FAQs, 2nd Edition

FAQs, 2nd Edition

I know that I am considered a mandated reporter for suspected adult and child abuse but what does that mean? Can I just call EMS5 and let them know about the situation?

  • No, you must make the phone call to APS or CPS (Social Services) directly and as soon as possible (within hours not days). The only exception is in the case of suspected child abuse, you can let the physician know immediately after arrival at the ED and that constitutes notification.  It is still better to call yourself since you may have information from the scene that the physician won’t know.  Technically, all EMS providers on the scene are required to make the call.  If there is an understanding that the AIC will be handling the call and you have any doubts that they made the call or if you saw something they did not, you are legally obligated to do it yourself.

When should I be wearing my traffic safety vest?

  • The reflective safety vest should be worn anytime you are working any type of incident on the interstate, highway, street or intersection.  Feel free to wear the vest anytime you feel there is an increased need for visibility.

We were dispatched to a patient who was tasered. What should we do for the patient?

  • Typically, EMS will be not be involved with a patient in custody that was tasered.  If the police officer is unable to remove the taser barbs from the skin or if the barbs struck the patient in the face, neck or groin, they will call EMS to have the patient transported to the ER.  We should be treating these just like any other impaled object.  The cases will most likely only need a BLS transport unless other factors play a part.

How do I dispose of my waste—red bag, regular trash bag, or sharps? How do I dispose of it at the hospital?

  • Sharps: Any needles or sharps obviously need to be placed in a sharps container.  Full sharps containers should not be placed in a trash bag.  They should be taped closed and you should ask each hospital the best way to dispose of it.
  • Red Bags:  The only items that should be placed in red bags should be items with a biohazard symbol on it or items saturated with body fluids.  A good rule of thumb is that if you can squeeze or pour fluids out, it should go in a red bag.  Red bags can only go into red bags at the hospital.  Hospitals pay extra disposal fees for these items since they are incinerated.  This is why regular trash should not be placed into a red trash bag!
  • Regular trash:  Most of our trash falls into this category.  Wrappers, used supplies, bandages with small amounts of blood, cups, gloves, and your left over lunch should all be placed into a regular trash bags.  Typically, you can keep a regular trash bag for duty use and if you happen to get a messy case, you can pull out the red bag for the specific incident.  Regular trash bags should be placed into similar bins at the hospitals.

There is an accident on the interstate. Can I stop in my POV?

  • Responding to calls on the interstate in your personal vehicle is never a good idea.  You put yourself and your car at risk by stopping on your own.   Remember that Fire, EMS and State Police units are positioned all along the interstate.  Just let the duty crews handle the emergency while you stay safe.

Can a BLS crew transport a patient who has an IV from a doctor’s office or other location?

  • If a doctor’s office has established an IV and the patient does not need the EKG monitor, medications or other ALS interventions, the state regulations allow for BLS providers to transport a patient with a simple IV (normal saline, lactated ringer’s, D5W) to the hospital.  If there are medications added to the IV bag, ALS must transport.  If a prehospital provider starts the IV, ALS must transport.

What items can I restock at the hospital?

  • Hospitals are only required to restock the items on the TEMS restock list on a one-for-one use basis.  If the items that you are looking for are not readily available or accessible, please do not take them from secure areas or code carts without permission.  In addition, you should not be restocking your entire ambulance with random missing items and linens.  You can only take what you used on the patient that you brought in.  The other items need to be restocked back at the station.  You may restock items you used for a patient that was not transported to the hospital, such as during patient refusal or termination of resuscitation situations.

It is 6:05 and my partner isn’t here. What should I do?

  • You should first log on as a driver-only unit. Then you need to contact EMS5 to advise them of the situation and then try to make contact with your partner and station officers (as station policies dictate).  This will allow EMS5 to make alternate staffing arrangements right away if necessary.

VBEMS is now using a new device or started doing a new skill and I use that same exact product or do that same exact skill at my other job. Do I have to go through Virginia Beach training too?

