Operations Unit Exam

Ethnocentrism

Considering your own cultural values more important than those of others

Cultural imposition

Forcing your values onto others

Physical factors of nonverbal communication

Literal noise, sounds in the environment, lightening, distance, physical obstacles, cultural norms, gestures, body movements, attitude towards patient

Verbal Communication

Ask open ended question whenever possible. Use close ended questions to minimize the patient’s use of their airway

Techniques to avoid when talking to patients

• Providing false assurance or reassurance

• Giving unsolicited advice

• Asking leading or biased questions

• Talking too much

• Interrupting

• Using “why” questions

• Using authoritative language

• Speaking in professional jargon

Golden Rules

• Make and keep eye contact at all times.

• Provide your name and use the patient’s proper name.

• Tell the patient the truth.

• Use language the patient can understand.

• Be careful what you say about the patient to others.

• Be aware of your body language.

• Speak slowly, clearly, and distinctly.

• If the patient is hard of hearing, face the patient so he or she can read your lips.

• Allow the patient time to answer or respond.

• Act and speak in a calm, confident manner.

Attributes of emotional intelligence

• Self-awareness

• Self-regulation

• Motivation

• Empathy

• Social skills

Patient care report

Prehospital care report, legal document, records all care from dispatch to hospital arrival

Patient care report functions

• Continuity of care

• Compliance and legal documentation

• Administrative information

• Reimbursement

• Education

• Data collection for continuous quality improvement and research

Information collected on the PCR

• Chief complaint

• Mechanism of injury and illness

• Level of consciousness or mental status

• Vital signs

• Initial and ongoing assessment

• Patient demographics

• Transport information

Repeater

Base Station Radio. Receives messages and signals on one frequency. Automatically retransmits them on a second frequency. Allows two mobile or portable units that cannot reach each other directly to communicate using its greater power and antenna.

Role of dispatched

Receives and determines the relative importance of the 911 call. Assigns appropriate response unit(s)

Lifting Position

• Shoulder girdle should be aligned over pelvis. Hands should be held close to legs.

• When directly lifting a patient, tightly grip the patient in a place and manner that will ensure that you will not lose your grasp on the patient.

The Power Lift

• Lift the patient by raising your upper body and arms and straightening your legs until standing.

• Lifting by extending the properly placed flexed legs is the safest and most powerful way to lift

• Keep the weight close to your body.

• Keep your arms the same distance apart as when hanging your arms at each side of your body

The Power Grip

• Palms up and the thumbs extended upward

• Hands about 10 inches apart

• All fingers at same angle; fingers and thumb curled tightly over the top of the handle

• Fully support the handle on your curved palm.

Body Drag

• Keep your back locked in a slight curve created by tightening your abdominal muscles, not curved or bent laterally

• Kneel and extend your arms no more than 15–20 inches in front of you.

• When you can pull no farther because your hands have reached the front of your torso, stop and move back another 15–20 inches.

• Alternate between pull­ing the patient by slowly flexing your arms and repositioning yourself.

Sheet Pull

• If you must drag a patient across a bed, kneel on the bed to avoid reaching beyond the recommended distance

• Kneel on the bed to avoid reaching beyond the recommended distance.

• Drag the patient to within 15–20 inches.

• Complete the drag while standing at the side of the bed.

• Use the sheet or blanket under the patient rather than dragging the patient by his or her clothing. The stretcher should be the same height or slightly higher than the bed.

• You and a partner should kneel on the bed and drag in increments

Backboards

• Long, flat boards made of rigid, rectangular material

• Used to carry and immobilize supine patients with suspected hip, pelvic, spinal, and lower extremity injuries or other multiple trauma

• Commonly used for patients found lying down

• Used to move patients out of awkward places

• 6–7 feet long

• Holes serve as handles and as a place to secure straps

Log Rolling

Kneel as close to the patient’s side as possible.

When you lean forward, keep your back straight and lean solely from the hips.

