Professional Issues

Question 1

Transport Clinicians are responsible for not only the patient care but also for SAFETY within the transport environment. This includes:

Answer 1

• Securing patient and equipment
• Adhering to aviation or vehicle safety protocols
• Managing environmental hazards (noise, vibration, and temperature)
• Monitoring crew fatigue and situational risks

(Safety is a core domain of transport practice)

Question 2

Unique vulnerabilities of Neonates and Children

Answer 2

• Limited ability to regulate temperature
• Higher metabolic rates and oxygen consumption
• Reduced cardiovascular reserve
• Immature respiratory control mechanisms

Question 3

Physiologic Stressors during transport

Answer 3

• Movement and vibration
• Noise
• Altitude-related pressure changes
• Temperature fluctuation
• Limited access to interventions

Question 4

Neurologic Stress Responses

Answer 4

• The developing bran is highly sensitive to hypoxia, hypotension, and glucose abnormalities.
• Transport stress can increase ICP, exacerbate seizures, or worsen neurologic injury

Question 5

Thermoregulation and Metabolic Stress

Answer 5

• Hypothermia increases oxygen consumption
• Worsens metabolic acidosis
• Impairs coagulation

Question 6

Endocrine and Metabolic Stress

Answer 6

• Stress triggers hormonal responses - release of catecholamines and cortisol
• Can worsen metabolic instability

Question 7

Impact of Altitude and Pressure Changes

Answer 7

Decreased ambient pressure can affect:
- Oxygen partial pressure
- Gas expansion in body cavities and equipment
- Ventilator performace

Question 8

Primary Assessment

Answer 8

Rapid, systemic, and focused on identifying LIFE-THREATENING conditions. ABCDE

A - Airway - patent, evaluate for obstructions, malformations or secretions. Consider advanced airway
B - Breathing - Assess RR, effort and symmetry. Listen for abnormal breath sounds, monitor O2.
C - Circulation - HR, perfusion, skin color, cap refill. Identify signs of shock (tachy, hypotension, AMS). Establish IV for fluid resuscitation and meds
D - Disability (Neuro status) - Assess LOC, neuro compromise (seizures, lethargy, posturing). Consider BG.
E - Exposure/Environment - Fully expose to assess for trauma, skin color. Maintain thermal regulation (blankets, incubator or warming devices)

Question 9

Secondary Assessment

Answer 9

1. History (SAMPLE) - Signs/symptoms, Allergies, Medications, Past med hx, Last meal, Events leading to illness
2. Physical examination - head-to-toe for injuries, deformities or med devices
3. Focused Assessment for Transport Needs - identify potential complications
4. Ongoing Assessment - reassess frequently

Question 10

Neonatal Heart Rate

Answer 10

1. Heart Rate (120-160 bpm) -

-Tachycardia: May indicate hypoxia, sepsis, pain
-Bradycardia: hypoxia, shock, heart block

Answer 11

1. Heart Rate (120-160 bpm)

Question 12

Neonatal Respiratory Rate

Answer 12

30 - 60 breaths/min

Tachypnea: Respiratory distress, metabolic acidosis
Bradypnea: Fatigue, CNS depression

Question 13

Neonatal Blood Pressure

Answer 13

60-80/40-50

Hypotension: Shock, sepsis; Hypertesion: congenital heart disease, pain, stress

Question 14

Neonatal Temperature

Answer 14

36.5-37.5

Hypothermia: increases oxygen consumption
Hyperthermia: infection or environmental exposure

Question 15

Neonatal Oxygenation

Answer 15

90-95% (pre-ductal)

Evaluate oxygen delivery and perfusion; monitor for desaturation during interventions

Question 16

HIPPA

Answer 16

Confidentiality

Question 17

EMTALA

Answer 17

EMTALA: Emergency Medical Treatment and Active Labor Act

• Must Screen, stabilize, THEN transfer, but MUST be to higher level of care and must be accepted into care.

