RC 41 Maryland Protocols 2026

(p. 4 / PDF p. 16) What is the contact info of Poison Control?

Check Protocol Page 4 (PDF Page 16) under Important Numbers to find the Poison Control contact

(p. 5 / PDF p. 17) What is the name and location of the Primary Adult Resource Center?

R Adams Cowley Shock Trauma Center (UM), Baltimore

(p. 5 / PDF p. 17) What is the name of the Level I Trauma Center located in Baltimore?

The Johns Hopkins Hospital Adult Trauma Center (JHM), Baltimore

(p. 5 / PDF p. 17) What is the name and location of the specialty center for eye trauma?

Wilmer Eye Institute/The Johns Hopkins Hospital (JHM), Baltimore

(p. 5 / PDF p. 17) What is the name and location of the specialty center for hand/upper extremity trauma?

The Curtis National Hand Center for Treatment of the Hand and Upper Extremity/Union Memorial Hospital (MedStar), Baltimore

(p. 5 / PDF p. 17) What facility has the hyperbaric medicine referral center?

Center for Hyperbaric Medicine/R Adams Cowley Shock Trauma Center (UM), Baltimore

(p. 5 / PDF p. 17) What specialty referral center handles neuro-trauma patients?

Neurotrauma Center/R Adams Cowley Shock Trauma Center (UM), Baltimore

(p. 5 / PDF p. 17) What are the names and locations of the two pediatric trauma centers? a. / b.

a. Johns Hopkins Children's Center (JHM), Baltimore | b. Children's National Medical Center, Washington, DC

(p. 5 / PDF p. 17) What are the names and locations of the burn centers in our area? a. / b. / c. / d.

a. Adult Burn Center/Johns Hopkins Bayview Medical Center (JHM), Baltimore | b. Adult Burn Center/Washington Hospital Center (MedStar), Washington, DC | c. Pediatric Burn Center/Johns Hopkins Children's Center (JHM), Baltimore | d. Pediatric Burn Center/Children's National Medical Center, Washington, DC

(p. 6-8 / PDF p. 18-20) Frederick Health Hospital is what Specialty Referral Center? a. / b. / c. / d. / e.

a. Perinatal Referral Center | b. Primary Stroke Center | c. Cardiac Interventional Center | d. Maryland Sexual Assault Forensic Examination (SAFE) Hospital (Pediatric and Adult) | e. (Base Station / Not a designated Trauma Center)

(p. 12 / PDF p. 24) Who should be notified via radio as soon as an error or protocol variance is discovered, prior to arriving at the receiving hospital?

The consulting physician

(p. 12 / PDF p. 24) The EMS Clinician must notify the _______ and _______ within 24 hours of the incident.

local EMS jurisdiction (or licensed commercial ambulance service) AND Program Medical Director

(p. 12 / PDF p. 24) The EMS Operational Program Quality Assurance Officer, in accordance with COMAR regulations (see p. 12), must: a. Within ___ days of being made aware of an incident, submit written notification of the incident to the: 1) Local EMS jurisdiction, 2) Program Medical Director, 3) MIEMSS Compliance Office (Office of Integrity), and 4) State EMS Medical Director. b. Within ___ days of the written notification of the incident, initiate a Medical Review Committee QA investigation. c. Within ___ days of the written notification of the incident, forward to MIEMSS' Compliance Office (Office of Integrity) and State EMS Medical Director the written results of the Medical Review Committee QA investigation and recommendations.

a. 5 days | b. 14 days | c. 30 days

(p. 13 / PDF p. 25) Give 3 examples of when you may be unable to carry-out physician's orders. a. / b. / c.

a. The clinician feels the administration of an ordered medication would endanger the patient | b. A medication is not available | c. A physician's order is outside the protocol

(p. 13 / PDF p. 25) How long do you have to notify the local EMS jurisdiction when unable to carryout physician's orders?

As soon as practical following the call (and written notification within 5 days by the EMS Operational Program)

(p. 14 / PDF p. 26) Name the four criteria that MUST be present for EMS clinicians to proceed with a physician's orders for extraordinary care not covered by Maryland Protocols. a. / b. / c. / d.

a. During the consultation, both the consulting physician and the EMS clinician must agree that the patient's condition and extraordinary care are not addressed elsewhere within these medical protocols and that the order is absolutely necessary to maintain the life of the patient. | b. The EMS clinician must feel capable of correctly performing the care directed by the consulting physician, based on the instructions given by the consulting physician. | c. The EMS clinician must inform the consulting physician of the effect of the treatment and notify the receiving physician of the treatment upon arrival at the hospital (if the receiving physician is different than the consulting physician). | d. The EMS clinician must inform the EMS Operational Program Medical Director as soon as practical after the call.

