2018 Protocol Update Survey of Learning - ALS

ALS Provider

Thank you for participating in this Survey of Learning Please feel free to contact the SCEMS Education and QA Coordinator at any time with additional suggestions and feedback.

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* 1. Please enter your first name

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* 2. Please enter your last name

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* 3. Please enter your PRIMARY department affiliation

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* 4. Please enter your SECONDARY department affiliation if any

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* 5. Which of the following influences the protocol update?

Current trends in prehospital care

Quality assurance reports

Routine review of existing protocols

Field provider requests

All of the above influence protocol updates

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* 6. How many ALS protocol changes alter actual patient care?

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* 7. How many BLS protocol changes alter actual patient care?

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* 8. How will education on some of the new ALS changes be provided?

A single countywide class that is mandatory for all paramedics to attend on Christmas Day

By your department’s Delegate Physician

There will be no additional education

By appointment only at the EMS Office with Kelly

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* 9. According to the note from Dr. Cooper in the presentation, county EMS protocols are " - developing in and advancing step by step"

Progressive, stages

Proactive, layers

Popular, sequence

Escalating, levels

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* 10. True or false: By completing this protocol update education and survey of learning you are automatically authorized to perform any and all skills/procedures that fall within your level of certification.

True

False

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* 11. The creation of an Airway Management chapter:

Meets NREMT requirements for accreditation

Ensures that all ambulances are equipped with oxygen regulators

Demonstrates the commitment of Snohomish County EMS to safe and skillful airway management

Provides guidance for the management of snake bites

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* 12. In which chapter would you find the protocol for removal of a Supraglottic Airway?

Cardiac Emergencies – Adult

Appendix B – Special Situations

Airway Management

Appendix C - Advanced Protocols

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* 13. How useful do you think having the PROCEDURES in SKILL SHEET format will be? (this question is asking for your opinion and will not be graded as correct/incorrect)

Definitely useful

Possibly useful

Not at all useful

I won't know until I try using them

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* 14. Checklist use is:

Optional

Only for ALS providers

Still mandatory

Required by the DOH

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* 15. True or False: Advanced protocols are for use by all ALS and BLS providers

True

False

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* 16. According to the DSD protocol (p. 143), “Double Sequential Defibrillation is not synchronous. It is two separate shocks delivered as closely together as possible with separate pad placement. It is believed the different ______________ provided by two sets of pads provide the benefit of the procedure”

Currents

Vectors

Wattages

Ranges

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* 17. True or False: Participation in Double Sequential Defibrillation is mandatory.

True

False

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* 18. True or False: The Maintenance of Peripheral IV Therapy for EMTs protocol applies only for hospital-to-hospital transfer.

True

False

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* 19. Who does the Snohomish County Diversion Center EMT protocol apply to?

Paramedics in their first certification period

All Advanced EMTs (a.k.a. Intermediates)

EMTs who are employed by paid departments

Only a small number of EMTs employed by the Snohomish County Diversion Center

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* 20. Who is responsible to assure checklists are executed?

Engine Captains

The transporting agency

Only paramedics

All providers on scene

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* 21. The Checklists have been removed from the protocol book, where can they be found instead?

The SCEMS website

The smartphone application

The DOH website

Both A & B

Both A & C

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* 22. According to the 2018 Airway Management – General protocol, before intubation providers should utilize two sources of oxygen to pre-oxygenate including a nasal cannula set at ____________________?

6 liters per minute

10 liters per minute

15 liters per minute

25 liters per minute

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* 23. According to the 2018 Airway Management – General protocol, “routine use of the Bougie is ____________________”.

Expected

Encouraged

Prohibited

Optional

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* 24. According to the 2018 Airway Management – General protocol, which of the following are appropriate methods for confirmation of endotracheal tube placement?

Visualization of the tube passing through the cords, misting in the tube, and absence of breath sounds over the epigastrium

Visualization of the tube passing through the cords, bilateral and equal breath sounds, and presence of breath sounds over the epigastrium

Visualization of the tube passing through the cords, bilateral and equal breath sounds, and absence of breath sounds over the epigastrium

ETCO2 is acceptable as the sole indicator of successful tube placement

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* 25. According to the 2018 Airway Management – General protocol, tube placement should be reconfirmed “after and at ”.

Each move, all major intersections

Each move, transfer of care

Each move, termination of resuscitation

Each move, ten minute intervals

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* 26. Please complete the following statement: “For purposes of reporting intubation, an attempt shall be defined as any time a laryngoscopy blade with intent to ”.

