In the Field Trauma Triage Standard, what is the PHYSIOLOGICAL CRITERIA that a patient has to meet?
a) Patient does not follow commands
b) Systolic BP <90 mmHg, OR
c) RR <10 or >30 breaths per min OR need for ventilatory support (<20 in infant ages <1yr)
If a patient meets PHYSIOLOGICAL CRITERIA AND land transport time is <30 mins to a Lead Trauma Hospital (LTH) OR regionally designated equivalent hospital (RDEH), where are you bringing the patient?
LTH or regionally designated equivalent hospital (RDEH)
In the Field Trauma Triage Standard, what is the ANATOMICAL CRITERIA that a patient has to meet if they do not meet the PHYSIOLOGICAL CRITERIA and transport time/location considerations??
a) Any penetrating injuries to head, neck, torso, and extremities PROXIMAL TO ELBOW OR KNEE
b) Chest wall instability or deformity (i.e flail chest)
c) Two or more proximal long-bone fractures
d) Crushed, de-gloved, mangled or pulseless extremity
e) Amputation proximal to wrist or ankle
f) Pelvic fractures
g) Open or depressed skull fracture
h) Paralysis
If a patient meets ANATOMICAL CRITERIA AND land transport time is <30 mins to a Lead Trauma Hospital (LTH) OR regionally designated equivalent hospital (RDEH), where are you bringing the patient?
LTH or RDEH
In a trauma, if you are unable to secure a patient’s airway or survival to LTH or RDEH is unlikely, where are you transporting your patient?
Closest ED DESPITE physiological and anatomical criteria
What following situations must have a coroners inquest?
- Suspicious deaths
- Deaths in a mental health facility
- In a workplace
- In prison or juvenile homes
- Children residences
- Schools
- Pregnant
For helicopter utilization
a) What must the landing zone dimensions be?
b) What additional space do you need for a safety zone?
BLS (2007) states:
i) Landing zone must be 30m x 30m (100ft x 100ft), with an additional 30m (100ft) as a safety zone
MOH Air Ambulance Utilization document states:
ii) Landing zone must be 45m x 45m (148ft x 148ft) to land, with an additional 30m (100ft) as a safety zone
What do red tags in MCI’s indicate?
- Immediate life threatening injury
- Typically CTAS 1 & 2 patients
- High probability of survival if transported within 30-60 mins
i) Respiratory arrest (RR <8-10 or >28-30)
ii) Severe uncontrolled external hemorrhage
iii) Severe head injuries
iv) Unresponsive/unconscious
v) Open chest injuries
vi) Severe hyper/hypothermia
vii) MI
viii) Witnessed cardiac arrest when SUFFICIENT PERSONNEL AVAILABLE and CPR initiated
ix) Struck by lightning and VSA
What do yellow tags in MCI’s indicate?
- Urgent
- Potentially life threatening injuries
- Delay in 2-3 hours is not anticipated to threaten outcome
- Typically CTAS 3 and 4 patients
i) Stable head injuries
ii) Non-life threatening fractures
iii) Significant amount of pain from injury
iv) Controlled moderate bleeds
v) Burns <25%
vi) Clean amputations (upper limb, hand or thumb)
What do green tags in MCI’s indicate?
- Non life threatening injuries
- Delays will not threaten outcomes at all
- Typically CTAS 5 patients
i) Ambulatory patients
ii) Minor fracture or dislocation
iii) Minor soft tissue injury
iv) Minor blood loss
What do blue tags in MCI’s indicate?
- Deceased
- Obviously dead as per Code 5 criteria
- VSA patients where there is INSUFFIENCE PERSONNEL to perform CPR
- MOST SENIOR OFFICER of all responding agencies (police, fire, EMS)
- Oversees entire on-site response
- Coordinates with all responding agencies
What role is this?
Incident Site Manager
- SENIOR PARAMEDIC OR FIRST RESPONDING UNIT ASSUMES THIS ROLE
- Ensures scene safety
- Assigns a Triage Officer
- Utilize MCI bag
- Establish command post
- Liaise with allied agencies
- Coordinate patient transport with CACC
What role is this?