(p. 14 / PDF p. 26) If an EMS clinician receives an order for care that is not covered by Maryland protocols and does not feel comfortable with it or does not agree that it is absolutely necessary to maintain the life of the patient, they shall proceed with the _______.

"Inability to Carry Out Physician Order" section

(p. 15 / PDF p. 27) If you have identified a critically unstable patient, do the following: a. / b. / c.

a. STOP ALL MOVEMENT OF PATIENT | b. DO NOT INITIATE TRANSPORT | c. PROCEED TO CRITICALLY UNSTABLE PATIENT PROTOCOL IMMEDIATELY

(p. 15 / PDF p. 27) During the initial assessment of the pediatric patient, what are the three areas of the assessment triangle? a. / b. / c.

a. Appearance | b. Work of Breathing | c. Circulation to Skin

(p. 16 / PDF p. 28) If, after you determine the patient is not breathing adequately, at what rates would you ventilate a patient for the below age groups: a. For patients 13 years of age and older: / b. For neonates and patients less than 13 years of age: / c. For a newly born:

a. Deliver 1 breath every 6 seconds (10 breaths per minute) | b. Deliver 1 breath every 3 seconds (20 breaths per minute) | c. Refer to the Universal Algorithm for the Newly Born (40-60 breaths per minute)

(p. 17 / PDF p. 29) What is the criteria for hyperventilation of a patient?

Hyperventilate the head-injured patient only if signs/symptoms of herniation are present, including posturing, loss of pupillary light response, dilation of one or both pupils, vomiting, hypertension, bradycardia, and/or irregular respirations (or rapidly decreasing GCS).

(p. 17 / PDF p. 29) At what ventilation rates would you hyperventilate a patient for the below age groups: a. Adult (age group: ___) ___ per minute / b. Child (age group: ___) ___ per minute / c. Infant (age group: ___) ___ per minute

a. Adult (including adolescent 13 years of age or older): 20 breaths per minute | b. Child (1-12 years of age): 30 breaths per minute | c. Infant (less than 1 year of age): 35 breaths per minute

(p. 17 / PDF p. 29) True or False: A patient with moderate hypoxia should receive 100% oxygen and assisting ventilations if necessary.

True (SpO2 86-90%: Give 100% oxygen, Assisting Ventilations if necessary)

(p. 18 / PDF p. 30) A patient who is 13 years or older, and without a pulse, should be referred to what universal algorithm?

Universal Algorithm for Adult Emergency Cardiac Care for BLS

(p. 18-19 / PDF p. 30-31) Patients who have a blunt trauma with a high-energy mechanism of injury that has potential to cause spinal cord injury or vertebral instability and one or more of the following should receive spinal motion restriction: a. / b. / c. / d. / e.

a. Midline spinal pain, tenderness, or deformity | b. Signs and symptoms of new paraplegia or quadriplegia | c. Focal neurological deficit | d. Altered mental status or disorientation | e. Distracting injury

(p. 19 / PDF p. 31) In addition to the above indications for adults, the criteria below apply to children that have not yet reached their 15th birthday: a. / b. / c. / d.

a. Neck pain or torticollis | b. High-impact diving incident or high-risk motor vehicle crash (head on collision, rollover, ejected from the vehicle, death in the same crash, or speed greater than 55 mph) | c. Substantial torso injury | d. Conditions predisposing to spine injury

(p. 19 / PDF p. 31) Match the following: Priority 1, Priority 2, Priority 3, Priority 4

Priority 1 = C) Critically ill or injured person requiring immediate attention; unstable patients with life-threatening injury or illness. | Priority 2 = A) Less serious condition, yet potentially life-threatening injury or illness, requiring emergency medical attention but not immediately endangering the patient's life. | Priority 3 = D) Non-emergent condition, requiring medical attention but not on an emergency basis. | Priority 4 = B) Does not require medical attention.

