BLS Study Guide 020620013

Basic Life Support
Study Guide
Knowledge Objectives
Clinical Operating Guidelines
02.06.2013
This study guide encompasses all the knowledge objectives for the Austin/Travis County
EMS System Clinical Operating Guidelines (COG). Every exam question will reference one
or several knowledge objectives found in this document. This study guide follows the COG
released in the Fall of 2012 for Spring 2013 implementation. In addition, some knowledge
objectives covered here address basic BLS knowledge, as it is expected that the BLS will
have a knowledge base appropriate for his or her certification level.
Review of this study guide will cover every point on the COG exam. More importantly, it is
designed to prepare the provider to use the COG to provide patient care to the citizens of
Austin/Travis County.
There are two ways to utilize this study guide. For the experienced System provider I
suggest you open the COGs, read the study guide question and glance at the COG to
make SURE you know it. The study guide looks cumbersome but this will allow you to just
review everything pretty quickly and focus on the things you are not as familiar with. For
the new System provider taking the COG test for the first time it is highly encouraged that
you write out the answers to each of the questions. It will take a while but you will be very
familiar with the COGs when you are done. The study guide is designed to help you focus
on things youd have to know in a hurry or wont have time to look up as those are the
things that usually get people in trouble. If you are reading a COG and think, Id need to
know that in a hurry (like who is a patient or when to stop/start CPR) its probably a
higher-than-normal chance that there will be a question on it on the COG test.
As always if there are any questions please feel free to contact the OMD at
www.atcomd/contact.htm or call the office at 978-0000.
A/TCEMS COG Study Guide BLS 02.06.13
Clinical Standards
Atypical Protocol Utilization and Online Medical Direction
This standard is designed to do what?
Describe the purpose of this standard.
There are two types of clinical encounters where the use of this protocol should be
used. What are they?
Does the provider requesting OLMC need to actually be with the patient?
Who should the provider call FIRST regarding operational or administrative issues?
How should this call be made?
Who should the provider contact if they cannot get in touch with that person?
How should THAT call be made?
Who can provide OLMC?
How would you document the use of OLMC?
BLS Transport Decision Process (note some of these are only appropriate for
transport BLS providers)
Explain the purpose of this standard
Which provider is responsible for conducting an initial evaluation of the patient?
What type of patients may be attended by a non-paramedic during transport?
Who is responsible for making the decision regarding which patients can be safely
transported by a lower credentialed provider
List the patients who CANNOT be transferred to a lower level of credential by a
transport paramedic
Describe the exceptions to the scenarios listed from the question above
Cancellation or Alteration of Response
What is this standard?
What is the purpose of this standard?
How are resources initially dispatched?
Who can modify or cancel the response of other System Providers not yet on
scene?
How and under what circumstances could a cancelled provider continue to the
scene?
What does this not apply to?
Child Abuse (<18 years old) Recognition and Reporting
Assessment of an abused child is based on what principles?
What does the Texas State Law say about reporting child abuse?
What is the Child Abuse Prevention and Treatment Act?
What is the first thing to do under application of this standard?
When is law enforcement notified?
When do you initiate a report to law enforcement?
How do you document?
When should you notify the Texas Department of Family and Protective Services?
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Does notification of hospital staff meet the minimum State requirements for
reporting?
Clinical Event Review

Describe this standard
What events will always be reviewed?
When do you need to self-report Level 1 or Level 2 events?
What will each organizations Performance/Quality Improvement staff review
initially?
What does confidential mean in this instance?
Does each organization and provider have to participate with the review process?
Does the medical director have to review Level 1 and Level 2 events before a
clinical improvement plan is implemented?
Crime Scene
What is the purpose for this standard?
General principles of crime scene management:
o What must the first arriving credentialed provider do?
o If law enforcement prevents entry what should be done with additional
responding units?
o How should a provider handle weapons found on scene?
o Is it appropriate for a provider to use items from a crime scene such as
towels, sink or phone?
o Should a provider encourage a victim to wash or shower prior to the arrival of
law enforcement?
o What needs to be done with ligatures and knots?
o What needs to be done with disposable items used during a resuscitation?
o If you have to touch things on scene how should you do it?
o Should the existence of a possible crime scene influence the decision to
initiate resuscitative efforts?
o May a body be covered if requested by law enforcement?
o Once a pronouncement time is obtained the body falls under whose
jurisdiction?
o Can a provider share patient care information with appropriate on-scene law
enforcement if a patient has been pronounced dead?
Crime scene management where no resuscitation is initiated:
o What should a provider who is not properly credentialed to seek
pronouncements of an obvious Dead On Scene patient do?
o How many providers should enter a scene where a pronouncement of death
is required?
Crime scene management with unsuccessful resuscitation:
o Should a provider remain on scene once a pronouncement has been made?
Crime scene management with transport:
o What should be done with clothing, jewelry or other objects removed from the
patient?
o What do you need to consider when cutting clothing?
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o If the patient has been placed on a sheet what must be communicated to the
receiving facility?
o What should first responders do if there is not law enforcement on scene
when they arrive?
Criteria for Death or Withholding Resuscitation
Can a provider honor an OOH-DNR from another state?
Under what circumstances can a provider decide to not initiate resuscitation efforts?
How do you document withholding resuscitation for fetal death?
If you are unsure whether or not a patient meets the criteria for withholding
resuscitation what should you do?
Definition of a Patient
Describe the purpose of this standard
A patient is any human being that: (list the five criteria)
What must be done for anyone that fits the definition of a patient?
What is the definition of an adult?
What is the definition of a minor?
What must be in place for a minor to be considered emancipated?
Describe when a minor may consent to treatment
Explain the protocol definition of a pediatric patient
Discontinuation of Prehospital Resuscitation
Under what circumstances can any System Credentialed Provider discontinue
resuscitation efforts WITHOUT OLMC?
Describe what criteria must be met for discontinuing resuscitation for a suspected
medical cause (only describe to your credentialing level)
If calling a System Medical Director for a determination to terminate efforts
resuscitation must continue while what happens?
Describe documentation for discontinuation of resuscitation
DNR/ Advanced Directives
Describe the standard
List the exceptions
Describe the purpose for this standard
What must be present to honor the DNR request and withhold CPR and ALS
therapy
Under what circumstances can a DNR request be overridden?
Explain what to do if there is a question regarding whether or not to honor an OOHDNR or Advanced Directive
Does the presence of a DNR or Advanced Directive mean that a patient receives no
care?
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If a family member says that there is an OOH-DNR but is unable to provider the
document what would you do?
Documentation of Patient Care Report