  • All providers must be certified/authorized to perform skills and use VBEMS equipment.  Sometimes, but not all times, VBEMS Training gives “credit” for verified training and use of the same equipment from other places of employment.  This is not automatic and the member must contact EMS Training for clarification for specific instances.

If I have a patient who was sexually assaulted and wants to go to the hospital, they have to be transported to a specific hospital such as Chesapeake Regional right?

  • No.  There is no special program directly affiliated with any hospital.  Patients requesting transport to the hospital should be taken to the closest facility.  If the victim has sustained very minor physical injury, it would likely be more beneficial to the patient to go with the SVU detectives to a clinic that the Virginia Beach Commonwealth Attorney authorizes.  Work with the patient and detectives on the best option for the specific case.

My patient has a proper DNR. What can I or should I do to treat this patient?

  • You can apply oxygen and comfort measures (such as pain management, control nausea) as applicable.  Certain illnesses or conditions that develop and are not directly related to the patient’s terminal condition can be treated per protocol such as hypoglycemia, opiate overdose, allergic reactions and seizures.  Hypotension can be treated with fluids but not with Dopamine.  You should not administer any cardiac medications, intubate, ventilate, defibrillate, cardiovert or pace patients with a valid DNR.  If you have any questions or concerns regarding a specific patient, consult online medical control.

Durable DNR, living will, advance directives—what is the difference and which one can I follow?

  • VA EMS providers can honor 3 types of DNRs:
    • The standardized Virginia Durable DNR Order Form is the only do not resuscitate form issued by the Virginia Department of Health (VDH). A Durable DNR Order Form does not expire and remains in effect until the patient or someone designated to act on the patient’s behalf revokes the order. Virginia EMS providers CANNOT honor a Living Will or a DNR from another state.
    • EMS providers can honor a physician’s written order that is not on the standard Virginia Durable DNR Order Form when the patient is within a licensed health care facility. This “Other” DNR Order may be on a form developed by the health care facility or any other type of written physician’s order.
    • Approved Durable DNR bracelets or necklaces can be honored in place of the Virginia Durable DNR Order Form by EMS providers.
  • The term “Advance Directives” refer to treatment preferences and the designation of a surrogate decision- maker in the event that a person should become unable to make medical decisions on her or his own behalf.  Advance directives generally fall into three categories: living will, power of attorney, and health care proxy.  Living wills are a written document that specifies what types of medical treatment are desired. A living will can be very specific or very general.  It basically describes the patient’s wishes if they become incapable of explaining them to their family.

I am responding to a hospice patient. I heard that if we transport them to the hospital, it nullifies their hospice contract.  Is this correct?

  • No.  The best thing to do when dispatched to a patient receiving hospice care is to determine what the family and patient needs are.  Often the family panics over a change in the patient and their instinct is to call 911.  If possible, take a moment to figure out exactly what the family needs and contact the hospice nurse (or on-call nurse).  Many times, with a little support, things can be handled without a trip to the hospital.  In other cases, a trip to the hospital may be completely warranted.  For instance, if a cancer patient falls and breaks their hip, they should go to the ER.  Either way, do what you think is best based on the circumstances and don’t forget to contact a supervisor or medical control if you have questions regarding a specific case.

The engine has a patient on the 12-lead. Can we trade monitors?  What about swapping cables?

  • No.  If the patient needs to remain attached to the current monitor, that unit can either go to the hospital or go out of service for EMS calls until they get their equipment back.  Swapping monitors, cables, leads and other equipment can lead to lost items or units being out of service longer than necessary trying to get them back.

I administered D50 to a diabetic patient and they are now refusing transport. Do I have to contact medical control?

  • No.  If you feel that the patient is unable to make an informed decision or has other medical issues, you should encourage transport and/or contact medical control for guidance.  In addition, some patients have chronic hypoglycemic episodes their physician never knows about.  A trip to the ER once in a while might be the trigger for a medication or lifestyle change.  You should also be cautious if the patient is on oral agents only since they are at higher risk for recurrence or is alone since their sugar levels could drop again if they don’t continue to monitor them or eat.

