EMS

Question 1

Review the differences in scope of practice for EMTs and paramedics.

Answer 1

EMTs:

• Can obtain EKGs but not interpret them
• Cannot place IVs
• Can give epinephrine and naloxone but not other meds
• Can place King airways but not intubate or use iGel
• Roughly 140 hours of training

Paramedics:

• Can obtain and interpret EKGs
• Can place IVs and give meds
• Can intubate, place iGels, and place King airways
• Roughly 1200 hours training

Question 2

North Carolina EMS is organized at what governmental level?

Answer 2

County

Each county has an MD medical director.

Question 3

What do EMS medical directors do?

Answer 3

• Grant, suspend, and revoke credentials for EMTs and paramedics
• Develop protocols
• Conduct quality improvement projects
• Establish educational materials for credentialing
• Directly and indirectly supervise medical care provided by EMTs and paramedics (chart review)
• Designate base stations, trauma centers, and specialty centers (e.g., what STEMI center are you going to take patients to?)

Question 4

What is high risk refusal?

Answer 4

When a patient is refusing EMS transport for a high-risk complaint, the EMS team often calls MDs for assessment.

You need to assess for capacity, understanding of the risks and benefits, and the person’s reasons for refusal.

Question 5

What should you know about your EMS systems?

Answer 5

• Their protocols

- What meds they carry

Question 6

When taking a call from an ambulance for an incoming patient that seems inappropriate for your center, always remember that ____________.

Answer 6

refusing to accept any patient from EMS is an EMTALA violation; what you can do is remind the EMS provider that there may be a better place for them — for instance, say “yes we will accept this patient; we are not a comprehensive stroke center but we can provide their medical screening and stabilization and transfer them if needed”

Question 7

Paramedics reports are called what?

Answer 7

Run sheets

Question 8

One key thing to removing helmets is to what?

Answer 8

Check for deflation ports

Many sports helmets have inflatable air bladders to make them fit more tightly. If you use a blunt needle to deflate those bladders, then the helmet will come off more easily.

Question 9

Review the color coding system for triaging mass casualty incidents.

Answer 9

Green: well currently and not likely to decompensate.

Yellow: well currently and potentially going to decompensate.

Red: sick currently and likely to decompensate further.

Black: likely to die imminently regardless of intervention.

Question 10

What three life-saving interventions should you consider in triaging mass casualty incidents?

Answer 10

• Tourniquets
• Airways (such as repositioning and/or OPA)
• Needle decompression of suspected PTX

Question 11

Explain the legality of diversions.

Answer 11

Because of EMTALA, an ER can never truly go on diversion. Diversions are essentially suggestions to EMS, but ultimately EMS can decide where to go.

Question 12

Transfers of unstable patients can only happen when the the transferring facility has done what four things?

Answer 12

1: The transferring hospital must continue to provide care to the best of their ability
2: Provide copies of records
3: Confirm that the receiving facility has space and qualified personnel, and has accepted the transfer
4: Transfer happens with the qualified personnel

Question 13

Review the training levels of EMS personnel.

Answer 13

Emergency medical responder:
- Less than 100 hrs training. Can operate AEDs.

Emergency medical technician (formerly called EMT basic):
- 120-150 hrs training
- AEDs, first aid, help patients take their own medicines

Advanced EMT:
- 150+ hours
- Start IVs, telemetry, AEDs, first aid

Paramedics:
- 1200 hours
- ECG interpretation, defibrillation, give medicines according to protocols

Question 14

What legislation initially set federal guidelines for EMTs?

Answer 14

National Highway Traffic Safety Act of 1966