Passes the tongue, manage the airway

Passes the glottic opening, manage the airway

Passes the lips, manage the airway

Passes the nasopharynx, manage the airway

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* 27. According to the Drug Assisted Intubation protocol, DAI is prohibited in which of the following patients:

Pediatric patients less than 6 months old

Pediatric patients less than 2 years old

Pediatric patients less than 13 kilograms

Adult patients

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* 28. According to the Drug Assisted Intubation protocol, documentation should include:

Description of all attempts at airway management

ETCO2 numerical values and waveforms must be recorded in the EHR

SPO2 before, during, and after intubation

All of the above

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* 29. According to the Rapid Sequence Intubation protocol, how should a provider select the proper dose of a paralytic?

Refer to medication dosing protocols

Rely on memory

Contact Kelly Fox

Wing it

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* 30. According to the Rapid Sequence Intubation protocol, what should be reassessed immediately and then every five minutes?

Lung sounds

ETCO2

SPO2

All of the above

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* 31. According to the Post-Intubation Management protocol (p. 23), when should tube depth be documented?

Time of placement

After moves

Transfer of care

All of the above

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* 32. According to the Difficult Airway Protocol (p. 24), when documenting a difficult airway providers must:

Provide witness statements attesting to difficulty

Complete the Difficult Airway QA report form

Contact the MPD

Notify Kelly Fox

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* 33. According to the Capnography protocol, which of the following patients should have ETCO2 monitoring?

A fifteen year old male who is intubated with a traumatic head injury

A sixteen year old female with Kussmaulbreathing, profound thirst, and a blood glucose reading “Hi”

A sixty year old man with heart rate of 110, respiratory rate of 30, temperature of 100.6 degrees F, and BP 90/60

All of the above

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* 34. According to the Capnography protocol, which of the following represents a NORMAL ETCO2 reading?

29 mmHg

39 mmHg

49 mmHg

59 mmHg

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* 35. True or False: It is okay to skip contacting Medical Control and only tell the communication RN that you are delivering a patient on CPAP.

True

False

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* 36. According to the Cricothyrotomy (Surgical) protocol, which of the following patients is the most likely candidate for Surgical Cric?

A four year old male with acute respiratory distress due to airway swelling from anaphylaxis

A fourteen year old female with very slow and ineffective respirations due to suspected opioid overdose

A forty-four year old STEMI patient with sudden V-Fib arrest witnessed by your crew

A fifty-four year old obese motorcyclist with significant facial trauma and a failed ET attempt

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* 37. According to the Cricothyrotomy (Needle) protocol, which of the following patients is the most likely candidate for Needle Cric?

A four year old male with acute respiratory distress due to airway swelling from anaphylaxis

A fourteen year old female with very slow and ineffective respirations due to suspected opioid overdose

A forty-four year old STEMI patient with sudden V-Fib arrest witnessed by your crew

A fifty-four year old obese motorcyclist with significant facial trauma and a failed ET attempt

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* 38. According to the Supraglottic Airway Placement protocol, which of the following patients is the most likely candidate for a supraglottic airway?

A four year old male with acute respiratory distress due to airway swelling from anaphylaxis

A twenty-four year old female with very slow and ineffective respirations due to suspected opioid overdose before Narcan

A forty-four year old chest pain patient with sudden cardiac arrest witnessed by your BLS crew

A fifty-four year old obese motorcyclist with facial trauma who is conscious and protecting his airway well

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* 39. According to the Supraglottic Airway – Removal Without ET Placement protocol, the patient’s airway is the responsibility of the Provider who placed the SGA until he/she:

Educates the higher level medical personnel to the specifics of the device

Evaluates placement with Capnography

Ensures MD or ALS personnel make an informed decision to remove the device

Both A & B

Both A & C

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* 40. According to the Spinal Assessment Decision Chart (p. 107), which of the following patients most likely requires Spinal Motion Restriction with a C-Collar and backboard?

A 28 year old female with neck pain who fell down the stairs, apparently intoxicated, and with a badly broken leg

A 58 year old male pedestrian struck by a car at low speed, well oriented and conversant, with minor bumps and bruises

A 38 year old male who banged his forehead on a low pipe in his basement, has a goose egg, did not lose consciousness, and Is well oriented and conversant

A 78 year old female with chronic back pain, who felt a “pop” in her upper back after twisting and lifting a heavy object, and will require a 45 minute transport to the hospital

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* 41. According to the Communication & Notification Issues protocol, ALL of the following patients require contact directly with the ED physician EXCEPT:

Patients requiring advanced airway measures

Patients with a tourniquet in place

Decapitated patients

Critically ill patients having a life threatening event

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* 42. Please complete the following statement seen throughout the protocols: “When in doubt ____________________”

Use the Force

Go shopping

Take a nap

Contact Medical Control

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* 43. True or False: Upon arrival at a cardiac arrest patient SCEMS providers must wait 1-2 minutes before turning on the AED

True

False

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* 44. According to the Intraosseous Access protocol, what is the appropriate IO anesthesia dose of Lidocaine for a 24 kilogram child?