List the minimum documentation requirements for your credentialing level
Do you need to do a PCR for every patient contact?
How soon after a patient encounter does your PCR need to be available?
Explain how documentation for the delivery of a stillborn/non-viable fetus differs
from usual documentation
Describe how changes or clarifications can be made to a PCR once it is completed.
Documentation of Vital Signs
List the components of an initial complete set of vital signs
Explain when vital signs must be taken manually vs. mechanically
Explain what you will do if manual vital signs differ from the mechanical vital signs
When can an initial set of vital signs be deferred?
Explain when palpated blood pressures are acceptable
Explain what you would do if the patient refuses to allow you to acquire vital signs
Explain what you would do if a vital sign obtained falls out of the normal range for
a healthy person in the same age range as your patient
Domestic Violence (> 18 years old) (Partner and/or Elder Abuse) Recognition and
Reporting
Describe domestic violence
Describe psychological characteristics of abuse
Describe physical signs of abuse
Describe signs and symptoms of neglect
Describe when a healthcare provider must report suspicious findings
Describe how a healthcare must report suspicious findings
Does reporting to hospital staff meet the reporting requirements?
Emergency Medical Dispatch
Explain this standard
Describe when a unit that has been dispatched for Code 1 response can upgrade to
a Code 3 response
Explain when a unit or first responder may be diverted to another call
Explain whether an EMS unit and/or first responder may by-pass an incident
Hospital Diversion (applicable to BLS Transport)
Explain this standard
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Describe a Black-Internal Disaster

Describe a Black-Trauma Priority
Describe what should be done if a hospital attempts to divert an ambulance for
reasons other than those noted
Explain how to communicate a diversion status to a patient
Describe what would happen if a patient insists on transport to a facility on diversion
for the reasons noted
Explain the circumstances under which an EMS Supervisor can close a hospital to
EMS traffic
Identification Badges
Explain the standard
Explain why a patient must wear badges
Describe the only occasions when a badge does not have to be immediately visible
At what level may a provider without a badge function?
What must happen if a provider performs a procedure they are not credentialed to
perform?
What is the only exception to this?
Infant Abandonment
Describe Section 262.302 of the Texas Family Code
List the two purposes of this standard
Who do you notify after stabilizing the infant?
Interfacility Transfers (applicable to BLS transport)
Explain the purpose for the standard
Describe a MOT (Memorandum of Transfer)
Describe what should be done if the patient deteriorates during transfer
If transporting with hospital staff describe who is responsible for the management of
the patient
Describe the minimum care that will be provided for the transfer patient
Memorandum of Transfer or MOT (applicable to BLS transport)
List the items that must be present on an MOT
Describe what must happen if there is a conflict between the existing ATCEMS
destination policy and the indicated destination on the MOT
Describe reasons a unit might divert from the indicated destination on the MOT
Explain what would happen if the patient refused transport/transfer
Describe which two facilities are currently excluded from having a required MOT

Minimum Equipment to Patients Side
Be able to recognize the equipment required for your credential level
OMD Modification or Revocation of Credential to Practice
Explain the purpose of the standard
What is the duty of the Medical Director under this purpose?
Describe Unrestricted Status
Describe OMD Administrative Hold
Give examples of things that could lead to an OMD Administrative Hold
Describe Credential Suspension
Give examples of actions that could lead to the Suspension of credential
Describe the process for Suspension of credential
Describe Modified Credential Status
Explain things that may occur while on Modified Status
List reasons why a provider may be placed on Modified Status
Describe Voluntary Surrender of credential
Explain what will happen if a provider voluntarily surrenders their credential but
wishes to return later
Describe Revocation of credential
Describe what may constitute an integrity violation
Describe what constitutes intentionally withholding care
Describe what constitutes intentionally harming a patient
If a patient is restrained for their safety or that of a provider is that considered
intentionally harming a patient?
Describe what will occur if a provider willfully reports for a shift while taking
medication known by the provider to cause impairment
Describe what failure to remediate means
On-scene Authority for Patient Care
Explain the focus in case there is a disagreement on scene
Who has the authority over the scene in the event of conflicting approaches to
providing patient care?
How should significant or unresolved conflicts be handled?
In what instance should the Office of the Medical Director be notified as soon as
practical?
Patients with Special Healthcare Needs
Describe how you would handle a situation if you arrived on scene to discover a
patient with medical equipment that is unfamiliar.
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Physician on Scene
Explain the two different types of situations regarding on-scene physicians.
What must a physician provide on scene if he or she wants to intervene in your
patient care?
Under what circumstances can you defer to the orders of an on-scene physician?
Describe what you would do if the physician on scene wants you to do something
that is different than the System COGs?
Describe the circumstances where an Intervener Physician would be able to
manage patient care.
Describe under what circumstances a provider can accept medical orders by a nonphysician healthcare provider.
Provider Clinical Performance Review
Under what circumstances will the Medical Director convene a Clinical Performance
Review?
How will Clinical Performance Reviews be conducted?
How will conflicts of interest be handled?
Describe how confidentiality must be handled for this process
Provider Credentialing
Explain the difference between Certification or Licensure and Credential to Practice
Under what authority are you allowed to provide care within the ATCEMS System?
At what point is an individual Credentialed to Practice
Explain under what circumstances an individual would need to go through System
Clinical Reintegration
Provider Qualifications
Explain what a qualification is
Explain how qualifications are created and granted
Refusal of Treatment and/or Transport
Describe who can refuse care and/or transport against medical advice
Describe informed consent in detail
Upon what is informed consent based?
What must you provide for informed consent?
Explain implied consent in detail
Explain Substituted (Surrogate) consent in detail
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Identify exactly who may or may not consent to or refuse treatment, evaluation
and/or transportation of a minor
Identify the requirements that must be in place for a patient to refuse treatment
and/or transport
What would you do if a patient does not meet the criteria to refuse treatment and/or
transport but wishes to do so?
Can an ATCEMS System provider refuse or deny treatment or EMS transportation
to any patient?
Can an ATCEMS System provider discourage a patient (or their representative)
from seeking medical care?
If a patient wishes to refuse care what must you do?
If a patient refuses transport can he or she call 911 again for the same complaint?
What information would you provide the patient to make sure he/she understands
the possible risks associated with refusal?
What things must be documented for a refusal?
Request for Service by Individuals at a Hospital (applicable to BLS transport)