Ambulance Site Coordinator
- Usually Site Coordinator’s partner (paramedic)
- Ensures scene safety
- Designate a triage area
- Utilize triage tags and apply to each casualty
- Assign personnel to deal with casualties
What role is this?
Triage Officer
- Ensures scene safety by continually monitoring hazards, weather conditions, etc
- Remind crews to utilize safety equipment
- Arrange for refreshments and sanitary facilities
- Rotate crews to reduce physical and mental stress
What role is this?
Safety Officer
According to the Head Injury Standard:
If ETCO2 is not available what rate should we hyperventilate an adult, child, and infant?
Adult - 20 breaths/min
Child - 25 breaths/min
Infant - 30 breaths/min
According to the Oxygen Therapy Standard:
Assuming that pulse oximetry is not working, if a patient has COPD, needs oxygen and is NOT on home oxygen, what are you giving them?
2 LPM via nasal cannula
According to the Oxygen Therapy Standard:
a) What O2 saturation are you trying to achieve for ALL COPD patients?
b) How often do you re-assess vital signs?
c) If patient states they feel worse/are deteriorating, what are you going to do?
a) 88-92%
b) Every 10 mins
c) Increase O2 by increments of 2LPM above starting level approx. every 2-3 minutes
According to the Oxygen Therapy Standard:
Assuming that pulse oximetry is not working, if a patient has COPD, needs oxygen and REGULARLY on home oxygen, what are you giving them?
O2 via nasal cannula, 2 LPM ABOVE patient’s regular home O2 levels
According to the Field Trauma Triage Standard:
If a patient has penetrating trauma to torso or head/neck, what criteria must they meet to be transported to an LTH or RDEH?
a) VSA but does not meet TOR criteria AND
b) Transport to LTH or RDEH <30 mins
According to the Field Trauma Triage Standard:
If a patient does not meet physiological or anatomical criteria, what are the MECHANISMS OF INJURY that can consider them to be transported to an LTH or RDEH?
a) Falls
- Adults: Falls >6 m (one story = 3 m)
- Children (age <15): Falls >3 m or 2-3 times the height of child
b) High Risk Auto Crash
- Intrusion >0.3 m occupant site. >0.5 m any site including roof
- Ejection (partial or complete) from vehicle
- Death in same passenger compartment
- Vehicle telemetry data indicates high risk injury (if available)
- Pedestrian or bicyclist thrown, run over or struck with significant impact (>30 km/hr)
- Motorcycle crash >30 km/hr
According to the Field Trauma Triage Standard:
What special criteria should you always consider in conjunction with physiological, anatomical, and MOI criteria?
a) Age
- Risk of injury/death increases after AGE 55
- SBP <110 may represent shock after age 65
b) Anticoagulation and bleeding disorders
c) Burns (with trauma mechanism: triage to LTH)
D) Pregnancy >20 weeks
According to the DNR Standard:
What criteria is required to deem a DNR valid?
1) Name of patient (surname AND first name) to whom form applies
2) Check box to identify that one of following conditions are met:
- Current plan of treatment exists that reflects patient’s expressed wish (when capable) OR consent of SDM (when patient incapable) that CPR not be included patient’s treatment plan
- Physician’s opinion that CPR will not benefit patient and is not part of treatment. Physician has discussed this with capable OR SDM when patient is incapable
3) Check box identifying professional designation of Medical Doctor (M.D), RPN, RN, or RN (EC)
4) Printed name of MD, RPN, RN, or RN (EC)
5) Signature of an MD, RPN RN, or RN (EC)
6) Date form was signed (which must be the same or precede date of request for ambulance service)
In cases of patients with a DNR, what palliative treatment can paramedics give?
Oxygen
Nitro
Glucagon
Salbutamol
ASA
Suctioning (NOT ETT)
Epi (FOR ANAPHYLAXIS ONLY)