2.4 mg

24 mg

48 mcg

48 mg

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* 45. According to the Intraosseous Access protocol, ALL of the following bone sites may be used EXCEPT:

Proximal Humerus

Sternum

Distal Tibia

Distal Femur

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* 46. True or False: Additional education is required before ALS providers are cleared to place IO access in the pediatric distal femur.

True

False

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* 47. According to the Pericardiocentesis protocol, which of the following patients is the most likely candidate for pericardiocentesis?

An 87 year old female “found down” at dinner time by her family after not showing up to church that morning

A 27 year old motorcyclist involved in a high speed head on collision with decreased level of consciousness, decerebrate posturing, and brain matter showing

A 47 year old female with tearing chest and abdominal pain, flat neck veins, and numbness with absent circulation in her L hand/arm

A 37 year old male pedestrian struck by a large pick-up truck with blunt chest trauma, absent peripheral pulses, and rapidly decreasing mental status

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* 48. According to the Needle Thoracostomy Protocol, which of the following are indications for needle-chest-decompression?

Acute respiratory distress

Persistent hypotension after fluid boluses

Absent lung sounds on one side of the chest

All of the above

None of the above

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* 49. What is the minimum acceptable length for an angiocath used for needle thoracostomy?

2.5 cm

4.5 cm

4.5 inches

8 cm

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* 50. True or False: A bedside report to the receiving nurse is sufficient to meet the requirements of the Mandatory Reporting RCW.

True

False

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* 51. Which of the following statements is TRUE regarding the Glasgow Coma Scale?

It is easy to calculate GCS while managing a critically injured patient on a chaotic scene

GCS is commonly used language among field providers while managing a critically ill patient in the back of an ambulance on the way to a trauma center

It is of no benefit to the receiving hospital staff when making decisions regarding patient care

Although not necessarily required for field care decisions, GCS drives clinical decision making in the hospital and it would be helpful if prehospital providers got better at calculating it

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* 52. Which of the following is the most likely Right ROUTE to administer Narcan to an unconscious heroin overdose patient who has irregular, slow, snoring respirations, as well as arms badly scarred with track marks?

Sublingual injection

Rectal

Nasal

Intramuscular

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* 53. According to the Cerebrovascular Accident Protocol (p. 56), how many abnormalities on the FAST exam are required to qualify your patient for CODE STROKE criteria (depending on time range)?

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* 54. Your 65 year old patient has sudden onset of persistent headache, slight left hand weakness, and multiple risk factors. You suspect a stroke. When documenting the assessment findings, which of the following best summarizes her condition:

Positive FAST

Negative FAST

Within normal limits

Negative FAST except mild L hand weakness

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* 55. Please complete the following summary statement, “SCEMS providers are expected to combine with verification by and ”.

Good intentions, Medical Control contact, thorough documentation

Good study habits, the SCEMS office staff, Google searches

Good clinical judgement, protocols, checklists

Good lifestyle choices, your MSO, peers

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* 56. Please rate this educational process for future education planning:

	Fail	Poor	Neutral	Good	Excellent
Ease of access to presentation	Ease of access to presentation Fail	Ease of access to presentation Poor	Ease of access to presentation Neutral	Ease of access to presentation Good	Ease of access to presentation Excellent
Content of presentation	Content of presentation Fail	Content of presentation Poor	Content of presentation Neutral	Content of presentation Good	Content of presentation Excellent
Style of presentation	Style of presentation Fail	Style of presentation Poor	Style of presentation Neutral	Style of presentation Good	Style of presentation Excellent
Length of presentation	Length of presentation Fail	Length of presentation Poor	Length of presentation Neutral	Length of presentation Good	Length of presentation Excellent
Ease of access to survey of learning	Ease of access to survey of learning Fail	Ease of access to survey of learning Poor	Ease of access to survey of learning Neutral	Ease of access to survey of learning Good	Ease of access to survey of learning Excellent
Content of survey	Content of survey Fail	Content of survey Poor	Content of survey Neutral	Content of survey Good	Content of survey Excellent
Length of survey	Length of survey Fail	Length of survey Poor	Length of survey Neutral	Length of survey Good	Length of survey Excellent
Overall satisfaction	Overall satisfaction Fail	Overall satisfaction Poor	Overall satisfaction Neutral	Overall satisfaction Good	Overall satisfaction Excellent

Question Title

* 1. Please enter your first name

Question Title

* 2. Please enter your last name

Question Title

* 3. Please enter your PRIMARY department affiliation

Question Title

* 4. Please enter your SECONDARY department affiliation if any

Question Title

* 5. Which of the following influences the protocol update?

