NREMTP Review-Matthew 🚑🚒 "Operations"
"NIMS"
Incident Command System
Whoever the first person on scene is=Establishes Incident Command
Establishment and Transfer of Command: The Incident Commander (1st on scene) should clearly establish the command function at the beginning of an incident. The jurisdiction or organization with primary responsibility for the incident designates the individual at the scene responsible for establishing command and protocol for transferring command. When command transfers, the transfer process includes a briefing that captures essential information for continuing safe and effective operations, and notifying all personnel involved in the incident.
"C-FLOP": (Memory tool for the I.C & the 4 section Chiefs)
Incident Command: Sets the incident objectives, strategies, and priorities and has overall responsibility for the incident.
Finance/Administration: Monitors costs related to the incident. Provides purchasing and accounting support.
Logistics: Provides resources and needed services to support the achievement of the incident objectives.
Operations: Conducts operations to reach the incident objectives. Establishes the tactics and directs all operational resources.
Planning: Supports the incident action planning process by tracking resources, collecting/analyzing information, and maintaining documentation
3 Types of Commands
****Single Incident Command-When an incident occurs within a single jurisdiction and without jurisdictional or functional agency overlap, the appropriate authority designates a single Incident Commander who has overall incident management responsibility. In some cases, where incident management crosses jurisdictional and/or functional agency boundaries, the various jurisdictions and organizations may still agree to designate a single Incident Commander.
***All people on scene, regardless of who they work for, will report to 1 commander
Example-Broward, Miami-Dade, Palm beach are all on scene, but they all report to 1 single I.C
*****Unified Command-. As a team effort, Unified Command allows all agencies with jurisdictional authority or functional responsibility for an incident to jointly provide management direction to the incident
*****Both departments share the I.C, and anybody on scene can go to any I.C
****Unity of command-means that each individual only reports to one person. This clarifies reporting relationships and reduces confusion caused by multiple, conflicting directives, enabling leadership at all levels to effectively direct the personnel under their supervision
________________________________________________________
Multi-Agency Coordination (MAC) Groups are part of the off-site incident management structure of NIMS.
MAC Group members are typically agency administrators or senior executives from stakeholder agencies impacted by and with resources committed to the incident.
The MAC Group may also include representatives from non-governmental
organizations.
During incidents, MAC Groups act as a policy-level body, support resource prioritization, and allocation, make cooperative multi-agency decisions and enable decision making among elected and appointed officials with those managing the incident (IC/UC).
MAC Groups do not perform incident command functions.
MAC Groups do not replace the primary functions of operations, coordination, or dispatch organizations
Standardized Communication Types Incident personnel and their affiliated organizations should use standard communication types, including:
Strategic: High-level directions, including resource priority decisions, roles, and responsibilities determinations, and overall incident management courses of action.
Tactical: Communications between on-scene command and tactical personnel and cooperating agencies and organizations.
Support: Coordination in support of strategic and tactical communications (e.g., communications among hospitals concerning resource ordering, dispatching, police, and tracking; traffic, water, electric company and public works communications).
Public: Alerts and warnings, press conferences. (PIO)
Legal
Tort-The act of bringing on a lawsuit
****IMPORTANT*****
4 Elements needed to prove a Negligence Tort
Duty to act (you are employed, on shift, in uniform)
Breach of Duty (Broke rules, regulations, or protocols)
Injury (The patient must have an injury or have died)
Causation (The specific thing you did or did not do, directly caused the injury or death)
Certification-Indicates a completion of requirements, and competency (NREMT)
Licensure-States provide a licensure to practice
What is the main purpose of the NREMT?
A. To provide licensure to practice
B. To ensure competency and provide certification
C. To provide accreditation
D. To perform research and OA/QI
"The White Paper"
1966 – President Lyndon B. Johnson and the President's Commission on Highway Safety of the National Academy of Sciences published a report entitled "Accidental Death and Disability: The Neglected Disease of Modern Society," also known as the EMS White Paper.
This document, along with the National Highway Traffic Safety Act, provided a federal standard for creating EMS systems.