(p. 20 / PDF p. 32) All healthcare clinicians are obligated by law to report cases of suspected child or vulnerable adult abuse or neglect to either the _______ or _______.

local police/law enforcement OR adult/child protective services (Check Protocol Page 20 / PDF Page 32 and Page 83 / PDF Page 95 for the statewide reporting hotline)

(p. 21 / PDF p. 33) In order for a clinician to administer a patients prescribed rescue medication not specifically mentioned in The Maryland Medical Protocols for Emergency Medical Services, the following criteria is needed: a. / b. / c.

a. Clinicians should obtain on-line medical direction | b. The rescue medication must be provided by the patient or caregiver | c. The label must have the patient's name and the amount of medication to be given

(p. 21 / PDF p. 33) For patients with fever documented by EMS as greater than 100.4 F (38 C), clinicians may treat with _______.

acetaminophen

(p. 21 / PDF p. 33) Pediatric section of the treatment protocol will be used for children who have not reached their _______ birthday (trauma) or their _______ birthday (medical), except as otherwise stated in the treatment protocol.

15th birthday (trauma); 18th birthday (medical)

(p. 21 / PDF p. 33) Pediatric medication dosing applies to patients weighing less than ___ kg. For pediatric patients equal or greater than ___ kg, utilize _______ dosing.

50 kg; 50 kg; adult

(p. 21 / PDF p. 33) True or False: All Priority 1, Priority 2, and Specialty Alert patients require hospital notification through EMRC on a recorded line.

True

(p. 22 / PDF p. 34) _______ is a bi-directional communication via EMRC between an authorized hospital-based physician (or EMSOP medical director) and prehospital EMS clinician for the purpose of incorporating the physician's knowledge and experience into ongoing patient care.

Medical Consultation

(p. 22 / PDF p. 34) What are the eight suggested elements for hospital notifications and medical consults? a. / b. / c. / d. / e. / f. / g. / h.

a. Assigned patient priority (1 to 4) | b. Age | c. Chief complaint | d. Clinician impression | e. Pertinent patient signs and symptoms | f. HR, RR, BP, Pulse Ox (do not use "within normal limits" or "stable" in description) | g. Pertinent physical findings | h. ETA

(p. 22-23 / PDF p. 34-35) When a local jurisdiction declares an MCI, it is extremely important to maximize patient care resources and reserve EMS communications for emergent situations. Except for _______ care interventions, EMS clinicians _______ perform all skills and administer medications within protocol, during a declared MCI. When the MCI condition is instituted, the _______ call box must be checked on the PCR.

extraordinary; may; "Exceptional Call"

(p. 23 / PDF p. 35) Priority ___ patients shall be triaged according to Maryland Medical Protocols to the closest appropriate hospital-based emergency department, designated trauma, or designated specialty referral center. Critically unstable patients in need of immediate life-saving interventions that cannot be provided in the field shall, with the approval of EMS system medical consultation, be diverted to the _______ (including _______) capable of immediately providing those interventions.

1; closest facility; freestanding emergency medical facility

(p. 23 / PDF p. 35) Priority ___ patients shall be triaged according to the Maryland Medical Protocols to the closest appropriate hospital-based emergency department, designated trauma or designated specialty referral center unless otherwise directed by EMS System medical consultation.

2

(p. 23 / PDF p. 35) Stable priority ___ or ___ patients who do not need a time-critical intervention may be transported to the local emergency department or freestanding medical facility.

3 or 4

(p. 23 / PDF p. 35) Medevac patients with indications for specialty referral center should be flown to the appropriate type of specialty center if not more than ___ to ___ minutes further than the closest trauma center. (Patients with an airway, breathing, or circulatory status who would be jeopardized by going an additional ___ to ___ minutes should go to the closest trauma center.)

10 to 15 minutes; 10 to 15 minutes

(p. 24 / PDF p. 36) All requests for scene helicopter transports shall be made through _______. For Trauma Decision Tree Category ___ and ___ receiving trauma center medical consultation is required when considering whether helicopter transport is of clinical benefit.

SYSCOM; Charlie and Delta

(p. 24 / PDF p. 36) If the time of arrival at the trauma or specialty referral center via ground unit is less than ___ minutes, there will generally be no benefit in using the helicopter, especially for Trauma Decision Tree categories ___ and ___.

30 minutes; Charlie and Delta

(p. 24 / PDF p. 36) On-line medical direction should be obtained from the local trauma center and the specialty referral center when transport to the specialty center would require more than ___ to ___ minutes additional transport time.

10 to 15 minutes

(p. 25 / PDF p. 37) True or False: BLS clinicians have the right to decline the transition of patient care from an ALS provider.

True

(p. 25 / PDF p. 37) A Patient Care Report (PCR) will be completed and delivered to the receiving facility as soon as possible, ideally upon transfer of care. If this is not immediately possible, clinicians must provide documentation of the patient's prehospital care on a template and in a format provided or approved by MIEMSS for inclusion in the patient care record before leaving the receiving facility, then deliver the completed PCR within ___ hours after dispatch, in compliance with COMAR regulations (see p. 25).

