what is The Hot zone?
the contaminated area
What is the warm area?
an area where hazmat professionals will decon patients and other first responders.
what is the cold area
the safe zone where any personel not trained in hazmat should be.
should be 200 yards away from the incident, up hill and upwind.
Who is responsible for determining the ambulance standards?
who is in-charge of the design and manufacturing guidelines?
US general services administration.
DOT KKK 1822 are reviewed and updated every 5 years.
the DOT KKK establised three types of ambulances what is a type 1 ambulance?
type 1- COnventional a truck cab chassiss with a modular ambulance body that can be transferred if needed.
the DOT KKK establised three types of ambulances what is a type 2 ambulance?
type 2 i a standard van with forward control integral-cab body ambulance.
the DOT KKK establised three types of ambulances what is a type 3 ambulance?
a specialty van forward control integral body AMR trucks
the occupational saftey and health administration (OSHA) Makes reccomendations reguarding
Infection control practices
the american college of surgeons has developed ....
the first list of standards in 170
what does the NFPA control for ambulance
they control the safety of an ambulance
what do high-performance ems systems analyze?
Response times- 90% should be establised in the right amount time.
productivity- how many transports
unit costs- salaries, vehicle equipment and costs.
tax-payers subsidies- local government may help lower the costs.
system status management, deveoed by jack stout in 1983 goals were to....
maximize efficiancy and reduce response times. it was also used to help with peak demand staffing
what should you clean the stretcher with?
an EPA registered germicidal/ virucidal solution. or bleach water at 1:100 dilution.
how far back should you be from a vehicle driving average speed?
4 to 5 seconds.
avoid being tail gated by constanty scannng side and rear view mirriors.
what things should you do when backing up?
- -keep window cracked to hear.
- -use a spotter
- -check outside before u back up
- -avoid backing up if you can
where should you park your vehicle?
- - 100 feet past the the scene and on the same side as the road.
- -park where your departure wont be hampered.
what is the difference between braking in the different types of vehicles?
type 1 and type three ambulances will have a harder time slowing down than a type 2.
how does hydroplanning happen
- happens at speeds higher than 30 mph on wet roads.
- just gradually slow down without slamming on the brakes if possible.
what is the rules with driving an ambulance and school buses.
- -Never pass a school bus that has stopped to load or unload children or that has its stop arm extended.
- - must stop before reaching a bus with their lights on. wait for driver to ensure the kids saftey.
in many states it is illegal to exceed the speed limit in school zones.
what factors should you consider when using air medical transport?
does the patient condition really need it? or will this really save time.
what is the difference between rotorwing vs fixed wing ambulance.
Fixed wing is usually used for long distance transportation.
rotor wing is the standard of care for transporting critically ill patients
what are the Major disadvantages for using air ambulances?
- -wheather and terrain can prevent the use.
- -there is altitude, speed limitations
- -cardiac arrest cant be transported due to limited resources.
what are the advantages of using an air ambulance?
- faster times
- -provide less injury to patients with spinal damage due to terrain.
which types of patients should get a med evac?
patients with time dependent injuries or illnesses such as a stroke, heart attack, or spinal cord injury. also patients such as divings, near drowning or wilderness activities.
for trauma why should you call for medevac?
- 1- limb replantation
- 2-burn center
- 3-hyperbaric chamber
- 4-venemous bite center.
** when you call you should inform the dispatcher the weight and CC should be known.
why was NIMS created?
to encourage well organized emergency response from the reigonal, state and national levels.
was created by the homeland security presidential directive. hspd-5
what is the role of the incident commander.
is to evaluate the incident and create a plan of action based on strategic priorites.
in smaller situations IC will handle it all. in bigger ones the IC will appoint people to different roles.
what is a unified command system?
its used when an incident requires multiple organizations or jurisdictions. the plans are made way in advance by all the organizations responsible in decision making.
the plan determines who is the leader (such as hazmat for chemical situation.)
what is a single command system?
its a system that has ony one agency involved. its really used for short term, limited incidents.
any transfers of command should be done face to face
What is the role of the Finance division?
they are responsible for documenting all expenses that should be reimbursed. they track and report personel hours and cost of materials and supplies at meetings.
they also deal with vendor contracts, incident and injury compesation. and they analyze all of the costs.
what is the role of the logistics division?
- only one reports the the IC. They are responsile for
- -communications and equipment
- -food and water'
- -medical equipment and supplies.
what is the role of the OPERATIONS division?
they manage the tactical operations at a large incident. they oversee the res-ponders working at the scene. usually a fire chief
what is the role of the plannng division in a MCI?
they use data from the previous plan to devise a new one. as well as taking on new problems as they come. they also are the ones who set up the plan for demobilization.
in the command staff.. what is the safety officers job?
they continually monitor the area for any hazards to res ponders or patients. they can stop a whole operation if a rescuer is in danger. they also can interact with the hazmat teams.
in the command staff.. what is the role of the public information officer (PIO).
presents information to the public or the media. they take the post away from the incident to keep media safe and distractions to a minimum. may be responsible to send a message to prevent further panic.
in the command staff ...what is the liaison officer job do?
relays information between command general staff and other agencies.
who do you check in with one you have been moilized to an MCI?
it allows you to be assigned to a superviosr, personell tracking .
after finance who should u check in with after being mobilized to an MCI?
supervisor, to get debriefing and job responsibilities.
what is the role of the staging supervisor?
they make an area thats efficient and away from the scene to plan access and exit from the site. they also prevent traffic an congestion from all of the vehicles.
what is the role of the rehab supervisor
creates an area that where responders can come rest eat and drink up. they also moniter ems for stress signs such as fatigue, altered or collapsing.
what is an open or closed MCI?
unknown amount of casualties. people need to be searched for, or the incident is still going on.
closed means that the number of patients are not expected to change, patients are triaged until they are removed.
what is the criteria for the Immediate(red) tag?
