SNHD AEMT PROTOCOLS NEWEST EXAM
QUESTIONS MARKING SCHEME CURRENT UPDATE
A patient is defined as - ans -A person who has a complaint or mechanism
suggestive of potential illness or injury; A person who has obvious evidence of
illness or injury; or A person identified by an informed 2nd or 3rd party caller as
requiring evaluation for potential illness or injury
Pediatric patient considerations - ans -For patients < 18 yo, use the Pediatric
Patient Destination protocol; Pediatric treatment protocols are to be used on
children who have not yet experienced puberty.
Signs of puberty include - ans -chest or underarm hair on males, and any breast
development in females.
General Adult Assessment - ans -1. Scene safety / scene size up; NOI/MOI;
PPE/BSI; Bring all equipment to patients side
2. Level of consciousness -> unresponsive -> check pulse-> none -> Cardiac arrest
Airway -> sigs of compromised or non protecting -> Ventilation management
Breathing -> inadequate or resp. distress -> Resp. Distress
Circulation -> bleeding -> General trauma
Disability -> Altered or confused -> altered mental status/syncope
3. History - HPI & AMPLE
Vital signs and physical exam
blood glucose testing if indicated
Special treatment protocol as indicated
Cervical Stabilization as indicated
Comfort measures (splint, position of comfort)
Vascular access as indicated
Oxygen therapy to keep SPO2 > 94%
4. Radio contact for all trauma center patients, Code 3 returns, need for telemetry
physician & as per protocol
Transport per Disposition Criteria if applicable
*Transport to closest facility for Airway emergencies (inability to adequately
ventilate)
,Disposition for patients sustaining traumatic injuries - ans -transported in
accordance with the Trauma Field Triage Criteria Protocol
Disposition for patients sustaining burn injuries - ans -Transported in accordance
with the Burns Protocol
Disposition for pediatric patients (<18 y/o) - ans -Transported in accordance with
the Pediatric Destination protocol
Disposition for patients with evidence of stroke - ans -Transported in accordance
with the Stroke (CVA) protocol
Disposition for sexual assault victims < 13 y/o - ans -Transported to Sunrise
Hospital
Disposition for sexual assault victims 13-18 y/o - ans -Transported to Sunrise
Hospital or UMC
Disposition for sexual assault victims 18 y/o and older - ans -transported to UMC
Disposition for sexual assault victims outside a 50-mile radius from the above
facilities - ans -Transported to the nearest appropriate facility
Disposition for stable patients - ans -Transported to the hospital of their choice, if
the patient has no preference the patient should be transported to the nearest
appropriate facility
Disposition for patients outside a 50 mile radius from the protocol designated
transport destinations - ans -The licensee providing emergency medical care shall
transport the patient to the nearest appropriate facility
Waiting room criteria - ans -Upon arrival in the ED, if transfer of care has not
occurred in accordance with NRS 450B.790, any patient, excluding patients on a
legal psychiatric hold, meeting ALL criteria may be placed in a waiting room
1. Normal vital signs
Heart rate 60-100
Respiratory rate 10-20
,Systolic BP 100-180
Diastolic BP 60-110
Room air pulse ox > 94%
A&Ox4
2. Did not receive any parenteral medications during EMS transport except a
single dose of analgesia and/or an anti-emetic
3. In the judgment of the Paramedic, does not require continuous cardiac
monitoring
4. Can maintain a sitting position without adverse impact on their medical
condition
5. Is left with a verbal report to hospital personnel
Internal disaster - ans -If a hospital declares internal disaster, that facility is to be
bypassed for all patients except patients in cardiac arrest or in whom the ability to
adequately ventilate has not been established
Operational exceptions may be initiated in regard to transport to hospitals on
internal disaster.
General Adult Trauma Assessment
- ans -1. General Adult assessment; cervical stabilization
2 GCS
<8 Ventilation management BVM if O2 sat < 94%
>8 Oxygen Keep SPO2 > 94%
3. Palpable radial pulse>
No -> vascular access, 1 L NS or LR bolus
Yes -> Vascular access
4. Secondary survey:
Suspected tension pneumothorax -> Paramedic
Sucking chest wound -> apply 3-sided occlusive dressing
Control active hemorrhage -> Hemorrhage control
Obvious fractures -> Immobilize fractures; assess distal pulse
Suspected traumatic brain injury -> Raise head of bed 30 degrees
Open wounds -> cover with gauze; wet trauma dressing for abdominal
evisceration
5. Transport and radio contact to appropriate trauma center based on TFTC
General Adult Trauma History - ans -Time and mechanism of injury
, damage to structure or vehicle
location in structure or vehicle
other injured or dead
speed and details of MVC
restraints/protective equipment
past medical history
medications
General adult trauma signs and symptoms
- ans -Pain, swelling
Deformity, lesions, bleeding
AMS or unconscious
Hypotension or shock
Arrest
General Adult Trauma Differential (life threatening)
ans -Tension pneumothorax
Flail chest
Pericardial tamponade
Open chest wound
Hemothorax
Intra-abdominal bleeding
Pelvis/femur fracture
Spine fracture/cord injury
Head injury
Extremity fracture
HEENT (airway obstruction)
Hypothermia
General Adult trauma Pearls - ans -Recommended exam: mental status, skin,
HEENT, heart, lung, abdomen, extremities, back, neuro
Transport should not be delayed for procedures; ideally procedures should be
performed enroute when possible
Geriatric patients should be evaluated with a high index of suspicion; occult
injuries may be present and geriatric patients can decompensate quickly
BVM is an acceptable method of ventilating and managing an airway if pulse ox
can be maintained >90%
QUESTIONS MARKING SCHEME CURRENT UPDATE
A patient is defined as - ans -A person who has a complaint or mechanism
suggestive of potential illness or injury; A person who has obvious evidence of
illness or injury; or A person identified by an informed 2nd or 3rd party caller as
requiring evaluation for potential illness or injury
Pediatric patient considerations - ans -For patients < 18 yo, use the Pediatric
Patient Destination protocol; Pediatric treatment protocols are to be used on
children who have not yet experienced puberty.