24 hours

(p. 28-29 / PDF p. 40-41) Using the START/JumpSTART Triage Algorithm answer the below questions: a. You have a patient that is able to walk, what category would he/she be placed into? / b. You have an adult patient that is not breathing and after you position the airway that patient is still apneic, what category would they be placed into? / c. You have a pediatric patient that is breathing on his/her own and has a respiratory rate of 50 breaths per minute - what category would they be placed into? / d. You have an adult patient that is breathing, has a respiratory rate of 24 and a Capillary Refill of 5 seconds - what category would they be place into?

a. MINOR | b. EXPECTANT | c. IMMEDIATE | d. IMMEDIATE

(p. 30 / PDF p. 42) What are the six steps a BLS clinician must take under the Critically Unstable Patient protocol? a. / b. / c. / d. / e. / f.

a. Consider the need for more resources, if available, including multiple ALS clinicians. | b. Obtain a complete patient assessment, including pulse oximetry. | c. Control life-threatening external hemorrhage. | d. Manage the patient's airway (positioning and suctioning) and ventilation (e.g., BVM with or without OPA/NPA) as indicated and tolerated. (Pediatric: if no trauma, consider towel roll under shoulders; if stridor present, assess for foreign body). | e. Treat hypoxia and respiratory distress promptly (e.g., oxygen, albuterol, IM epinephrine as per protocol). | f. If there is clinical concern for severe head injury (e.g., with hypertension and bradycardia): Elevate the head of the patient to 30 degrees and maintain neutral position of the neck.

(p. 51 / PDF p. 63) True or False: Patients who are found in arrest or who arrest prior to transport and are attended to by BLS clinicians must only be resuscitated in place (with minimal movement, no attempts at patient loading, and no attempts at transport).

True (until on-scene resuscitation criteria are accomplished)

(p. 51 / PDF p. 63) What are the four exemptions from on-scene resuscitation? a. / b. / c. / d.

a. Physical barriers prevent resuscitation | b. Clinicians are in danger | c. Pregnant patients | d. Patients in cardiac arrest thought to be secondary to hypothermia or submersion

(p. 51 / PDF p. 63) For pregnant patients greater than ___ weeks gestation in cardiac arrest, provide constant _______.

20 weeks; left lateral uterine displacement

(p. 57 / PDF p. 69) Cardiac Arrest - Pediatric Indications: Pediatric patients (medical arrest: less than ___ years of age; trauma arrest: less than ___ years of age) who are unconscious, apneic, and pulseless.

13 years of age; 15 years of age

(p. 65 / PDF p. 77) BLS clinicians may terminate resuscitation for adult patients (age ___ years or older) if: a. / b. / c.

Age 18 years or older: a. ALS resources are genuinely unavailable, and | b. The patient has received a minimum of 15 two-minute cycles of HPCPR, and | c. During the five AED analyses immediately prior to TOR there was "no shock advised."

(p. 65 / PDF p. 77) What are the two exclusions to TOR? a. / b.

a. Pregnant patients | b. Patients in cardiac arrest that is suspected to be due to hypothermia

(p. 69 / PDF p. 81) True or False: BLS may terminate resuscitation for pediatric medical arrest patients.

False (May NOT terminate resuscitation for pediatric medical arrest patients under age 18 years)

(p. 72 / PDF p. 84) What are the indications for a BLS clinician to pronounce the death of a patient? a. / b. / c. / d. / e.

a. Decapitation | b. Rigor mortis | c. Decomposition | d. Dependent lividity | e. EMS clinician has terminated resuscitation per the Termination of Resuscitation protocol

(p. 73 / PDF p. 85) Define the following resuscitation statuses: a. Attempt CPR: / b. MOLST A-1: / c. MOLST A-2: / d. MOLST B:

a. Attempt CPR: if cardiac or respiratory arrest occurs, perform CPR, artificial ventilation, and all medical efforts that are indicated during arrest in order to restore or stabilize cardiopulmonary function. | b. MOLST A-1: if cardiac or respiratory arrest occurs, do not attempt resuscitation (no CPR). Prior to arrest: maximal restorative efforts including intubation. | c. MOLST A-2: if cardiac or respiratory arrest occurs, do not attempt resuscitation (no CPR). Prior to arrest: comprehensive efforts to prevent arrest excluding intubation. | d. MOLST B: if cardiac or respiratory arrest occurs, do not attempt resuscitation (no CPR). Prior to arrest: limited, palliative care only.