Describe the application of this standard
Describe the process for this standard
Safe Transport of Patients (applicable to BLS transport)
Describe the application of this standard
Describe how pediatric patients will be transported
STEMI Alert Criteria
Can a BLS or ILS first responder call a STEMI alert?
Stroke Alert
What provider can call a Stroke Alert?
List the components of the Cincinnati Prehospital Stroke Scale (CPSS)
List the requirements to call a Stroke Alert
System Design
Explain the goal of the Clinical Operating Guidelines
Explain how all patient care within the EMS System should be provided
Do individuals providing patient care in the EMS system need to be credentialed?
What may a provider holding current qualifications do?
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Describe what happens if a provider is not currently certified or licensed by the

Texas Department of State Health Services
Where are 911 requests managed?
What must a Tier 2 First Responder Organization be capable of delivering (at a
minimum)?
Explain Minimum Equipment List
How might a stand-by be different?
Under what conditions might the system design criteria be modified?
May a provider use a medication or equipment not approved by the System Medical
Director?
Transfer of Care to a Provider of Lesser Credentials (some only applicable to BLS

transport)
Under what circumstances might a provider transfer patient care to a provider with
lesser credentials?
Under what circumstances can a patient NOT be transferred to a provider with
lesser credentials?
Who is responsible for assessing the patient?
Under what circumstances can a patient requiring immediate and advanced
stabilization be left on scene?
Transport Destination Decision
Explain who, under most circumstances, can approve transport decision for a
patient
Describe what will be done if a patient refuses to go to a recommended facility
Describe a MOT
Describe how destination decisions are made if there are multiple patients from the
same event
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Universal Protocols
Deceased Person
List pertinent history questions that need to be asked
Describe signs/symptoms
If you are the first responder on scene and the patient meets system responder
criterion for obvious death or has a valid DNR what would you do next?
If the death seems suspicious or is traumatic who is notified?
What resources are available for the family of the deceased?
Patient Safety
Describe what should be done at the beginning of each shift
Describe what should happen if supplies fall below required levels
Describe the equipment failure procedure
Describe the parameters for Clinical Event Reporting
Spinal Motion Restriction Algorithm
Explain the need for a Spinal Motion Restriction Algorithm
Identify indications for the use of the algorithm
Identify sensory/motor considerations for the use of spinal motion restriction
Identify spinal pain/tenderness considerations for the use of spinal motion restriction
Identify distracting injury considerations for the use of spinal motion restriction
Identify patient exam considerations for the use of spinal motion restriction
Describe what a second rescuer should do
Describe when you should perform peripheral motor/sensory function and distal
pulses
Describe how and when you would pad void spaces
Describe how you would manage a patient who does not fit into SMR
Universal Patient Care
List all components of an appropriate history for a patient
Describe the difference between a Primary and Secondary Assessment and list the
components of each
List differentials
What is the first thing that must be done for each patient contact?
Describe a full patient assessment
List what would be considered a full set of vital signs
What is the minimum repeat time for vital signs?
Under what circumstances should a temperature be part of the initial vital signs?
List the minimal exam for each patient
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Trauma Protocols
Traumatic Arrest (Adult/Pedi)
Describe conditions where a trauma arrest should not be resuscitated or there
should be a discontinuation of resuscitation
If it is unclear whether this is a traumatic or medical arrest what should you do next?
Adult Burns
Describe signs/symptoms that would indicate a burn
Describe different types of burns
After scene safety and PPE what is the first thing you will do regardless of the type
of burn?
Describe the steps for taking care of a patient with a <10% body surface area burn
Describe what you would do for a chemical burn
Describe what would constitute a critical burn
Why should you not apply ice or cool burns that involve >10% of the body surface
area
Explain why circumferential burns to extremities are dangerous
What else do you need to look for during your assessment of the burn patient?
Pediatric Burns
Describe signs/symptoms that would indicate a burn
Describe different types of burns
After scene safety and PPE what is the first thing you will do regardless of the type
of burn?
Describe the steps for taking care of a patient with a <10% body surface area burn
Describe what you would do for a chemical burn
Describe what would constitute a critical burn
Why should you not apply ice or cool burns that involve >10% of the body surface
area
Explain why circumferential burns to extremities are dangerous
What else do you need to look for during your assessment of the burn patient?
Drowning Adult/Pedi
Describe other things you need to consider in your differential
If the patient is in respiratory distress post submersion describe the BLS treatment
Under what circumstances would a provider apply CPAP?
Describe the criteria for resuscitation
Under what circumstances should SMR be considered?
Describe why all submersion victims should be transported for evaluation
Describe who should remove the victims from the water
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Extremity Trauma Adult/Pedi
Describe signs/symptoms to look for
Describe your differential list
What procedures might you be using to treat this patient?
Describe treatment of an amputation
What should be documented on all splinted extremity injuries?
Explain what you would do if an injured, angulated extremity is pulseless
Describe treatment of an incomplete amputation
Explain concerns with hip, knee and elbow injuries
Head Trauma Adult
Describe the differential
What is considered hypotension?
Describe what you would do differently for the patient exhibiting clear evidence of
brain herniation
Describe Cushings Response/Reflex
If a patient with an obvious head injury is hypotensive what else do you need to look
for?
Describe the most important item to monitor and document
Explain what should happen to any patient with a documented loss of
consciousness, prolonged confusion or mental status abnormality even if his or
her symptoms have resolved by the time of your arrival
Head Trauma Pedi
What is considered hypotension?
Describe what you would do differently for the patient exhibiting clear evidence of
brain herniation
Describe Cushings Response/Reflex
If a patient with an obvious head injury is hypotensive what else do you need to look
for?
Describe the most important item to monitor and document
Explain what should happen with any patient with a reported loss of consciousness
even if it has resolved at the time of your arrival
Multiple Trauma Adult
Describe under what circumstances you would declare a Trauma Activation
Explain the tool/procedure available for a patient with an unstable pelvic fracture
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Describe what you would do for severe bleeding from an extremity not rapidly
controlled by direct pressure
Describe permissive hypotension and under what circumstances you should use it
Multiple Trauma Pedi