Libel
Spreading lies about someone through written words
Article, a post, newspaper
Slander (S for speech)
Spreading lies about someone through the use of speech
Interview, public announcement, News
****IMPORTANT****
Misfeasance (Think a "Mistake")
You did not purposely injure the pt, but you made a mistake against protocols or regulations
Example-You gave 10 mg of Morphine, instead of 5 mg per protocol to a patient
Nonfeasance (Think "Non"=Nothing...You did nothing to help)
You did not do any actions or care, when the pt. required it
Example-On arrival the pt. is in cardiac arrest, but you did not do CPR
Malfeasance (Think "Malicious)
Purposely caused harm, by acting out of your SOP
Example-your pt. is yelling, cussing, and screaming, so you decide to give a paralytic to shut them up
Assault
A verbal threat of violence and/or injury
Battery
Actually, placing hands on someone w/ an intent to injure them
False Imprisonment
Holding someone against their own will
Inappropriate use of restraints
Locking someone in the back of an ambulance
Kidnapping
Taking a patient from the scene or to the hospital, against their own will
Consents
Implied Consent
Pt. is unresponsive, has a critical-life threatening illness/injury, or a minor is injured, and we are unable to locate or contact guardians
Informed Consent
You are informing the pt. about the Tx plan, and the positive vs Negative outcomes
Expressed Consent
The patient expresses (verbalizes) an okay to treat them
Involuntary Consent
When a patient is a danger to themselves (Suicidal or Homicidal), others, or are gravely disabled (unable to adequately care for themselves)
You are on scene of a 3 y/o in Cardiac Arrest. The parents are on scene as well and are visibly emotional and distraught. Which of the following actions are most appropriate?
A. Have P.D remove the parents to an outside location
B. Have the parents stay to witness the resuscitation
C. Have the fire captain talk w/ the parents in the next room
D. Call other family members to come and support the family
*****Always have the family watch the resuscitation, while having a crew member explain what is happening
When can a minor consent for themselves?
Emancipation (legally divorced from guardianship)
Legally married
Have their own children
Pregnancy
Active military
Pulseless & Apneic, plus the following:
Obvious Death on Scene (When we are NOT going to treat, resuscitate, or transport)
Rigor mortis (stiffening of body, extremities, jaw)
Dependent Lividity (pooling of blood in the back, extremities)
Decomposition
Decapitation
Incineration (Burnt beyond all recognition)
Evisceration of the heart, lung, or brain
NFPA 704 Placards
Present on fixed structures/buildings
Numeric Scale-0-4
The higher the number, the higher the risk
Red
Flammability
Yellow
Reactivity
Blue
Health
White
Special Hazard
START Triage
No Vital signs
No complete assessments
No sample Hx
No lifesaving measures (CPR/Ventilation)
Black-Dead/Expectant (You get 1 attempt to open/reposition the airway, if breathing is not spontaneous/adequate)
Red-Immediate
They need immediate care within 1 hr. to survive
Treated 1st
TBI, Head injuries, ALOC, Chest trauma, Internal bleeding
Yellow-Delayed
care may be delayed up to 1-2 hrs.
Treated 2nd
Femur fracture, other fractures, mod. burns
Green-Walking wounded
Do not need immediate care
Treated 3rd
You are on scene of an MCI, w/ multiple pts. going to multiple destinations. How do you keep track of where the pts. go?
BARCODES on the triage tags
SALT Triage
Step 1-Global Sorting
Lying still/Obvious life threat-Assess 1st
Waving/Purposeful Movement-Assess 2nd
Walking-Assess 3rd
Step 2-Individual Assessment
Control bleeding
Rescue breaths
Resuscitation
Antidotes/meds
Beck's Triad
JVD
Hypotension
Muffled Heart Tones
Decontamination
Hot Zone
Immediate Danger
Warm Zone
Decontamination
Cold Zone
Ambulance staging
*****On an MCI scene with multiple pts. how do you keep track of where the pts. are going and to what hospitals??
utilize the barcodes on the triage tags
PPE & Levels of protection
Airborne
Droplet
Contact
Airborne.......N95...."MTV"
Measles/Mumps
T.B
Varicella (Chickenpox & Shingles-Herpes Zoster)
Droplet.......Surgical mask
Meningitis
Pneumonia
Influenza
Epiglottitis
Pertussis (Whooping Cough)
RSV
Covid
Contact........Gown
C-Diff (Clostridium Difficile)
MRSA
Hepatitis
HIV/AIDS
Scabies
Organophosphates=Nerve agents=Pesticides=Insectides
It completely turns on the parasympathetic N.S and does not let go
Para-sympathetic N.S-Rest & Digest-"We are very moist & slow"
HR is down
BP is down
Making urine, gastric juices, saliva, mucous
SLUDGE-M
Salivation
Lacrimation (Tearing from the yes)
Urination
Defecation
G.I symptoms
Emesis
Miosis (Constricted pupils)
Treatment
Atropine
Pralidoxime (2-pam chloride)
Duo-dote=Mark 1