(p. 73 / PDF p. 85) What are acceptable forms of a valid EMS/DNR Order? a. / b. 1) / c. / d. / e. 1) / f.

a. Maryland MOLST Form or Bracelet | b. Maryland EMS/DNR Form or Bracelet (1. There is no expiration on older versions of DNR forms) | c. Medic Alert DNR Bracelet or Necklace | d. Out-of-state EMS/DNR Form | e. Oral DNR Order from EMS System Medical Consultation (1. Acceptable if a MOLST or DNR form is not present) | f. Oral DNR Order from other on-site physician, physician assistant, or nurse practitioner

(p. 77 / PDF p. 89) What are the five indications for the Chest Pain/Acute Coronary Syndrome, Suspected - Adult & Pediatric protocol? a. / b. / c. / d. / e.

a. Angina or anginal equivalents | b. Chest pain, pressure or discomfort | c. Pain or discomfort in the upper abdomen, arm, or jaw | d. Shortness of breath | e. Unexplained diaphoresis

(p. 77 / PDF p. 89) What are the BLS treatments, in order, for the Chest Pain / Acute Coronary Syndrome, Suspected- Adult & Pediatric protocol? a. / b. / c. 1) / d.

a. Place patient in position of comfort. | b. Administer aspirin 324 mg or 325 mg chewed, if not given prior to EMS arrival. | c. Assist with administration of patient-prescribed nitroglycerin (BLS) 0.4 mg SL. (1. May be repeated in 3-5 minutes if chest pain persists, blood pressure is greater than 90 mmHg, and pulse is between 60-150 bpm. Maximum 3 doses total (patient and EMT-assisted)). | d. Assess and treat for shock if indicated.

(p. 81 / PDF p. 93) For VAD-related complications or suspected cardiac/respiratory conditions, where should the patient be transported to if the patient's clinical condition and time allow?

Transport to the medical facility where the VAD was placed

(p. 83 / PDF p. 95) What are the five indications for the Abuse/Neglect protocol? a. / b. / c. / d. / e.

a. Injuries or burns in a pattern suggesting intentional infliction | b. Injuries in various stages of healing or injuries scattered over multiple areas of the body | c. Patient, parent, or caregiver responding in an inappropriate manner to the situation | d. Malnutrition or extreme lack of cleanliness of the patient or environment | e. Bulging of fontanels and altered mental status in infants

(p. 83 / PDF p. 95) Under the Abuse/Neglect protocol, what must be documented in the patient care report? a. / b. / c. / d. / e.

a. All statements made by the patient, parent, or caregiver; include verbatim statements in quotation marks | b. Any abnormal behavior on the part of the patient, parent, or caregiver | c. The condition of the environment and other residents present | d. Document the time the police or social service agency was notified along with the name and identifier, if possible | e. Document the name of the receiving health care clinician (RN, PA, or MD)

(p. 84, 86 / PDF p. 96, 98) What are the indications for the Agitation - Adult & Agitation - Pediatric protocols? a. Mild: / b. Moderate: / c. Severe:

a. Mild: Patient is agitated but cooperative and making rational decisions. No immediate concern for patient or clinician safety. | b. Moderate: Patient is irrational and exhibiting behavior that puts self or clinicians at risk. | c. Severe: Patient is physically violent and presents an immediate and imminent threat to self or others.

(p. 84, 86 / PDF p. 96, 98) Under the Mild Agitation treatment plan, what is the SAFER model? a. S: / b. A: / c. F: / d. E: / e. R:

a. S: Stabilize the situation by containing and lowering the stimuli. | b. A: Assess and acknowledge the crisis. | c. F: Facilitate the identification and activation of resources (chaplain, family, friends, or police). | d. E: Encourage patient to use resources and take actions in their best interest. | e. R: Recovery or referral - leave patient in care of responsible person/professional or transport.

(p. 90, 91 / PDF p. 102, 103) What are the indications for the Allergic Reaction - Adult & Allergic Reaction - Pediatric protocols? a. Mild: / b. Moderate: / c. Severe:

a. Mild: localized swelling and itching at the site | b. Moderate: hives OR mild wheezing | c. Severe: (Refer to Allergic Reaction: Anaphylaxis Protocol): Acute onset of severe illness after exposure to a known or suspected allergen with two or more of the following: Urticaria (hives) or acute swelling of the mucosa, Respiratory compromise, Hypotension, GI symptoms; OR Hypotension after exposure to a known or suspected allergen.