Describe under what circumstances you would declare a Trauma Activation
Explain the tool/procedure available for a patient with an unstable pelvic fracture
Describe what you would do for severe bleeding from an extremity not rapidly
controlled by direct pressure
Describe permissive hypotension and under what circumstances you should use it
What must you always consider with pediatric trauma?
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Adult Protocols
Abdominal Pain
Describe what you would do if the patient was lightheaded or had orthostatic vital
signs
What must you always consider in a woman of childbearing age?
Describe when you would not have to check orthostatic vital signs
Describe signs and symptoms of an abdominal aneurysm
Adult Failed Airway
Describe what you would do if you are able to maintain good air movement and/or
keep SPO2 >90% with BVM ventilation
At what rate should the patient be ventilated?
What should you do with patients with a suspected spinal injury?
Airway
Explain what you would do if the ABCs are adequate
Explain what you would do if the ABCs are not adequate
Describe what you would do if you suspect a foreign body or obstructed airway
Is an advanced airway always required?
Under what circumstances may a BLS provider place a blind insertion advanced
airway (currently the King LT)?
Allergic Reaction
What can you apply to the bite or sting site for patient comfort?
Describe how you decide to use the Severe Distress algorithm versus the Mild to
Moderate Distress algorithm
Describe how the Severe and Mild to Moderate distress algorithms differ
Describe how albuterol works and why you would use it for allergic reactions
Describe how epinephrine works and why you would use it for allergic reactions
Describe under what circumstances the BLS provider should provide CPAP and
how it should be applied
Describe the concerns if there is a very short onset from exposure to symptoms
Altered Mental Status
15
Under what circumstances can you give the patient oral glucose?
What should you not do if the patient has ingested alcohol?
If a patient is given glucose and their hypoglycemia resolves but they are on oral
hypoglycemic medications what should you do?
Describe what you should do if the patient returns to baseline after oral glucose, are
not on oral hypoglycemic medications and wish to refuse
Back Pain
Describe signs and symptoms of an abdominal aneurysm
Behavioral
After scene safety what do you need to do?
If the patient is a danger to him/herself and/or others what do you need to consider?
What evaluation must be done on all behavioral patients?
How will restrained patients be positioned?
Bites and Envenomations
Describe how you would care for an insect bite
Describe how you would care for a snakebite
Which gets an ice pack?
Is it necessary to take the snake to the ED if it is available?
Describe the difference between a pit viper bite and a coral snake bite
Explain why bites have a high risk of infection
List signs/symptoms of infection
List types of patients who are at higher risk for infection
Who can you contact for guidance regarding bites or envenomations?
Bradycardia
Carbon Monoxide
Describe treatment of the suspected CO patient with signs/symptoms of CO and/or
hypoxia
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Cardiac Arrest
Describe the criteria for withholding resuscitation
If ALS is not on scene describe the CPR and AED procedure to be followed
Describe when the airway should be reassessed
Describe the keys for success
Describe the Cardiac Arrest Checklist
List things you would not interrupt compressions for
Chest Pain, Suspected Acute Coronary Syndrome
What is the dose for aspirin?
Explain why it is important to apply 12-lead electrodes as soon as possible
Explain how oxygen will be titrated
Describe how nitroglycerine (NTG) will be administered
List contraindications to NTG
Explain how diabetics and geriatric patients my present differently
Cyanide
Under what circumstances would you remove and decontaminate a patient?
Describe how oxygen will be administered
What must happen before the patient is transported
List exposure signs/symptoms
Explain how cyanide may affect pulse oximeter readings
Excited Delirium
What is the first and most important step in this algorithm?
Describe what you would do if the patient has a temperature of >101
Who should assist with patient restraint if available?
Explain what must happen if a patient is handcuffed or restrained by Law
Enforcement
List possible medical/trauma causes for the patients behavior
Describe how restrained patients will be transported
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Eye Injury/Complaint
Describe the exam you will do if there is no known or suspected injury
Describe how you will treat an injured eye in socket with a burn or chemical injury
Describe how you will treat an injured eye in socket without a burn or chemical
injury
Can visual acuity be normal even with severe injury?
Under what circumstances would you cover both eyes?
Explain when you would use a shield vs. a pad for eye protection
Describe how you would care for an impaled object
Fever/Infection Control
Describe appropriate contact precautions and under what circumstances they would
be appropriate
Describe appropriate droplet precautions and under what circumstances they would
be appropriate
Describe appropriate airborne precautions and under what circumstances they
would be appropriate
Environmental Hyperthermia
Describe the initial steps to reduce heat exposure
Describe how treatment of the patient with altered mental status differs from
treatment for a patient without an altered mental status
Under what circumstances should a rectal temperature be checked?
If the patient has altered mental status what else must you check?
Hypotension (non trauma)
Define hypotension
Describe how the hypotensive patient will be positioned
Hypothermia Environmental
Describe initial steps that will be taken to decreased heat loss
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Induced Hypothermia
Describe the criteria for induced hypothermia
List the first steps that you will take to start external induced hypothermia
When should the airway be reassessed?
Nausea/Vomiting
Explain why you will perform a glucose assessment
Organophosphate Poisoning
Describe when, and how many times, you will use an atropine auto injector for
these patients
Describe who decontaminates these patients
Describe when the patient will stop receiving atropine
Overdose Adult
Describe signs and symptoms of a tricyclic antidepressant overdose
Describe signs and symptoms of a depressant overdose
Describe signs and symptoms of a stimulant overdose
Describe anticholinergic signs and symptoms
Describe signs and symptoms from cardiac medication ingestion
Describe signs and symptoms from solvent ingestion
What resource is available to you for overdose patients?
Who should you use to decontaminate a patient if needed?
Pain Management
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Post Resuscitation
List the considerations for induced hypothermia
What must be removed from the BVM as soon as pulses return?
Describe exactly how the post resuscitation patient will be ventilated
Describe why hyperventilation is bad for the post arrest patient
Describe how oxygen should be titrated
Pulmonary Edema
Describe how you will position the patient to maximize their breathing effort
Describe how nitroglycerine (NTG) will be administered
List contraindications to NTG
Describe under what conditions CPAP would be used
Describe how CPAP works
Respiratory Distress
Describe what it means if the patients lung sounds get quiet
Describe when you would use nebulized saline versus albuterol
Describe when you would use the patients MDI versus a continuous nebulizer
Describe how albuterol works
Describe when you would consider CPAP
Seizure
Describe what a vagus nerve stimulator or VNS is and how you would assist a
patient with it
Define status epilepticus
Describe a generalized/grand mal seizure
Describe a petit mal/focal seizure
Describe a Jacksonian seizure
Suspected Stroke
Describe the Cincinnati Pre-hospital stroke screen (CPSS)
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Describe what you would find that would trigger a Stroke Alert
Can any provider call a Stroke Alert?
Describe onset of symptoms or time of onset
Explain why a family member should accompany the patient to the hospital
Syncope
What is the cause of approximately 25% of geriatric syncope episodes?
Describe what things you need to check for the syncope patient
Ventricular Fibrillation & Pulseless Ventricular Tachycardia
Describe the defibrillation procedure
Describe treatment priorities for these patients
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Pediatric and Obstetric Protocols