Signs of puberty include - ans -chest or underarm hair on males, and any breast
development in females.
General Adult Assessment - ans -1. Scene safety / scene size up; NOI/MOI;
PPE/BSI; Bring all equipment to patients side
2. Level of consciousness -> unresponsive -> check pulse-> none -> Cardiac arrest
Airway -> sigs of compromised or non protecting -> Ventilation management
Breathing -> inadequate or resp. distress -> Resp. Distress
Circulation -> bleeding -> General trauma
Disability -> Altered or confused -> altered mental status/syncope
3. History - HPI & AMPLE
Vital signs and physical exam
blood glucose testing if indicated
Special treatment protocol as indicated
Cervical Stabilization as indicated
Comfort measures (splint, position of comfort)
Vascular access as indicated
Oxygen therapy to keep SPO2 > 94%
4. Radio contact for all trauma center patients, Code 3 returns, need for telemetry
physician & as per protocol
Transport per Disposition Criteria if applicable
*Transport to closest facility for Airway emergencies (inability to adequately
ventilate)
,Disposition for patients sustaining traumatic injuries - ans -transported in
accordance with the Trauma Field Triage Criteria Protocol
Disposition for patients sustaining burn injuries - ans -Transported in accordance
with the Burns Protocol
Disposition for pediatric patients (<18 y/o) - ans -Transported in accordance with
the Pediatric Destination protocol
Disposition for patients with evidence of stroke - ans -Transported in accordance
with the Stroke (CVA) protocol
Disposition for sexual assault victims < 13 y/o - ans -Transported to Sunrise
Hospital
Disposition for sexual assault victims 13-18 y/o - ans -Transported to Sunrise
Hospital or UMC
Disposition for sexual assault victims 18 y/o and older - ans -transported to UMC
Disposition for sexual assault victims outside a 50-mile radius from the above
facilities - ans -Transported to the nearest appropriate facility
Disposition for stable patients - ans -Transported to the hospital of their choice, if
the patient has no preference the patient should be transported to the nearest
appropriate facility
Disposition for patients outside a 50 mile radius from the protocol designated
transport destinations - ans -The licensee providing emergency medical care shall
transport the patient to the nearest appropriate facility
Waiting room criteria - ans -Upon arrival in the ED, if transfer of care has not
occurred in accordance with NRS 450B.790, any patient, excluding patients on a
legal psychiatric hold, meeting ALL criteria may be placed in a waiting room
1. Normal vital signs
Heart rate 60-100
Respiratory rate 10-20
,Systolic BP 100-180
Diastolic BP 60-110
Room air pulse ox > 94%
A&Ox4
2. Did not receive any parenteral medications during EMS transport except a
single dose of analgesia and/or an anti-emetic
3. In the judgment of the Paramedic, does not require continuous cardiac
monitoring
4. Can maintain a sitting position without adverse impact on their medical
condition
5. Is left with a verbal report to hospital personnel
Internal disaster - ans -If a hospital declares internal disaster, that facility is to be
bypassed for all patients except patients in cardiac arrest or in whom the ability to
adequately ventilate has not been established
Operational exceptions may be initiated in regard to transport to hospitals on
internal disaster.
General Adult Trauma Assessment
- ans -1. General Adult assessment; cervical stabilization
2 GCS
<8 Ventilation management BVM if O2 sat < 94%
>8 Oxygen Keep SPO2 > 94%
3. Palpable radial pulse>
No -> vascular access, 1 L NS or LR bolus
Yes -> Vascular access
4. Secondary survey:
Suspected tension pneumothorax -> Paramedic
Sucking chest wound -> apply 3-sided occlusive dressing
Control active hemorrhage -> Hemorrhage control
Obvious fractures -> Immobilize fractures; assess distal pulse
Suspected traumatic brain injury -> Raise head of bed 30 degrees
Open wounds -> cover with gauze; wet trauma dressing for abdominal
evisceration
5. Transport and radio contact to appropriate trauma center based on TFTC
General Adult Trauma History - ans -Time and mechanism of injury
, damage to structure or vehicle
location in structure or vehicle
other injured or dead
speed and details of MVC
restraints/protective equipment
past medical history
medications
General adult trauma signs and symptoms
- ans -Pain, swelling
Deformity, lesions, bleeding
AMS or unconscious
Hypotension or shock
Arrest
General Adult Trauma Differential (life threatening)
ans -Tension pneumothorax
Flail chest
Pericardial tamponade
Open chest wound
Hemothorax
Intra-abdominal bleeding
Pelvis/femur fracture
Spine fracture/cord injury
Head injury
Extremity fracture
HEENT (airway obstruction)
Hypothermia
General Adult trauma Pearls - ans -Recommended exam: mental status, skin,
HEENT, heart, lung, abdomen, extremities, back, neuro
Transport should not be delayed for procedures; ideally procedures should be
performed enroute when possible
Geriatric patients should be evaluated with a high index of suspicion; occult
injuries may be present and geriatric patients can decompensate quickly
BVM is an acceptable method of ventilating and managing an airway if pulse ox
can be maintained >90%