My patient is wheezing and has an allergy to peanuts. Can I give nebulized Atrovent?

  • Yes.  The Atrovent metered-dose inhaler formerly contained soy lethicin that was an inert ingredient serving as a preservative in the propellant.  With 2005 federal regulations that mandated that inhalers had to become free of CFC propellants, Atrovent HFA was launched and the contraindication for soybean was lifted.  The new, currently available Atrovent and Combivent inhalers do not contain CFC and do not contain soy lecithin.  It is safe for patients with peanut allergy and soy allergy to use their asthma inhalers.  Soybean and nuts were never contraindications to Ipratropium for nebulizer administration.  (Sources: American Academy of Allergy Asthma and Immunology, EMSMedRx)

Can I apply the 3-lead EKG monitor just to see what is going on and downgrade the patient to BLS if everything looks OK?

  • No.  As the ALS provider, if you have enough concern about the patient’s status that you want to check the patient’s EKG, the patient should remain on the monitor throughout transport and remain an ALS patient.  EKG monitors are not to be used as a rule-out tool or a way to check a pulse.  If the ALS provider ultimately responsible for transport determines that the patient is BLS and the EKG should never have been applied by first response personnel, it is OK to downgrade to a BLS crew with their consultation.

We worked a cardiac arrest and got a pulse back. I am not an RSI or hypothermia medic.  Can I apply cold packs and start the process anyway?

  • No.  Only providers who are qualified to perform therapeutic hypothermia can begin prehospital cooling.  At this time, only RSI qualified medics who complete the training are able to use the protocol.

I am with a possible STEMI patient at a doctor’s office and they already performed a 12 lead. Do I have to do another one?

  • Yes, you should perform a 12 lead and transmit it to the hospital. You can’t ensure that the office will fax the 12 lead to the ED and a second 12 lead can show changes after treatment has been given.

Can I use the Glidescope for a first attempt intubation on a routine cardiac arrest?

  • Yes.  The Glidescope can be used for a first attempt intubation on any case, not just difficult airways.  You should not wait for the Glidescope to arrive but if it is there, you can use it!

My patient is in cardiac arrest. Can I give Narcan on standing orders?

  • If you have reason to suspect an opiate overdose (you find drug paraphernalia at the scene, a bystander reports a history of drug abuse or you find empty containers of opiate medications), Narcan can be appropriate. You may not give Narcan simply because the patient is unconscious due to cardiac arrest without physician order.  If you have a secure airway and the patient is well oxygenated, the need for Narcan is eliminated anyway.

We are transporting a patient in cardiac arrest to the hospital. Can I use the Termination of Resuscitation protocol after 20 minutes?

  • No.  Once transport is initiated, medical control must be contacted for permission to cease efforts.  In fact, with the recent protocol update, the only time anyone can terminate resuscitation on standing order is when CPR with BLS procedures only was started inappropriately while still on scene.  If any ALS procedures have been attempted or established, medical control must be contacted for termination orders.

I want to make sure I get this right, the Lifepak machines are biphasic and we can defibrillate at escalating energy levels of 200J, 300J and 360J, correct?

  • Yes. Lifepak15s are FDA-approved for the reduced energy settings and providers should use 200J, 300J and 360J to defibrillate.  As a note: in AED mode, follow the prompts.

What patients do I have to call the hospital and make a report about? Can I use my phone to call it in?

  • You should call the hospital on the 800 radio and give them a heads up for all patients, BLS and ALS.  This is a change for some hospitals, but they really want that heads up so they can start determining patient flow as early as possible.  Calls to the hospitals should be made on the 800 radio.  If for some reason you cannot reach the facility by radio, phone calls can be made but should only be an absolute last resort.  Phone calls may be made if there is a need to relay patient information that cannot be given over the radio (e.g., demographics).

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