LA County 800 Series Exam Questions and Answers
814. Importance of on scene resuscitation for medical cardiac arrest and the specific circumstance when it is appropriate to transport pts with medical cardiac arrest w ongoing resuscitation. - Answer -Aggressive resuscitation in the field to obtain the return
of spontaneous circulation (ROSC) is encouraged. Transporting patients without ROSC is discouraged.
814. Reversible causes of pulseless electrical activity and awareness that reversible causes should be considered in consultation with the base physician when considering termination of resuscitation. - Answer -A. EMS Personnel may determine death if a patient is in asystole after 20 minutes of quality cardiopulmonary resuscitation on scene and meets ALL of the following criteria: 1. Patient 18 years or greater 2. Arrest not witnessed by EMS personnel 3. No shockable rhythm identified at any time during the resuscitation 4. No ROSC at any time during the resuscitation 5. No hypothermia B. Base Physician consultation for pronouncement is not required if Section A is met. C. Base Physician contact shall be established for all patients in cardiopulmonary arrest who do not meet the conditions described in Section I or IIA of this policy. D. In the event that immediate family members on scene request termination of resuscitation after resuscitation is in progress, and the patient does not meet criteria in section IIA, base physician consultation shall be made for termination and pronouncement. This does not apply to brief initiation of CPR while establishing patient/family wishes as per I.C.3.
814. Which pts require transport to the SRC for persistent cardiac arrest and the appropriate destination for transport. - Answer -Patients with non-traumatic cardiac arrest shall be transported to the most accessible open SRC if ground transport is 30 minutes or less regardless of service area boundaries including: A. Patients with sustained ROSC B. Patients with ROSC who re-arrest en route C. Patients with persistent cardiac arrest for whom the Base Physician determines transport is required, because futility is not met despite lack of ROSC with on scene resuscitation D. Patients who have progressed into cardiopulmonary arrest while en route and had a pre-arrest STEMI 12-lead ECG.
814. Policy for determining death in the field. - Answer -1. Decapitation 2. Massive crush injury 3. Penetrating or blunt injury with evisceration of the heart, lung or brain SUBJECT: DETERMINATION / PRONOUNCEMENT REFERENCE NO. 814 OF DEATH IN THE FIELD PAGE 3 OF 7 4. Decomposition 5. Incineration 6. Pulseless, non-breathing victims with extrication time greater than fifteen minutes, where no resuscitative measures can be performed prior to extrication. 7. Penetrating trauma patients who, based on the paramedic's thorough assessment, are found apneic, pulseless, asystolic, and without pupillary reflexes upon the arrival of EMS personnel at the scene. 8. Blunt trauma patients who, based on a paramedic's thorough patient assessment, are found apneic, pulseless, and without organized ECG activity (narrow complex supraventricular rhythm) due to traumatic mechanism upon the arrival of EMS personnel at the scene. 9. Pulseless, non-breathing victims of a multiple victim incident where insufficient medical resources preclude initiating resuscitative measures. 10. Drowning victims, when it is reasonably determined that submersion has been greater than one hour. 11. Rigor mortis (requires assessment as described in Section I, B.) 12. Post-mortem lividity (requires assessment as described in Section I, B.) - 1. Assess airway /listen to lungs for 30 seconds 2. Assess pulse for 60 seconds
814. Criteria for field determination of death for pts in traumatic full arrest. - Answer -
Penetrating trauma patients who, based on the paramedic's thorough assessment, are found apneic, pulseless, asystolic, and without pupillary reflexes upon the arrival of EMS personnel at the scene. Blunt trauma patients who, based on a paramedic's thorough patient assessment, are found apneic, pulseless, and without organized ECG activity (narrow complex supraventricular rhythm) due to traumatic mechanism upon the
arrival of EMS personnel at the scene.
814. The timing for on scene resuscitation of cardiac arrest according to rhythm. - Answer -
814. Assessments that must be performed to declare death by ref No 814 for pts with rigor mortis and/or dependent lividity. - Answer -1. Assess airway /listen to lungs for 30 seconds 2. Assess pulse for 60 seconds
815. The purpose and scope of approved forms used to convey pt wishes for medical treatment. - Answer -
815. Physician Order for Life Sustaining Treatment (POLST) form. - Answer -Follow the orders on the form first then contact the physician. It compliments an advanced directive
but does not replace it.
815. Resuscitation procedures involving prehospital DNR Orders. - Answer -Do Not Resuscitate (DNR): DNR is a request to withhold interventions intended to restore cardiac activity and respirations. For example: • no chest compressions • no defibrillation • no endotracheal intubation • no assisted ventilation • no vasoactive drugs.
Begin resuscitation immediately and contact the base hospital for further direction if family members/caretakers disagree or object to withholding resuscitation, or if EMS personnel have any reservations regarding the validity of the DNR directive.