Question Title

* 6. How many ALS protocol changes alter actual patient care?

Question Title

* 7. How many BLS protocol changes alter actual patient care?

Question Title

* 8. How will education on some of the new ALS changes be provided?

Question Title

* 9. According to the note from Dr. Cooper in the presentation, county EMS protocols are "____________________ - developing in ____________________ and advancing step by step"

Question Title

* 10. True or false: By completing this protocol update education and survey of learning you are automatically authorized to perform any and all skills/procedures that fall within your level of certification.

Question Title

* 11. The creation of an Airway Management chapter:

Question Title

* 12. In which chapter would you find the protocol for removal of a Supraglottic Airway?

Question Title

* 13. How useful do you think having the PROCEDURES in SKILL SHEET format will be? (this question is asking for your opinion and will not be graded as correct/incorrect)

Question Title

* 14. Checklist use is:

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* 15. True or False: Advanced protocols are for use by all ALS and BLS providers

Question Title

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* 17. True or False: Participation in Double Sequential Defibrillation is mandatory.

Question Title

* 18. True or False: The Maintenance of Peripheral IV Therapy for EMTs protocol applies only for hospital-to-hospital transfer.

Question Title

* 19. Who does the Snohomish County Diversion Center EMT protocol apply to?

Question Title

* 20. Who is responsible to assure checklists are executed?

Question Title

* 21. The Checklists have been removed from the protocol book, where can they be found instead?

Question Title

* 22. According to the 2018 Airway Management – General protocol, before intubation providers should utilize two sources of oxygen to pre-oxygenate including a nasal cannula set at ____________________?

Question Title

* 23. According to the 2018 Airway Management – General protocol, “routine use of the Bougie is ____________________”.

Question Title

* 24. According to the 2018 Airway Management – General protocol, which of the following are appropriate methods for confirmation of endotracheal tube placement?

Question Title

* 25. According to the 2018 Airway Management – General protocol, tube placement should be reconfirmed “after ____________________ and at ____________________”.

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* 26. Please complete the following statement: “For purposes of reporting intubation, an attempt shall be defined as any time a laryngoscopy blade ____________________ with intent to ____________________”.

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* 27. According to the Drug Assisted Intubation protocol, DAI is prohibited in which of the following patients:

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* 28. According to the Drug Assisted Intubation protocol, documentation should include:

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* 29. According to the Rapid Sequence Intubation protocol, how should a provider select the proper dose of a paralytic?

Question Title

* 30. According to the Rapid Sequence Intubation protocol, what should be reassessed immediately and then every five minutes?

Question Title

* 31. According to the Post-Intubation Management protocol (p. 23), when should tube depth be documented?

Question Title

* 32. According to the Difficult Airway Protocol (p. 24), when documenting a difficult airway providers must:

Question Title

* 33. According to the Capnography protocol, which of the following patients should have ETCO2 monitoring?

Question Title

* 34. According to the Capnography protocol, which of the following represents a NORMAL ETCO2 reading?

Question Title

* 35. True or False: It is okay to skip contacting Medical Control and only tell the communication RN that you are delivering a patient on CPAP.

Question Title

* 36. According to the Cricothyrotomy (Surgical) protocol, which of the following patients is the most likely candidate for Surgical Cric?

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* 37. According to the Cricothyrotomy (Needle) protocol, which of the following patients is the most likely candidate for Needle Cric?

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* 38. According to the Supraglottic Airway Placement protocol, which of the following patients is the most likely candidate for a supraglottic airway?

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* 39. According to the Supraglottic Airway – Removal Without ET Placement protocol, the patient’s airway is the responsibility of the Provider who placed the SGA until he/she:

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* 40. According to the Spinal Assessment Decision Chart (p. 107), which of the following patients most likely requires Spinal Motion Restriction with a C-Collar and backboard?

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* 9. According to the note from Dr. Cooper in the presentation, county EMS protocols are " - developing in and advancing step by step"

* 25. According to the 2018 Airway Management – General protocol, tube placement should be reconfirmed “after and at ”.

* 26. Please complete the following statement: “For purposes of reporting intubation, an attempt shall be defined as any time a laryngoscopy blade with intent to ”.

* 55. Please complete the following summary statement, “SCEMS providers are expected to combine with verification by and ”.