Oops!
You accidentally gave your agitated patient the wrong concentration of versed resulting in a total dose of 10mg IM instead of 5mg. Name 3 immediate actions to take for a significant medication overdose.
1. Assess patient
2. monitor for anticipated side effects
3. notify clinical care team in ED
4. documentation of medication error
5. patient follow up
6. notify EMS supervisor, who will then notify DCEMS and OMD. EMS inquiry will be made.
You are riding as the medic on the engine either as a dual hatter or left bucket. Your engine is dispatched with an ambulance for a report of a subject at the bus stop acting strange. You arrive on scene and quickly identify the patient is positive for STROKE. Your closest ALS medic transport unit is 15 min away, but you have a BLS transport unit on scene. You are 10 min away from Fairfax Hospital. How do you transport the patient?
You augment from the ENGINE to the AMBULANCE with all of your ALS equipment and ride to the hospital. If a second ALS provider is needed, you can consider an ALS intercept enroute to the hospital.
You are dispatched for a welfare check. When you arrive and make entry to the dispatched location you see a male subject laying prone on the ground. When you try to turn the subject over, you note signs of non-recent death to include rigor mortis. (ALS or BLS? Why?)
ALS
ALS provider must determine death and wait on scene for PD to arrive before leaving location
You are dispatched for a 90 YOM who is unconscious and not breathing. You arrive on scene and check his carotid and assess for breathing and find nothing. During your assessment the patient's son states that his father has a DNR from Maryland. Can we accept this DNR? If so name three of the five required key parts that must be present on the DNR for us to validate it.
Yes
We can accept out-of-state DNR. Key parts include the patient’s full name, a DNR determination, signature of Physician (MD) or Nurse Practitioner (NP), date of issue, the patient’s signature or signature of person authorized to consent on patient’s behalf
You are dispatched to a nursing home for an 89 YOM with a laceration to the head having what staff describes as sundown syndrome. The patient is oriented to person and place and can tell you who the president is. The patient begins throwing food and feces across the room. He refuses to go with EMS but had a laceration that obviously needs stitches. You will not be sedating this patient. What is another option?
ECO
An ECO can be requested to the Magistrate by a licensed physician when an individual, as a result of a physical injury or illness requires necessary treatment to prevent imminent and irreversible harm. Magistrate must ascertain that there is no legally authorized person to consent and that the adult person in need of treatment, is incapable of providing consent for treatment, transport to an emergency department. Medical ECO is good for 4 hours only.
You arrive at Fairfax Hospital with your patient and as your driver is unloading the Cot from the back of the medic unit, the catch bar gets stuck in the UP position resulting in a rough drop out of the back of the medic unit. List at least 3 actions you will take if you or another provider drop the cot with a patient on it.
1. assess patient
2. notify DPSC
3. notify the receiving facility
4. document event
5. EMS officer documentation: complete an inquiry intake form online FRD – 19, place cot out of service and get a loaner from EMS supervisor.
You have arrived at the hospital with your stable patient experiencing a medical emergency. You are about to transfer care to the Nurse/Physician in you patients assigned room of the ED. Name all items that should be communicated to the receiving clinician.
You are dispatched for a 14 YOM not acting appropriate. You arrive on scene to find a male subject yelling at his mom. You manage to separate the male from his mom and ask him to tell you what happened. The male is able to give you details about skipping school and getting caught by his mom. He can tell you his name, the date, and can recite his address. His mom says he is not being himself and she wants him taken to the hospital. (ALS or BLS? Why?)
BLS
The patient is alert and oriented X4. He is being cooperative for EMS and considered MILD
You are dispatched to a nursing facility for a working CPR on a patient who is a full code status. You take over resuscitation efforts. After 20 min of working the CPR, you decide to terminate resuscitation at the 30 min mark. Name 6 of the 10 items that could prohibit that decision.
1. Patients under 18 years of age
2. Any arrest in the setting of hypothermia, drowning, or cold-water immersion
3. Any EMS or bystander witnessed arrest
4. Any arrest with bystander CPR appropriately initiated
5. VAD patient
6. Patients with a shockable rhythm at any point in the resuscitation including AED prior to EMS arrival (any VF or VT)
7. ROSC (transient or permanent) at any point during the resuscitation
8. Any conversion to a shockable rhythm at any point in the resuscitation
9. Provider(s) feel efforts should continue
10. POLMD feels efforts should continue.
You are dispatched for a 40 YOF diagnosed with bipolar type 1 and Schizophrenia who has been off her meds for 2 months. Reports of patient trying to jump off the roof and set fires in the home have been received. PD is currently on scene. Before considering sedation what can you request?
TDO
Medical TDO can be requested by a licensed physician who has attempted to obtain consent to treat a medical condition that requires intervention within the next 24 hours to prevent harm, injury or death. Individual is believed to be incapable of making an informed decision or is not capable of communicating an informed decision.