815. When it is appropriate to withhold resuscitation based on family wishes on scene. -
Answer -In the event that immediate family members on scene request termination of
814. Importance of on scene resuscitation for medical cardiac arrest and the specific circumstance when it is appropriate to transport pts with medical cardiac arrest w ongoing resuscitation. - Answer -Aggressive resuscitation in the field to obtain the return
of spontaneous circulation (ROSC) is encouraged. Transporting patients without ROSC is discouraged.
814. Reversible causes of pulseless electrical activity and awareness that reversible causes should be considered in consultation with the base physician when considering termination of resuscitation. - Answer -A. EMS Personnel may determine death if a patient is in asystole after 20 minutes of quality cardiopulmonary resuscitation on scene and meets ALL of the following criteria: 1. Patient 18 years or greater 2. Arrest not witnessed by EMS personnel 3. No shockable rhythm identified at any time during the resuscitation 4. No ROSC at any time during the resuscitation 5. No hypothermia B. Base Physician consultation for pronouncement is not required if Section A is met. C. Base Physician contact shall be established for all patients in cardiopulmonary arrest who do not meet the conditions described in Section I or IIA of this policy. D. In the event that immediate family members on scene request termination of resuscitation after resuscitation is in progress, and the patient does not meet criteria in section IIA, base physician consultation shall be made for termination and pronouncement. This does not apply to brief initiation of CPR while establishing patient/family wishes as per I.C.3.
814. Which pts require transport to the SRC for persistent cardiac arrest and the appropriate destination for transport. - Answer -Patients with non-traumatic cardiac arrest shall be transported to the most accessible open SRC if ground transport is 30 minutes or less regardless of service area boundaries including: A. Patients with sustained ROSC B. Patients with ROSC who re-arrest en route C. Patients with persistent cardiac arrest for whom the Base Physician determines transport is required, because futility is not met despite lack of ROSC with on scene resuscitation D. Patients who have progressed into cardiopulmonary arrest while en route and had a pre-arrest STEMI 12-lead ECG.
814. Policy for determining death in the field. - Answer -1. Decapitation 2. Massive crush injury 3. Penetrating or blunt injury with evisceration of the heart, lung or brain SUBJECT: DETERMINATION / PRONOUNCEMENT REFERENCE NO. 814 OF DEATH IN THE FIELD PAGE 3 OF 7 4. Decomposition 5. Incineration 6. Pulseless, non-breathing victims with extrication time greater than fifteen minutes, where no resuscitative measures can be performed prior to extrication. 7. Penetrating trauma patients who, based on the paramedic's thorough assessment, are found apneic, pulseless, asystolic, and without pupillary reflexes upon the arrival of EMS personnel at the scene. 8. Blunt trauma patients who, based on a paramedic's thorough patient assessment, are found apneic, pulseless, and without organized ECG activity (narrow complex supraventricular rhythm) due to traumatic mechanism upon the arrival of EMS personnel at the scene. 9. Pulseless, non-breathing victims of a multiple victim incident where insufficient medical resources preclude initiating resuscitative measures. 10. Drowning victims, when it is reasonably determined that submersion has been greater than one hour. 11. Rigor mortis (requires assessment as described in Section I, B.) 12. Post-mortem lividity (requires assessment as described in Section I, B.) - 1. Assess airway /listen to lungs for 30 seconds 2. Assess pulse for 60 seconds
814. Criteria for field determination of death for pts in traumatic full arrest. - Answer -
Penetrating trauma patients who, based on the paramedic's thorough assessment, are found apneic, pulseless, asystolic, and without pupillary reflexes upon the arrival of EMS personnel at the scene. Blunt trauma patients who, based on a paramedic's thorough patient assessment, are found apneic, pulseless, and without organized ECG activity (narrow complex supraventricular rhythm) due to traumatic mechanism upon the
arrival of EMS personnel at the scene.
814. The timing for on scene resuscitation of cardiac arrest according to rhythm. - Answer -
814. Assessments that must be performed to declare death by ref No 814 for pts with rigor mortis and/or dependent lividity. - Answer -1. Assess airway /listen to lungs for 30 seconds 2. Assess pulse for 60 seconds
815. The purpose and scope of approved forms used to convey pt wishes for medical treatment. - Answer -
815. Physician Order for Life Sustaining Treatment (POLST) form. - Answer -Follow the orders on the form first then contact the physician. It compliments an advanced directive
but does not replace it.
815. Resuscitation procedures involving prehospital DNR Orders. - Answer -Do Not Resuscitate (DNR): DNR is a request to withhold interventions intended to restore cardiac activity and respirations. For example: • no chest compressions • no defibrillation • no endotracheal intubation • no assisted ventilation • no vasoactive drugs.
Begin resuscitation immediately and contact the base hospital for further direction if family members/caretakers disagree or object to withholding resuscitation, or if EMS personnel have any reservations regarding the validity of the DNR directive.
815. When it is appropriate to withhold resuscitation based on family wishes on scene. -
Answer -In the event that immediate family members on scene request termination of