Define a pediatric patient
Pediatric Failed Airway
Describe what you would do if you are able to maintain good air movement and/or
keep SPO2 >90% with BVM ventilation
Pediatric Airway
Explain what you would do if the ABCs are adequate
Explain what you would do if the ABCs are not adequate
Describe what you would do if you suspect a foreign body or obstructed airway
Is an advanced airway always required?
Explain how pediatric airways are usually managed
Pediatric Allergic Reaction
Describe how you decide to use the Severe Distress algorithm versus the Mild to
Moderate Distress algorithm
Describe how the Severe and Mild to Moderate distress algorithms differ
Describe how albuterol works and why you would use it for allergic reactions
Describe how epinephrine works and why you would use it for allergic reactions
What can you apply to the bite or sting site for patient comfort?
Describe the concerns if there is a very short onset from exposure to symptoms
Pediatric Altered Mental Status
Under what circumstances can you give the patient oral glucose?
Describe concerns regarding patients on oral hypoglycemics
Pediatric Bradycardia
Describe under what circumstances you will begin CPR
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Pediatric Carbon Monoxide
Describe treatment of the suspected CO patient with signs/symptoms of CO and/or
hypoxia
Pediatric Cardiac Arrest
Describe the criteria for withholding resuscitation
If ALS is not on scene describe the CPR and AED procedure to be followed
Describe when the airway should be reassessed
Describe the keys for success
Describe the Cardiac Arrest Checklist
List things you would not interrupt compressions for
Childbirth/Labor
Describe what you would check next after determining the patient is in active labor
Describe how you would take care of the patient who is not crowning
Describe how you would take care of the patient who is crowning and is >36 weeks
gestation
Describe what you will do if the patient has a prolapsed cord
Describe what you will do if the patient is crowning but < 36 weeks gestation
Describe when eclampsia can occur
Describe what needs to be documented
Explain the most common cause of post-partum hemorrhage
Pediatric Cyanide
Under what circumstances would you remove and decontaminate a patient?
Describe how oxygen will be administered
What must happen before the patient is transported
List exposure signs/symptoms
Explain how cyanide may affect pulse oximeter readings
Pediatric Fever/Infection Control
23
Describe appropriate contact precautions and under what circumstances they would
be appropriate
Describe appropriate droplet precautions and under what circumstances they would
be appropriate
Describe appropriate airborne precautions and under what circumstances they
would be appropriate
Pediatric Hyperthermia
Describe the initial steps to reduce heat exposure
Describe how treatment of the patient with altered mental status differs from
treatment for a patient without an altered mental status
Under what circumstances should a rectal temperature be checked?
If the patient has altered mental status what else must you check?
Pediatric Hypotension (non trauma)
Define hypotension
Pediatric Hypothermia Environmental
Describe initial steps that will be taken to decreased heat loss
Pediatric Nausea/Vomiting and Diarrhea
Describe signs and symptoms of dehydration
Explain why you will perform a glucose assessment
Explain one of the first clinical signs of dehydration
Newly Born
Describe how you will suction the newly born patient
Describe what you will do with the newly born infant
Describe when you will note the APGAR scores
Describe what you will do first if the infants pulse is less than 100 beats per minute
Describe what you will do next if the heart rate is less than 60 beats per minute
Describe what you will do if the heart rate is between 60-100
24
Describe what you will do if the heart rate is >100