You arrive at your station for shift on a Medic transport unit and perform your online daily medication check. You notice that ALS kit 1 is missing medications. What actions do you immediately take.
- Immediately notify the station officer in charge
- The OIC shall: Immediately notify the EMS Officer and ensure the unit replenishes the medication
- The EMS officer may contact the EMS Battalion Chief and/or EMS Regulatory Officer for guidance on any additional steps. Discrepancies found during medication checks should be considered for referral to the chain of command. Discrepancies discovered after medication administration shall be handled as an EMS Inquiry.
During the course of your morning, after checking out the unit medications and equipment, you notice that one of your peers in the station does not look good. She looks unwell and admits to feeling lightheaded. She has been vomiting and having diarrhea that began after a strenuous day of PT the day before. She has a low blood pressure and rapid pulse. As you begin thinking about how to handle this situation, how do you determine when a FCFRD member become a patient?
A person becomes a patient the moment the EMS provider has determined an assessment is necessary to ensure that no illness or injury is overlooked and to ensure that the individual’s capacity to decline an assessment is not impaired by illness, injury, or intoxication.) Shift leader should be notified. He will then make appropriate calls to the Safter officer, chief, UFO, and DPSC if transport is required. Employee should be transported or go home sick if vitals signs are not within normal range to perform their job. EMS
You are dispatched for a 51 YOF who wants her vitals assessed. You arrive on scene to find one patient outside of her home planting flowers in her garden. She stands up and walks over to EMS without difficulty. She tells you that her apple watch is alerting that her HR is 53. She speaks in complete sentences and does not complain of any pain. She has a HX of atrial fibrillation which is controlled with medication. The Zoll monitor matches the patient’s heart rate reading on her apple watch. (ALS or BLS? Why?)
BLS
The patient’s HR is above 50 and she is asymptomatic
You are dispatched to the Schar Cancer Institute for a patient who became unstable during a bowel resection. Upon arrival you are greeted by a physician who wishes to assume responsibility for patient care. Patient is currently sedated. Does FRD allow this? Why? or Why not?
YES
A physician may assume patient responsibility if they can provide the following, confirm identity, proof of licensure, and have a current doctor/patient relationship with the patient. Refer to Integration of On Scene Physicians FRD-210. Under such circumstances, reasonable requests should be followed. EMS providers shall not carry out orders that exceed their training, certification, and authorization.
You are dispatched to a third-party call to a remote home in the back woods of the county, with no car in the drive, for a patient with altered mental status. The patient’s daughter called from Michigan concerned about her father because he seemed confused when she spoke to him this morning. When you arrive at the patient, in addition to the relative isolation, you realize your patient has a walker next to the couch. You also suspect he has been drinking alcohol. Patient has no primary doctor or health insurance. Although you assess him to have decision-making capacity you feel uncertain about his refusal of transport. Name some helpful steps you as a FRD provider can take to aid and manage care for this patient.
-Request an EMS supervisor or specialist to the call immediately
-Use the CURVES mnemonic to assess decision making capability
-Perform a Functional assessment
-Note Medical or social isolation and attempt to contact family members for welfare checks
-Follow Abuse, Neglect, Exploitation, & Social Welfare protocol. Contact APS.
-CRT Referral
-Contact the Fairfax-Falls Church Community Services Board (CSB)
You are starting an IV on a sick patient in the back of the medic unit and suddenly the medic driver moves the unit without warning causing the catheter to come out of the patient and you stick yourself with the needle. After you clean the area, your captain calls the SAFO. Name 3 details you will provide to the SAFO?
1. Hospital destination
2. Source patient name
3. Medical record number
4. Trauma name
5. Date of birth
6. Employees must submit the Infectious Disease Exposure Report (FRD-314) to the SAFO.
7. If an infectious disease exposure is due to a needlestick or animal bite, an Injury Packet must be submitted to the SAFO
You and your crew have been working an unwitnessed cardiac arrest with no change from Asystole and NO signs of ROSC after 30 min of resuscitation efforts. You make the decision to Terminate Resuscitative Efforts. Name four of the five items you should communicate to the POLMD when you call for permission to terminate efforts.
You are riding a BLS rescue and get dispatched for a lift assist. You arrive on scene to find a 67 YOF who fell backwards from the bottom step of her stairs onto a tile floor. Her fall was unwitnessed. The patient’s daughter was home and came running when she heard the loud crash. When you arrive the patient is still lying on the floor because her daughter was afraid to move her. Patient presents as Alert and Oriented x4. No LOC noted. Her daily medications include Lisinopril, Crestor, and Pradaxa. Patient states she does not want to go to the hospital and wants her daughter to take her to follow up with her PCP. You convince her that she needs to be transported. Do you call for an ALS or BLS transport unit?