(p. 90 / PDF p. 102) What is different in the BLS treatment plan between Mild & Moderate Allergic Reaction?

For Mild symptoms, epinephrine is only administered IF the patient has a history of a life-threatening allergic reaction to the same allergen. For Moderate symptoms, epinephrine is administered regardless of history, AND Albuterol (2 puffs MDI or nebulized, may repeat once in 30 minutes) is also administered.

(p. 93 / PDF p. 105) Anaphylaxis is defined as the acute onset of severe illness after exposure to a known allergen with two of the following: a. / b. / c. / d.

a. Urticaria (hives) or acute swelling of the mucosa (e.g., tongue, airway, stridor, lips) | b. Respiratory compromise | c. Hypotension | d. GI symptoms, such as persistent nausea/vomiting, abdominal pain, or diarrhea

(p. 97 / PDF p. 109) What are the indications for the Apparent Life-Threatening Event/Brief Resolved Unexplained Event (ALTE/BRUE) protocol? a. / b. 1) 2) 3) 4)

a. Infant or child less than 2 years of age | b. Episode that is frightening to the observer that includes some combination of the following: 1) Apnea, 2) Skin color change (cyanosis, pallor, erythema), 3) Marked change in muscle tone, 4) Choking or gagging not associated with feeding or witnessing foreign body aspiration

(p. 97 / PDF p. 109) True or False: If the parent or guardian refuses medical care or transport, clinician SHOULD contact a Pediatric Base Station physician.

False (The clinician SHALL consult with a Pediatric Base Station physician)

(p. 101 / PDF p. 113) If blood glucose is less than ___ mg/dL, administer _______ of _______. a. Administer an additional dose of _______ of _______ if not improved after ___ minutes.

70 mg/dL; 10-15 grams; oral glucose (between the patient's gum and cheek) | a. 10-15 grams; oral glucose; 10 minutes

(p. 100 / PDF p. 112) The hyperglycemic patient that has a blood glucose greater than ___ mg/dL requires ALS.

300 mg/dL

(p. 104, 105 / PDF p. 116, 117) What is the BLS treatment for Nausea/Vomiting?

Place patient in position of comfort or in left lateral position, with consideration for spinal motion restriction if required. Allow patient to inhale vapor from an isopropyl alcohol wipe 3 times every 15 minutes, as needed and tolerated.

(p. 106, 108 / PDF p. 118, 120) What are the indications for the Pain Management - Adult & Pain Management - Pediatric protocol? a. / 1) Mild to moderate pain: / 2) Moderate to severe pain:

a. Patient presents with a painful condition that would benefit from treatment with an analgesic. This includes DNR/MOLST patients and patients being pre-medicated for a painful procedure. | 1) Mild to moderate pain: Pain rated in the 1-5 range on a scale of 1-10. Isolated musculoskeletal injuries such as sprains and strains (and pain related to childhood illnesses such as headache, ear infection, and pharyngitis in pediatrics). | 2) Moderate to severe pain: Pain rated in the 5-10 range on a scale of 1-10.

(p. 112 / PDF p. 124) Adult patients (___ years of age and older) with a suspected source of infection and present with at least ___ of the following criteria: a. / b. / c. / d.

18 years of age and older; two (2) | a. Temp greater than 100.4 F (38 C) or less than 95.9 F (35.5 C) | b. HR greater than 100 bpm | c. RR greater than 25 (or ETCO2 less than or equal to 32 mmHg) | d. Hypotension (systolic BP less than 90 mmHg)

(p. 113 / PDF p. 125) Name the ten adult patient populations that are considered especially high risk for sepsis and should have their temperature measured: a. / b. / c. / d. / e. / f. / g. / h. / i. / j.

a. Altered mental status | b. Patients in long-term care facilities (nursing home) | c. Indwelling catheters | d. Oncology patients | e. Solid organ transplant | f. Bed-bound | g. Post-operative | h. Currently on antibiotics | i. Asplenic | j. Left ventricular assist device

(p. 114 / PDF p. 126) Pediatric patients (less than ___ years of age) with a suspected source of infection and present with at least ___ of the Pediatric Sepsis Rule-In Criteria by Age. a. / b. / c. / d. / e. / f. / g.