Define non-vigorous infant
Why is it important to keep the infant warm and dry?
Obstetrical Emergency
Describe how you will begin assessing the obstetric patient
Describe what you will do with post-partum hemorrhage
Explain when eclamptic seizures may occur
Describe signs and symptoms of preeclampsia
Describe how hypertension is different for pregnant patients
Explain how you would determine how much a patient is bleeding
Describe the most common causes of post-partum hemorrhage
Describe any special positioning that you will do for the patient who is at >20 weeks
gestation
Pediatric Overdose
Describe signs and symptoms of a tricyclic antidepressant overdose
Describe signs and symptoms of a depressant overdose
Describe signs and symptoms of a stimulant overdose
Describe anticholinergic signs and symptoms
Describe signs and symptoms from cardiac medication ingestion
Describe signs and symptoms from solvent ingestion
What resource is available to you for overdose patients?
Who should you use to decontaminate a patient if needed?
Pediatric Pain Management
Describe the alternate pain scale you will use for pediatric patients
Pediatric Post Resuscitation
List the considerations for induced hypothermia
What must be removed from the BVM as soon as pulses return?
Describe exactly how the post resuscitation patient will be ventilated
Describe why hyperventilation is bad for the post arrest patient
Describe how oxygen should be titrated
25
Pediatric Respiratory Distress

Describe what albuterol is and how it works
Describe how you would assist a patient with their MDI and how many times you
can assist them
Describe how you would give a neb
Describe what a quiet chest indicates
Pediatric Seizure
Define status epilepticus
Describe a generalized/grand mal seizure
Describe a petit mal/focal seizure
Describe a Jacksonian seizure
Describe what a seizure may indicated in an infant
Pediatric Ventricular Fibrillation & Pulseless Ventricular Tachycardia
Describe the defibrillation procedure
Describe treatment priorities for these patients
26
Appendices
Approved Abbreviations
Youre on your own for this one. I always suggest flashcards for learning these. You
will not be asked questions on approved abbreviations but you may see hem used
in questions or answers and youll be expected to know them.
Infection Prevention Exposure Management
Who is responsible for infection prevention
Describe the infection triad
Describe how we can decrease the ability of the infection triad to cause disease
Discuss the importance of keeping current, appropriate immunizations
Describe when hands need to be washed
Explain what options are available if you cannot wash your hands
Describe how to wash your hands correctly
Describe standard PPE
Describe what should be worn during any airway management procedure
Describe when gowns should be won
Describe the signs and symptoms that would signal a provider that some level of
respiratory protection is required
Describe when a patient should be given a surgical mask to wear
Describe what should and should not be done with used needles
Describe how to disinfect surfaces
Describe what you would do if you have an exposure
Provider Clinical Performance Review Process
Describe the purpose of this process
Explain the background for this process
Define OMD Clinical Performance Review
Define Clinical Event Review
Be able to identify Indications that would indicate the need for an OMD Clinical
Performance Review
Describe who will make up the OMD Clinical Performance Review group
Explain why others are not permitted to observe or actively participate in the OMD
Clinical Performance Review group
Explain what will happen if providers from multiple System organizations are
involved in the same incident
Describe Conflict of Interest
Explain the need for confidentiality
Suspected Child Abuse and Reporting
Define Child Abuse
Describe incidents or conditions that would be considered child abuse
Describe the difference between abuse and neglect
Describe who must report and under what circumstances
Explain how confidentiality applies
27
Describe the reporting procedure for EMS

Describe signs/symptoms that would suggest child abuse
Describe procedures for taking care of suspected abuse patients
28
Clinical Procedures
12 Lead ECG
Describe the clinical indications for acquiring a 12 lead ECG
Describe where you should place each of the leads
AED
Describe the clinical indications for the use of the AED

List any contraindications for the use of the AED
List any precautions to the use of an AED
Describe the procedure for the use of the AED
Foreign Body Airway Obstruction

Describe the clinical indications for this procedure
Describe how you would assess of foreign body obstruction
Describe how you would clear the airway obstruction for an infant
Describe how you would clear the airway obstruction for a child
Describe how you would clear the airway obstruction for an adult
Explain what you would do if the patient becomes unresponsive while you are
attempting to clear the airway
Adult Assessment
Describe what you would do first, perhaps before even seeing/accessing the patient
Describe what is included in the initial assessment
Describe what is included in the focused assessment
Explain secondary assessment
Describe what you would include in an on-going assessment
Pediatric Assessment
Describe what you would do first, perhaps before even seeing/accessing the patient
Describe the pediatric assessment triangle
Explain what is included in disability
Explain why pediatric patients should not be exposed longer than necessary
Identify the most common sign of compensated shock in children
Discuss what you would include in history gathering
Auto-Injector Delivered Medication
Describe the clinical indications for the use of an auto-injector
List any contraindications for the use of an auto-injector
List any precautions to the use of an auto-injector
Describe the procedure for the use of an auto-injector
Where should your thumbs never be?
Describe site choice for the use of an auto-injector
29
Blood Glucose Assessment