ALS
Ground level or higher fall of a patient over 55 years old who is taking anticoagulants warrants a TRAUMA activation
You are dispatched to a daycare center for a 2 YOM having a seizure. Previous HX of epilepsy. You arrive on scene to find one male with nystagmus. Day care provider reports two back-to-back seizures with no return to normal for 9 minutes now. You are handed a cellphone with the patient’s mom on the line. She informs you that she is a neurologist at Fairfax Hospital and wants to provide medical direction. She asks you to give the patient his prescribed Depakote in his backpack. Can we do this?
No
You can't give medications or treatments outside of you scope of practice.
You are dispatched to an apartment complex with a 3rd party caller stating that they can hear a father yelling and beating his child. PD is also enroute to dispatched location. Upon arrival PD declares the scene cold and you proceed into the apartment. You find an 11 YOM sitting on his bed with bruises all over his body in various stages of healing. He is very scared to talk and just tells you that he doesn’t want to make his dad mad. He looks away from you as he tells you that his bruises are from the skate park. PD gets the same story from the father. The child does not want to go with EMS and his father tells you to get out of his house and leave his son alone. What is your next step?
You should expect abuse, and a MANDATORY notification should be made to an EMS officer and CPS. Proof of abuse is not required to make a report to CPS.
-In the event of a refusal of medical services, contact the appropriate social service agency and/or law enforcement agency (if indicated) prior to clearing the scene.
You are dispatched for a CRASH with injuries. Upon arrival you see that a vehicle turned up on its side. A civilian reports that he broke the driver's window of the car, cut the seatbelt, and pulled the patient out of the car. In the process he somehow cut himself and got the patient's blood on him. The patient is refusing transport. What can we do for a Good Samaritan following their exposure?
Venous Blood Specimen
Good Samaritan form FRD 399-A
You are backing your medic driver out of the parking lot at the grocery store. Your driver does not see you signal to STOP and backs into the dumpster in the parking lot. No damage is noted to the dumpster and minimal damage is noted to the back step of the medic. Your driver says, “Looks good to me, Let’s go!” What is your next step?
1. Notify DPSC (that will generate an incident number and dispatch the BC, SAFO, and PD.
2. The driver shall complete the “Employee” portion within the online Safety Incident Reporting System.
3. Employees who witnessed the incident must also complete witness statement on the online Safety Incident Reporting System.
4. If the vehicle can be driven and remains in service, the unit officer shall arrange for a repair estimate by submitting a M5 ticket. If unable to access M5 Vehicle Deficiency Reporting System, the Duty Apparatus shall be contacted the next business day
You are riding BL on the Ambulance and get dispatched for a CRASH with injury. (Car vs. motorcycle.) You arrive on scene and note one person currently being extricated from the car and the motorcyclist sitting upright on the curb. You approach the motorcyclist, and he takes his helmet off and begins speaking to you. As your partner performs a rapid trauma assessment, the patient informs you that he was driving approx. 35 MPH when the driver of the car switched lanes and ran into the side of his motorcycle causing him to crash. No serious injuries are noted. Both BLS and ALS units are On Scene. Who should transport? ALS or BLS?
ALS
The patient was involved in a motorcycle crash traveling at speeds >20MPH. He should be transported to a TRAUMA center. Provider should activate TRAUMA alert
You are dispatched to a middle school for a 12 YOF patient having a hypoglycemic emergency. Upon arrival you find one female patient alert and oriented x4. The nurse has made every attempt to contact her parents but was unsuccessful. The school nurse explains to you that she gave the patient her prescribed glucagon kit and she is all better now and no longer requires EMS transport. You are also unsuccessful in contacting her parents. If the patient is all better with normal vitals can you leave her with the nurse?
NO
Patients must be transported after the administration of glucagon. A representative from the school must also accompany the patient to the hospital
You are dispatched to a women’s shelter for a patient who is acting erratically. You arrive on scene to find a female patient in her 30’s running around screaming in the common area. She is soaked with sweat a has taken off most of her clothing and is now wearing only her undergarments. You smell something that smells like permanent markers. Staff at the shelter said they can confirm that she purchased and smoked PCP 30 min ago. You contact DPSC to dispatch PD and safety officer. When you try to approach the patient, she says, “I will punch you and bite you if you get near me!” She begins to throw furniture and cans of food around the room. PD is now on scene are wearing their body cameras. PD asks EMS to drug the patient. What is your very next step?
Contact POLMD for permission to treat behavioral control issues with ketamine. Then, assess for Agitated Delirium (metabolic syndrome) based on the following:
You determine the patient is Violent and Severely Agitated Patients (VSAP) requiring immediate Behavioral Control.