Remember to stabilize 1st. > 10 years = systolic > 90. Age x2 + 70

Question 18

Consent: Three main types

Answer 18

1. Expressed
2. Implied
3. Informed

Question 19

Expressed Consent

Answer 19

Verbal or written - without further information

Question 20

Implied Consent

Answer 20

Mentally, physically, psychologically unstable to write or verbalize consent.

*Assumes patient would want to receive lifesaving treatment.

*Emergency Doctrine

Question 21

Informed Consent

Answer 21

Legal age/sound mind

1. Procedure
2. Risks procedure
3. Alternatives
4. Risks of alternatives
5. Implications if procedure NOT performed

Question 22

Mandatory Reporting

Answer 22

1. Abuse - child abuse, injury doesn’t match the story
2. Neglect
3. Diversion (drug diversion by a teammate)
4. Non-accidental trauma

(GSW, Stab, Animal Bites)

Question 23

Legal Concepts

Answer 23

1. Negligence
2. Assault
3. Battery
4. Abandonment

Question 24

Legal Concepts - NEGLIGENCE

Answer 24

Negligence: Deviation from accepted standard of care. Reasonable person.

• FOUR elements

1. Duty
2. Breach
3. Harm
4. Causation

Question 25

Legal Concepts - ASSAULT

Answer 25

Assault: Placing someone under reasonable apprehension of imminent Bttery

Question 26

Legal Concepts - BATTERY

Answer 26

Battery - Harmful/offensive physical contact without consent.

Question 27

Legal Concepts - ABANDONMENT

Answer 27

Abandonment - Leaving patient AFTER initiating care BEFORE refusal/AMA, BEFORE transfer to greater level of care * KNOW negligence vs abandonment

Question 28

Patient Handoff: SBAR (clear, concise, coherent, consistent)

Answer 28

S - Situation B- Backgrond A - Assessment R- Recommendation

Question 29

CRM - Crew Resource Management (CAMTS)

Answer 29

Crew Resource Management: Integrated approach to decision making, focusing on interpersonal communication and shared decision making. * 3 to go….1 to say NO.

Question 30

Just Culture (CAMTS)

Answer 30

* Acknowledges human error *Non-punitive collaborative *Process improvement effort to optimize patient safety

Question 31

CISD (Critical Incident Stress Debriefing) - stress management (CAMTS) (Introduction, facts, thoughts, reactions, symptoms, teaching and re-entry)

Answer 31

CISD: Critical Incident Stress Debriefing. Small group of those exposed to same traumatic event. Occurs 24-72 hours after. 1. Assess (audit) the impact of the critical incident on support personnel and survivors 2. Identify immediate issues surrounding problems involving “safety” and “security” 3. Defusing - use defusing to allow for ventilation of thoughts, emotions and experiences associated with event 4. Predict events and reactions to come in the aftermath of the event 5. “Systemic Review” Look for maladaptive behaviors or responses to the crisis or trauma. 6. “Closure” - bring closure to the incident “anchor” or “ground” support personnel and survivors to community resources - rebuilding process (help identify possible positive experiences from the event. 7. Debriefing/“re-entry” process back into the community or workplace

Question 32

CISM (Critical Incident Stress Management) - Stress management (CAMTS)

Answer 32

CISM: Critical Incident Stress Management - Bigger Picture. Mitigates negative mental and physical health sequelae from traumatic events. (Pediatric code, aircrew fatalities, etc.) * Individual counseling may be needed.

Question 33

DEBRIEFING (Last step of CISD)

Answer 33

7. Debriefing assists in the “re-entry” process back into the community or workplace. Debriefing can be done in large or small groups or one-to-one depending on the situation. Debriefing is not a critique but a systematic review of the events leading to, during and after the crisis situation. *remember the last step of CISD is “re-entry”

Question 34

Follow-up and feedback programs for user agencies should be constructed so that the main focus is:

Answer 34

Quality Improvement * Think just culture * Fix the problem, not the blame * Proactive, NOT Reactive