Describe the procedure for the acquisition of a blood glucose reading
Childbirth
Explain why delivery should be controlled
Describe what you would do if the cord is wrapped around the neck
Explain how you would assist with the delivery of the posterior shoulder
Describe how you would clamp and cut the cord
When will you record an APGAR
What should you not do regarding the delivery of the placenta
Describe what you would do to decrease uterine bleeding and initiate delivery of the
placenta.
Describe what you would do with the placenta after its delivery
Cincinnati Prehospital Stroke Scale (CPSS)
Describe the CPSS
Identify indications for the use of the CPSS
Identify any contraindications for the use of the CPSS
Identify any notes/cautions for the use of the CPSS
List the three tests for the CPSS
Describe each of the tests, including abnormal and normal findings for each
Clinical Event Reporting
Describe the clinical indications for the use of this procedure
What will each System Transport Provider and First Responder Organization
establish?
Explain the process that credentialed providers will use to report clinical concerns
and events
Describe what reports of clinical concerns or events should include
Discuss examples of potential events and concerns that must be reported
Describe what should not be included in order to maintain confidentiality
Are credentialed providers expected to fully participate in clinical event reporting
and review processes?
Contact Precautions
Describe the clinical indications for the use of contact precautions
List any contraindications for the use of contact precautions
Describe the procedure for the use of contact precautions
Describe how gloves and gowns should be removed
CPR Pit Crew
Describe the clinical indications for the use of Pit Crew
List any notes or precautions to the use of Pit Crew
Describe the role of the person in Position 1
30

Describe the role of the person in Position 4 (if available)
For TWO person modified Pit Crew describe the role of the person in Position 1
For TWO person modified Pit Crew describe the role of the person in Position 2
Cricoid Pressure
Describe cricoid pressure (a.k.a. Sellick Maneuver)
List indications for the use of cricoid pressure
List contraindications for the use of cricoid pressure
List notes/precautions for the use of this procedure
Describe the procedure for performing the Sellick maneuver
Decontamination
Describe what HazMat Command will establish
Describe the initial decontamination procedures starting with removal of patients
from the Hot Zone
When should the initial triage of patients occur?
Describe technical decontamination
Explain what happens with a patients belongings
Determination of Capacity
Describe what you would do if the patient is suicidal or homicidal
How old does a patient need to be to determine capacity?
Describe what the patient must demonstrate to show the mental capacity to make
an informed decision
Describe what happens if a person who demonstrates present mental capacity
wants to refuse treatment
Describe what you will document
Equipment Failure
What should be done with equipment every day?
Describe what must happen immediately in the case of an equipment failure
What must be done with the equipment associated with the failure?
Describe the use of the Equipment Failure Report Form
End-Tidal CO2 Monitoring EZ Cap
List clinical indications for the use of an EZ Cap
List contraindications for the use of an EZ Cap
List notes/precautions for the use of an EZ Cap
Describe the procedure for using an EZ Cap
31

End-Tidal CO2 Monitoring Wave Form
List clinical indications for monitoring CO2
List contraindications for monitoring CO2
List notes/precautions for monitoring CO2
Describe the procedure for monitoring CO2
Describe what three things should be immediately considered if no CO2 is detected
Describe how you would record a waveform
Eye Irrigation BLS Only
List any contraindications for irrigation of the eye
List any notes or precautions to irrigating the eye
Describe the procedure for irrigating the eye
Gastric Tube Insertion
Describe the clinical indications for the use of a gastric tube
List any contraindications for the use of a gastric tube
Describe the procedure for the use of a gastric tube for the BLS provider
Impedance Threshold Device or Res-Q-Pod
Describe the clinical indications for the use of the ITD
List any contraindications for the use of the ITD
Describe the procedure for using the ITD if there is a BLS airway in place
Describe the procedure for using the ITD if there is an advanced airway in place
Insulin Pump
List any contraindications for the use of this procedure
List any notes or precautions to the use of this procedures
Describe the procedure for managing a situation involving an insulin pump
Describe how you would manage a patient who is refusing transport against
medical advice who has had a problem with their insulin pump
Kendrick Traction Device (KTD)
Describe the KTD
List clinical indications for the use of the KTD
Identify contraindications for the use of the KTD
Identify any notes/precautions for the use of the KTD
Describe the procedure for the use of the KTD
KING LTS-D Airway Device
Describe the clinical indications for the use of a KING airway
List any contraindications for the use of a KING airway
Describe any warnings/precautions for the use of a KING airway
Describe the procedure for inserting a KING airway
32

Lucas
Describe the Lucas Device
Identify indications for the use of the Lucas
Identify any contraindications for the use of the Lucas
Identify any notes/cautions for the use of the Lucas
Where are the AED pads placed for a patient with a Lucas
Nebulized Medication
Describe clinical indications for the use of a nebulized medication
Identify contraindications to the use of a nebulized medication
Describe how to put a nebulizer together
Describe how you would document
Describe the minimal monitoring that you need to do for your medicated patient
Orthostatic Blood Pressure Measurement
Describe orthostatic blood pressures
Identify indications for taking an orthostatic blood pressure measurement
Describe the procedure for taking an orthostatic blood pressure measurement
Describe signs/symptoms that would indicate orthostatic hypotension
Explain when you would omit checking an orthostatic exam on a patient who would
otherwise be a candidate for this exam
Pain Assessment and Documentation
Identify indications for the use of pain assessment and documentation
Define pain
Describe the general procedure for assessing pain
Explain the 0-10 scale
Explain the Wong-Baker Faces Scale
Explain the FLACC scale
Pelvic Binder (SAM Sling)
Identify the mortality rate for pelvic ring fractures
Describe the SAM Sling
Identify indications for the use of the pelvic binder
Identify contraindications for the use of a pelvic binder
Identify any notes/precautions for the use of the pelvic binder
Describe the procedure for the use of the Sam Sling
Physical Restraints
Identify indications for the use of the restraints
Describe the procedure for the use of restraints
Describe positioning for the restrained patient
Explain how often restrained extremities must be checked
Describe things that must be included in restraint documentation
Explain what should happen if a patient is restrained by law enforcement
33

