REMAC General Operating Procedures
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Acute Stroke: Tansfer to appropriate Stroke Center unless: - ANS-Patient has
unmanageable airway
Patient has other conditions that warrant the transportation to another 911 NYC facility
Patient has NYC S-LAMS score of ≤ 3, transport the patient to the closest appropriate
Primary Stroke Center.
If the patient has a NYC S-LAMS score of ≥ 4, contact OLMC for Transport Decision to
the closest Thrombectomy Stroke Center*,
Unless Stroke Exclusion Criteria are met:
● Total time from onset of patient's symptoms to EMS patient contact is greater than 5
(five) hours
● Patient is wheelchair or bed-bound
● Seizure is cause of symptoms
● Loss of Consciousness (LOC)
● Trauma is cause of symptoms
● Transport time to Thrombectomy Stroke Center is > 30 minutes
Major Trauma - ANS-Take patient to nearest NYC 911 Trauma Center
(Major Trauma) Unless: - ANS-The patient is in cardiac arrest
An on-line medical control physician so directs.
, Burns - ANS-Transport patient to nearest burn unit
Unless (Burns) ONE of the conditions are met: - ANS-● The patient is in cardiac arrest;
● The patient also has major trauma;
● An on-line medical control physician so directs.
● The event is declared a Burn MCI by FDNY-EMS, NYCOEM, NYSDOH, or
NYCDOHMH in which case
patients may be transported to New York City Burn Disaster Receiving Hospitals
(BDRH) as per NYC Burn Disaster Plan (Refer to Appendix S)
NOTE: Patients with major burns and major trauma must be taken to the nearest New
York City 911 system trauma center.
STEMI Elevation/ Myocardial Indarction - ANS-For all adults, if the historical / physical
findings indicate an acute myocardial infarction, and the 12 lead EKG reveals 1 mm ST
elevation in 2 or more contiguous leads; transport the patient to the closest 24 hour
NYS certified interventional cardiac catheterization facility.
Unless: - ANS-The patient has other conditions such as Burns,Trauma,CVA.
What is a CODE STEMI? - ANS-Patients with ST elevation greater than 2mm
High Index of Suspicion - ANS-The concern that an individual may have an acute
medical, traumatic, psychiatric, behavioral, or other condition that could result in a life-
threatening or life-altering outcome.
Indications for a high index of suspicion may include, but are not limited to - ANS-●
Mechanism of injury (the way in which traumatic injuries likely occurred. This would
include the forces that act on the body to cause damage and/or the mechanism or
cause of an illness or symptom)
● Assessment of injury/illness severity
● Abnormal vital signs
Exam Questions with 100% Accurate
Solved Answers
Acute Stroke: Tansfer to appropriate Stroke Center unless: - ANS-Patient has
unmanageable airway
Patient has other conditions that warrant the transportation to another 911 NYC facility
Patient has NYC S-LAMS score of ≤ 3, transport the patient to the closest appropriate
Primary Stroke Center.
If the patient has a NYC S-LAMS score of ≥ 4, contact OLMC for Transport Decision to
the closest Thrombectomy Stroke Center*,
Unless Stroke Exclusion Criteria are met:
● Total time from onset of patient's symptoms to EMS patient contact is greater than 5
(five) hours
● Patient is wheelchair or bed-bound
● Seizure is cause of symptoms
● Loss of Consciousness (LOC)
● Trauma is cause of symptoms
● Transport time to Thrombectomy Stroke Center is > 30 minutes
Major Trauma - ANS-Take patient to nearest NYC 911 Trauma Center
(Major Trauma) Unless: - ANS-The patient is in cardiac arrest
An on-line medical control physician so directs.
, Burns - ANS-Transport patient to nearest burn unit
Unless (Burns) ONE of the conditions are met: - ANS-● The patient is in cardiac arrest;
● The patient also has major trauma;
● An on-line medical control physician so directs.
● The event is declared a Burn MCI by FDNY-EMS, NYCOEM, NYSDOH, or
NYCDOHMH in which case
patients may be transported to New York City Burn Disaster Receiving Hospitals
(BDRH) as per NYC Burn Disaster Plan (Refer to Appendix S)
NOTE: Patients with major burns and major trauma must be taken to the nearest New
York City 911 system trauma center.
STEMI Elevation/ Myocardial Indarction - ANS-For all adults, if the historical / physical
findings indicate an acute myocardial infarction, and the 12 lead EKG reveals 1 mm ST
elevation in 2 or more contiguous leads; transport the patient to the closest 24 hour
NYS certified interventional cardiac catheterization facility.
Unless: - ANS-The patient has other conditions such as Burns,Trauma,CVA.
What is a CODE STEMI? - ANS-Patients with ST elevation greater than 2mm
High Index of Suspicion - ANS-The concern that an individual may have an acute
medical, traumatic, psychiatric, behavioral, or other condition that could result in a life-
threatening or life-altering outcome.
Indications for a high index of suspicion may include, but are not limited to - ANS-●
Mechanism of injury (the way in which traumatic injuries likely occurred. This would
include the forces that act on the body to cause damage and/or the mechanism or
cause of an illness or symptom)
● Assessment of injury/illness severity
● Abnormal vital signs