18 years of age; three (3) | a. Heart Rate (sustained) elevated for age | b. Respiratory Rate elevated for age | c. Temp greater than 38.0 C or greater than 100.4 F | d. Cap Refill/Skin: Delayed (greater than 3 seconds), mottled | e. Systolic BP (mmHg) low for age | f. Mental Status: Unresponsive, confused, inappropriate, lethargic | g. High Risk Condition: Cancer, Asplenia, Sickle Cell Disease, bone marrow or solid organ transplant, central or indwelling line/catheter, immunodeficiency or immunosuppression

(p. 114 / PDF p. 126) Pediatric patients who do not meet at least three criteria may be treated using the Sepsis-Pediatric protocol with approval from a _______ if sepsis is suspected by the EMS clinician.

pediatric base station

(p. 117 / PDF p. 129) Name the signs of shock that a patient may exhibit:

Altered mental status; cool, clammy skin; diaphoresis; hypotension; tachycardia or weak pulses; shallow, labored respirations; general weakness; and/or a decreasing pulse pressure (and in pediatrics: delayed capillary refill greater than 2 seconds, pallor or peripheral cyanosis).

(p. 117 / PDF p. 129) What is the BLS treatment for shock? a. / b. / c.

a. Place the patient in supine position with legs elevated. | b. Closely monitor airway and vital signs every 5 minutes. | c. Pregnancy: For pregnant patients greater than 20 weeks gestation with hypotension, provide constant left lateral uterine displacement.

(p. 119 / PDF p. 131) Hypotension is a systolic blood pressure less than what for the following age groups: a. Neonates (birth to 28 days old): / b. Infants (less than 1 years of age): / c. Child (1 to 9 years of age): / d. Child (10 to 17 years of age):

a. Less than 60 mmHg | b. Less than 70 mmHg | c. Less than 70 + (2 x age in years) | d. Less than 90 mmHg

(p. 121 / PDF p. 133) What are the indications for the Stroke - Adult & Pediatric protocol? a. / b. / c. / d. / e.

a. Blurred vision (including intermittent loss of vision in one or both eyes, which may have resolved upon arrival of EMS) | b. Difficulty speaking | c. Numbness or weakness (often one side only) | d. Sudden onset of dizziness or loss of balance | e. Severe, unexplained headache

(p. 121 / PDF p. 133) What are the three components to the Cincinnati Prehospital Stroke Scale? a. / b. / c.

a. Facial droop | b. Arm drift | c. Speech abnormal

(p. 121 / PDF p. 133) What is the Posterior Cerebellar Assessment?

Balance: patient complains of sudden onset of loss of balance or dizziness; Eyes: patient has sudden vision loss (including intermittent loss of or blurred vision). Any abnormality is positive for stroke.

(p. 121 / PDF p. 133) When should an EMS clinician calculate Los Angeles Motor Scale score?

If either the Cincinnati Prehospital Stroke Scale or Posterior Cerebellar Assessment is positive

(p. 122 / PDF p. 134) Destination determination for a suspected stroke patient who can be delivered to the appropriate stroke center within ___ hours from when they were last known well.

22 hours

(p. 122 / PDF p. 134) For all suspected stroke patients within ___ hours of last known well time, notify the receiving stroke center or hospital as soon as possible. During the consultation, the clinician shall use the verbiage:

22 hours; "Priority 1, Stroke Alert patient with a last known well time of XX:XX"

(p. 128 / PDF p. 140) After delivery if apnea/gasping, HR is less than 100 or central cyanosis- Ventilate with BVM at _______ using _______ for _______ before connecting to 100% oxygen.

40-60 BPM; room air; the first minute (and 30 more seconds for HR 60-100; attach O2 immediately if HR < 60)

(p. 128 / PDF p. 140) What is the compression rate and compression/ventilation ratio for a newly born?

120 compressions/minute; 3:1 compressions : ventilations

(p. 128 / PDF p. 140) True or False: AEDs are indicated for use on newly born patients.

False (CPR - NO AED)

(p. 127, 131 / PDF p. 139, 143) True or False: If postpartum bleeding, perform uterine massage with the heel of the hand applying firm pressure from the pubis toward the umbilicus only.

True

(p. 134 / PDF p. 146) What are the indications for the Asthma/COPD - Adult protocol? a. / b. 1) 2) 3)

a. Shortness of breath with wheezing or decreased air entry, presumed to be due to bronchospasm from reactive airway disease, asthma, or COPD | b. Signs of respiratory distress which may include: 1) Accessory muscle use and/or tripod positioning, 2) Cyanosis, mottled skin, 3) Nasal flaring, retractions

(p. 134 / PDF p. 146) What is the BLS treatment for the Asthma/COPD - Adult protocol?

