma victims complaining of head, neck, or back pain. C. All unconscious trauma victims. D. All trauma victims who may have spinal injury, who also exhibit altered mental states, (e.g., E. All trauma victims with facial or head injuries. F. All trauma patients with “mechanism of injury” that may have resulted in spinal injury. 99. An ambulance is called to a local residence for an injured child. All of the following might be Possible Indicators of Abuse and/or Neglect:
-Obvious or suspected fractures in a child under age two. -Injuries in various stages of healing, especially burns or bruises. -Injuries scattered over many body parts. -Bruises or burns in a pattern which suggests intentional infliction. -Injuries which do not match the history. -Vague, inconsistent or changing history. -Delay in seeking treatment. -Inappropriate clothing, signs of poor nutrition or poor care. -Abandonment of an elderly person or child unable to care for themselves. 100. You respond to a one-vehicle car crash in a remote area. Upon assessment of the driver, you note the patient to be in acute respiratory distress with absent breath sounds on the right side, jugular vein distention, hyperresonance to percussion on the right chest wall, normal heart INDICATIONS: SIGNS OF TENSION PNEUMOTHORAX
A. Absent or diminished lung sounds on the affected side B. Progressive respiratory distress and/or increased resistance to bagging C. Tracheal deviation D. Jugular vein distention

Source: http://www.blessinghealthsystem.org/upload/docs/Emergency%20Medical%20Services/01%20%20EMTP%20%20ECRN-STUDY%20GUIDE%202008.pdf