Pressure Infusion Bag
Identify clinical indications for the use of a pressure infusion bag
Identify any contraindications for the use of pressure infusion bag
Describe the procedure to use a pressure infusion bag
Pulse Oximetry
Describe pulse oximetry including how the oximeter works
List clinical indications for pulse oximetry
Identify notes/precautions for pulse oximetry
Describe the procedure for utilizing pulse oximetry
Respiratory Precautions
Identify clinical indications for the use of respiratory precautions
Identify any notes/cautions for the use of respiratory precautions
List the ways that respiratory infections can be transmitted
Describe droplet precautions
Describe high risk respiratory procedures
Describe airborne precautions
Discuss signs and symptoms that should make a provider suspicious for
tuberculosis
Describe the procedure for utilizing airborne precautions
Safe Injection Practices
Identify clinical indications for this procedure
Identify any contraindications for the use of this procedure
Identify any notes/cautions for this procedure
Describe how you will safely perform an injection
Spinal Motion Restriction Algorithm
Explain the need for a Spinal Motion Restriction Algorithm
Identify indications for the use of the algorithm
Identify sensory/motor considerations for the use of spinal motion restriction
Identify spinal pain/tenderness considerations for the use of spinal motion restriction
Identify distracting injury considerations for the use of spinal motion restriction
Identify patient exam considerations for the use of spinal motion restriction
Describe what a second rescuer should do
Describe when you should perform peripheral motor/sensory function and distal
pulses
Describe how and when you would pad void spaces
Describe how you would manage a patient who does not fit into SMR
Splinting
Identify clinical indications for splinting
Describe the splinting procedure
Describe what you would do if there is a deterioration in pulses, sensation or motor
function after application of the splint
Describe what you would do if there is a pulseless angulated fracture
34
Standard Precautions
Describe standard precautions
Identify clinical indications for the use of standard precautions
Identify any contraindications for the use of standard precautions
Identify any notes/cautions for the use of standard precautions
Describe the procedure for the use of standard precautions
Describe when the use of gloves is appropriate
Discuss when gloves should be removed
Discuss when the use of gowns is appropriate
Discuss when and how you should remove a gown
Discuss when there is a need for mouth, nose and/or eye protection
Taser Probe Removal
Identify clinical indications for the removal of a Taser probe
Identify any contraindications for the removal of a Taser probe
Describe the procedure for removing the Taser probe
Explain how probes will be discarded
Tourniquet
Identify clinical indications for the use of a tourniquet
Identify contraindications for the use of a tourniquet
Describe the procedure for applying a tourniquet
Identify when the tourniquet is adequately tight
Explain what may happen if the tourniquet is not adequately tight
Describe what you would do if transport is prolonged
Vagus Nerve Stimulator (VNS)
Identify clinical indications for this procedure
Identify any contraindications for this procedure
Discuss any notes or precautions
Describe the procedure for disabling the VNS
Wound Care
Identify clinical indications for wound care
Describe the procedure for wound care
Explain why you would monitor wounds and/or dressings throughout transport
35
Glossary
Define:
Adequate Airway
Anaphylaxis
Angina pectoris
Apnea
Aspiration
Auscultate
Avulsion
Axilla
Baseline Assessment
Body Substance Isolation
Breech Presentation
Bronchi
Bronchospasm
BURP
Clinical Review Process
Congestive Heart Failure
Credential
Cricoid Pressure
Criterion
Critical Incident Stress Management (CISM)
Cyanosis
Decredential
Diaphoresis/Diaphoretic
Diastolic Blood Pressure
Eclampsia
Epiglottis
Epistaxis
Evisceration
Excited Delirium Syndrome (ED)
Exsanguination
External Laryngeal Manipulation (ELM)
Extruded
Five Deadly Sins
Foramen Magnum
Glasgow Coma Scale
Hemoptysis
Hemorrhage
Herniation Syndrome
Hypertension
Hyperthermia
Hyperventilation
Hypoglycemia
36
Hypoperfusion
Hypotension
Hypothermia
Hypovolemia
Impedance Threshold Device (ITD)
Implied Consent
Infarct
Infection Control Officer
Informed Consent
Intervener Physician
Ischemia
Laceration
Meconium
Mediastinum
Medical Directive
Minimal Data Elements
Myocardium
Narcotic
Nuchal Cord
Nuchal Rigidity
Obstructive Airway Disease
Obtunded Patient
Office of the Medical Director
On-Line Medical Consultation (OLMC)
Oxygenation
Patent Airway
Patient
Patient Care Record (PCR)
Peer Review Process
Perfusion
Permissive Hypotension
Personal Physician
Personal Protective Equipment
Pneumatic Anti-Shock Garment (PASG)
Pneumothorax
Primary Injuries
Professional Practice
Prolapsed Cord
Pulmonary Edema
Pulse Oximetry
Pulse Pressure
Qualification
Return of Spontaneous Circulation (ROSC)
Secondary Injuries
Shoulder Dystocia
Substituted Consent
37
Syncope
Tachycardia
Tachypnea
Tension Pneumothroax
Thermoregulation
Tracheal Deviation
Traumatic Brain Injury (TBI)
Trendelenburg Position
Unwitnessed Arrest
Ventilation
Witnessed Arrest
38

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Basic Life Support

A/TCEMS COG Study Guide BLS 02.06.13

A/TCEMS COG Study Guide BLS 02.06.13

Clinical Event Review

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Documentation of Patient Care Report

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Describe a Black-Internal Disaster

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Request for Service by Individuals at a Hospital (applicable to BLS transport)

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Describe what happens if a provider is not currently certified or licensed by the

Transfer of Care to a Provider of Lesser Credentials (some only applicable to BLS

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Multiple Trauma Pedi

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Pediatric and Obstetric Protocols

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Describe what you will do if the heart rate is >100

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Pediatric Respiratory Distress

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Describe the reporting procedure for EMS

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Describe the clinical indications for the use of the AED

Foreign Body Airway Obstruction

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Blood Glucose Assessment

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Describe the role of the person in Position 2

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