Roll the patient without stopping until the patient is resting on his or her side and braced against your thighs.

Pulling toward you allows your legs to prevent the patient from rolling over completely and from rolling beyond the intended distance

Stair Chair

• Use a stair chair to carry a patient up or down a flight of stairs or other significant incline if:

  • The patient is conscious.

  • The patient’s condition allows him or her to be placed in a sitting position.

• A stair chair is a lightweight folding chair with a molded seat, adjust­able safety straps, and fold-out handles at both the head and feet.

• Most models have rubber wheels in the back with casters in front so that they can roll along the floor and make turns.

• Used to bring a conscious patient down to a stretcher

Flexible Stretchers

• Can be rolled up across the stretcher’s width or length so the stretcher becomes a smaller tubular package

• Conform around a patient’s sides and do not extend beyond them

• When extended, useful when removing a patient from or through a confined space

Basket Stretchers

Rigid stretcher; Used for patient removal in remote locations, including in water rescues and technical rope rescues

Scoop Stretcher

• Splits into two or four pieces

• Pieces fit around patient who is lying on flat surface, and then reconnect.

• Both sides of the patient must be accessible.

• The patient must be stabilized and secured on a scoop stretcher.

Terrorism

Involves violent acts or acts dangerous to human life that violate federal or state law

Weapons of mass destruction

Any agent designed to bring about mass death, casualties, and/or massive damage to property and infrastructure

Chemical agent types

• Vesicants (blister agents)

• Respiratory agents (choking agents)

• Nerve agents

• Metabolic agents (cyanides)

Biologic agents

Organisms that cause disease. Generally found in nature, but can be made in a lab. Types - Viruses, Bacteria, Toxins

Chemical Agents

Chemicals that cause issues through respiratory tract or contact

Route of Exposure

How the agent most effectively enters the body

Vesicants

• Primary route is the skin (contact).

• If they are left on the skin long enough, they produce vapors that can enter the respiratory tract. Cause burn like blisters to form on the victim’s skin and in the respiratory tract

• Usually cause the most damage to damp or moist areas of the body

Signs of exposure to vesicants

• Skin irritation, burning, and reddening

• Immediate, intense skin pain

• Formation of large blisters

• Gray discoloration of skin

• Swollen and closed or irritated eyes

• Permanent eye injury (including blindness)

Sulfur Mustard

• Brown-yellow oily substance

• Generally considered very persistent

• Begins an irreversible process of damage to the cells

• Attacks vulnerable cells within the bone marrow and depletes the body’s ability to reproduce white blood cells

• Vapors can be inhaled, creating upper and lower airway compromise.

Lewisite and Phosgene oxime

• Produce blister wounds very similar to those caused by sulfur mustard gas

• Produce immediate intense pain and discomfort when contact is made

• The patient may have a gray discoloration at the contaminated site.

Treatment for vesicants

• No antidotes for exposure

• Ensure that the patient has been decontaminated before treatment is initiated.

• If agent has been inhaled, the patient may require prompt airway support.

• Initiate transport as soon as possible.

• Generally, burn centers are best equipped to handle the wounds and infections.

Pulmonary Agents

• Primary route is respiratory

• Immediate harm when exposed

• Lung damage tissue and fluid leaks into the lungs developing edema and impairing gas exchange

Pulmonary Agent Treatment

• Remove the patient from the contaminated atmosphere.

• Manage the ABCs aggressively.

• Pay particular attention to oxygenation, ventilation, and suctioning.

• Do not allow the patient to be active.

• There are no antidotes.

• Consider requesting ALS.

Nerve Agents

• Among the most deadly chemicals developed

• Can cause cardiac arrest within seconds to minutes of exposure

• Organophosphates

• Found in household bug sprays and agricultural sprays

• Block an essential enzyme in the nervous system

Metabolic Agents

• Hydrogen cyanide (AC) and cyanogen chloride (CK) affect the body’s ability to use oxygen.