Patients that have problems with their ABC.s head trauma or shock.
what is the criteria for the yellow tag?
will need care, but it can be delayed.
may have bone, joint, or back injuries (but not spine)
what is the criteria for the green tag
walking wounded, usually have contusions,abrasios, lacerations. usually soft tissue injuries, need little to no on scene management.
what is the criteria for the black tag?
- -cardiac arrest
- -open head injury
- -respiratory arrest
- these people only get helped if every one else has been helped.
what is the basis of the start triage system?
- ability to walk
- -respiratory status
- -henmodynamic status
- -neuro status.
what is the first step of the start triage system?
call out all the waking wounded to a specific location and green tag them.
How do you evaluate the respiratory status in the start triage system?
open airway with manual manuver.
- -if breathing faster than 30 (red)
- -fewer than 30( continue)
how do you evaluate hemodynamic status in the start triage system?
check for radial pulse
- -absent radials (red)
- - present (continue assessment)
How do you evaluate neuro status in a patient in the start triage system?
ask them to follow simple commands.
- -if they do not understand and are unresponsive(RED)
- - if they do understand then (yellow tag)
what is the jumpstart triage system and what is its criteria?
The system is used to assess children under 8 years old or who appear to weigh less than 100 lbs.
first identify the walking wounded.( kids who arent developed enough to walk are taken to treatment for immediate secondary assessment).
after the walking wounded what is the next thing you do in the jump start system?
if the PED is not breathing check for a pulse.
- -if there is no pulse( black tag)
- -if there is a pulse, open the airway and give 5 rescue breaths.
- - if they dont respod to that (Black tag)
after assessing for a pulse, how do you determine the respiratory status of a ped
- fewer than 15 bpm(red)
- -15 to 45 continue with assessment.
how do you assess the hemodynamic status of a ped in the jump start system.
check for a distal pulse.
- - no distal pulse (red)
- - pulse? (continue)
how do you assess neuro in the jumo start system
modify and use AVPU.
- - a child who is alert and can pinpoint their pain (Yellow tag)
- -unresponsive, not understandable in voice, cannot locate pain (RED TAG)
what criteria should you use when transporting a patient to a trauma center
physiologic criteria, anatomic criteria, mechanisim of injury.
and then the special considerations such as age and underlying health conditions.
For a disentanglement. when should your primary assessment begin?
a team member should stay with the patient while they are being disentangled. unless there is immediate danger, perform your primary assessment.
if you are unable to use standard splints what should you do
splint the arms to the trunk and the legs to one another.
what is the most basic tool for vehicle stabilization?
Cribbing. includes wedges and such,
-a vehicle can still move when cribbing
what type of glass are in the cars
Front winsheild- made from laminated glass
side and rear are made from tempered glass and are easier to break.
what are the properties of hydrogen sulfide? and where is it found.
Colorless, toxic flammable gas. its heavier than air and has a horrible odor
found in swamps standing water and natural gas wells
what are the properties of carbon monoxide?
colorless, oderless, tasteless gas that cannot be detected by normal senses.
signs of CO posioning includes headache, nausea, disorientation and unconcsciousness.
any small amount can prevent oxygen from transporting to other parts of the body.
what are the properties of carbon dioxie?
- colorless gas associated with asphyixiation risk
- and is found in fire extingishers. it produces a sour taste and stinging sensation in the mouth.
what are the chemical properties of methane CH4?
methane is not toxic but can cause burns if ignited. its used as a feul from natural gas and can be made by fermented organic matter.
what are the chemical properties of Amonia (NH3)
its a toxic and corrosive chemical with a pundgent odor. it rises to the upper atmospher in confined spaces.
what are the chemical properties of nitrogen dioxide?
reddish brown gas with a sharp biting odor. really prominent in air pollution. and it is toxic by inhalation.
what is the mammalian diving reflex?
happens when a person dives or jumps into cold water. the heart rate slows down to brady followed by LOC.
the patient may survive a long time underwater because of the lower metabolic rate and the decrease demand for oxygen consumption.
what is the management for patients with crush syndrome
crush happens when large muscle groups are compressed for 2-4 hours. because of the lack of oxygen the cells metabolize anarobically producing lactic acid.
when everything gets reperfused the by product gets into the blood stream. you should treat with high flow oxygen. then administer sodium bicarbonate, calcium chloride, and a fluid bolus.
how should you manage pain in crush
talk to create distraction.
splint. and handle gently.
who deveops the regulations for responding to hazmat material.
ohsa and the EPA
the hazwoper is the document that outlines the hazardous materials competecies.