Albuterol (BLS) inhaler (2 puffs inhaled) or albuterol (BLS) 2.5 mg nebulized; may repeat dose one time, as needed, within 30 minutes. For severe respiratory symptoms, administer epinephrine auto-injector (BLS) 0.3 mg IM or administer epinephrine (BLS) (1 mg/mL) 0.5 mg in the lateral thigh. Medical consult required for asthma/COPD patient who has a cardiac history or is pregnant.

(p. 135 / PDF p. 147) What is the BLS treatment for the Asthma/COPD - Pediatric protocol?

Albuterol (BLS) inhaler (2 puffs inhaled) or albuterol (BLS) nebulizer (< 2 years: 1.25 mg; 2 years or greater: 2.5 mg); may repeat dose one time, as needed, within 30 minutes. For severe respiratory symptoms: Less than 5 years of age: pediatric epinephrine auto-injector (BLS) 0.15 mg IM or epinephrine (BLS) (1 mg/mL) 0.15 mg IM in the lateral thigh; 5 years of age or greater: epinephrine auto-injector (BLS) 0.3 mg IM or epinephrine (BLS) (1 mg/mL) 0.5 mg IM in the lateral thigh. Medical consult required for asthma/COPD patient who has a cardiac history/congenital heart or lung disease or is pregnant.

(p. 142 / PDF p. 154) What is considered to be an inadequate respiratory rate for pediatric patients?

Infant: less than 20 breaths per minute; Child: less than 16 breaths per minute; Adolescent: less than 12 breaths per minute

(p. 144 / PDF p. 156) Consider transport to the Hyperbaric Medicine Specialty Center if indications apply: a. / OR / b. 1) ANY of the following diagnostic indicators: a) b) c) / 2) AND one or more of the following: a) b) c) d) e) f) g)

a. Patients with exposure to products of combustion (smoke) or carbon monoxide who have a carboxyhemoglobin value of greater than 25%, with or without symptoms | b. Patients with proven exposure to products of combustion (smoke) or carbon monoxide who have: 1) ANY of the following diagnostic indicators: a) Carboxyhemoglobin value (co-oximeter or blood) of greater than 15%, b) Alarm of EMS or fire agency-maintained passive carbon monoxide monitor, c) Targeted atmospheric carbon monoxide value 100 ppm or greater in the patient environment; 2) AND one or more of the following: a) History of loss of consciousness during exposure (may have since resolved), b) GCS persistently less than or equal to 13, c) Rapid decline of neurological symptoms, including actively seizing patients with appropriate airway stabilization, d) Pregnancy, e) Chest pain, f) Extremes of age, g) Per clinician discretion

(p. 144 / PDF p. 156) What are the two contraindications for transport to Hyperbaric Medicine Specialty Center? a. / b.

a. Patients with burns who meet Burn Center referral criteria (transport to burn center) or patients with burns and trauma (transport to trauma center) | b. Transport time to a Hyperbaric Medicine Specialty Center is greater than 1 hour (or patients in cardiac arrest / ROSC post-cardiac arrest)

(p. 146 / PDF p. 158) What is the BLS treatment for frostbite?

Remove patient from cold environment and remove any wet clothing. Protect from further heat loss. Handle potential frostbitten areas gently; do not rub affected areas. Cover affected areas with lightweight gauze.

(p. 146 / PDF p. 158) What is the BLS treatment for hypothermia?

Remove patient from cold environment and remove any wet clothing. Protect from further heat loss. Passively rewarm the patient within a warm environment. Use a thermal blanket to cover the patient and a separate blanket to cover the patient's head, except for the face. Administer warmed oxygen, if available. Handle all hypothermic patients gently; rough handling may precipitate cardiac arrest.

(p. 146 / PDF p. 158) What is the BLS treatment for hypothermic patients in cardiac arrest?

Attempt resuscitation on all hypothermic cardiac arrest patients, unless there is an injury incompatible with life. Administer AED shocks, if indicated. Transport patients with severe hypothermia and patients in cardiac arrest to an ECPR capable center (if within 30 minutes; otherwise go to the closest facility).

(p. 149 / PDF p. 161) Define the following: a. Heat Cramps: / b. Heat Exhaustion: / c. Heat Stroke:

a. Heat Cramps: Moist, cool skin, cramps, normal to slightly elevated body temperature | b. Heat Exhaustion: Moist, cool skin, cramps, weakness, dizziness, normal to elevated body temperature, nausea | c. Heat Stroke: Hot, dry skin (25% of patients will still be moist), seizures, altered mental status, dilated pupils, rapid heart rate, or arrhythmia