• Commonly found in many industrial settings, colorless gas with almond odor

• Often present in fires associated with textiles and plastic

• In low doses Associated with dizziness, light-headedness, headache, and vomiting

Dissemination

Terrorist spread agent

Vector

animal spread disorder

Communicability

how easily the disease is spread from human to human

Incubation

The period of time between the person becoming exposed to the agent and the appearance of first symptoms

Neurotoxins

• Most deadly substances known to humans

• Produced from plants, marine animals, molds, and bacteria

• Route of entry is ingestion, inhalation, or injection.

• Not contagious and have a faster onset of symptoms

Ray Types (In order of increasing strenght)

Alpha, beta, gamma (x-ray), and neutron radiation

Medical/Legal/Ethical Issues

Consent/refusal of care, Confidentiality, Advance directives, Tort and criminal actions, Evidence preservation, Statutory responsibilities, Mandatory reporting, Ethical principles/moral obligations, End-of-life issues

Main Rule for health care providers

Do no further harm (act in good faith and according to an appropriate standard of care)

Consent

Permission to render care; Must be given by person to receive treatment; Exception only if patient is not conscious, rational, or capable of making decisions

Expressed Consent

The patient acknowledges he or she wants you to provide care or transport. Must have a verbal response, gesture, and/or body language. Must also be informed consent

Informed Consent

The nature of the treatment being offered, along with the potential risks, benefits, and alternatives to treatment, as well as potential consequences of refusing treatment has been explained.

Implied Consent

Applies to patients who are unconscious or incapable of making an informed decision. Applies only when a serious medical condition exists and should never be used unless there is a threat to life/limb.

Involuntary Consent

Only applies to patients who are mentally ill, in behavioral crisis, and/or developmentally delayed. While not always possible to obtain consent, try to from guardian or conservator.

Emancipated Minor

• Married, Has a child of their own, and/or Active military

• Has a official court order documentation

• Has been caring for themselves financially with no other support

Right to Refuse

Adults who are conscious, alert, and appear to have decision-making capacity have the right to refuse treatment, even if the result is death or serious injury, can withdraw from treatment at any time, even if the result is death or serious injury, and/or involve online medical control and document this consultation.

Forcible Restraints

Necessary for patients who are in need of medical treatment and transportation but are combative and presents a risk of danger to themselves or others. Legally permissible in this case

Rules for Forcible Restraints

• Consult medical control for authorization and utilize law enforcement on the scene.

• Restraint without legal authority exposes you to potential civil and criminal penalties.

• Once applied do not remove restraints en route unless they pose a risk to the patient.

• Consider calling ALS backup to provide chemical pharmacological restraint.

Landing Zone rules

• Hard or grassy level surface between 60 × 60 feet and 100 × 100 feet (recommended)

• Cleared of loose debris

• Clear of overhead or tall hazards

• Mark the landing site using cones or vehicles.

  • Never use caution tape or people to mark the site.

  • Do not use flares.

Extrication

The removal from entrapment or from a dangerous situation/position

Entrapment

A condition in which a person is caught within a closed area with no way out or has a limb or other body part trapped

Rapid Extrication

At least 4 providers, c-spine precautions are maintained, patient is becoming critical, but not yet critical

Emergency extrication

critical patient with threat to XABC, to be yanked out as quickly as possible, to be done when critical patient with threat to life/limb, another patient is blocking access to a more critical patient

Incident Command System

On scene incident management that has standard terminology, is modular, flexible, and adaptable, and allows multiple agency cooperation

ICS Structure

Incident Commander → Safety officer, Public Information Officer, Liaison Officer → Operations section, planning section, logistics section, finance and administration section

Incident Commander

• Overall responsibility for incident

  • Sets incident objectives

  • Determines strategies

  • Establishes priorities

• Only position that is always staffed

  • Responsible until delegation

Safety Officer

Monitors safety conditions, practices, and procedures

Liaison Officer

Primary contact for supporting agencies

Public Information Officer

Provides information to the stakeholders