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Milford Ambulance Service Field Training Program
Situations Manual - BASIC
Table of Contents
Introduction
Protocols and policies
Medical / legal issues
Ambulance equipment
IV establishment
Trauma case study
Main streets and back roads exam
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FTP Situations Manual – Basic
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January 1, 2004
Second Edition
Milford Ambulance Service Field Training Program
Situations Manual - BASIC
Introduction
This manual has been developed to assist the new ambulance member
with his or her transition into the service by providing them with various
situations that can or have occurred during the tenure of the Milford
Ambulance Service.
The situations in this manual are designed to engage the trainee in
problem solving and conversation with FTO’s. It is our hope that
trainees will take this opportunity to exercise their decision-making
abilities and apply them to the scenarios in this manual. By working
through each situation with an FTO and obtaining what the service
considers to be an “appropriate” response or answer to each, it will better
prepare the trainee for future scenarios they may be faced by during the
course of their duty.
This manual address situations involving violations of policy, law, and
questions on protocols. It is important to understand that there may be
more than one correct answer to the situation, as with any incident in
the EMS field, and the explanations contained here within are to be used
as a guideline.
As a new trainee to the service we welcome you and encourage you to ask
questions not just of your FTO’s but also of all service members alike. It
is also up to you, the attendant, to help make yourself a vital and
respected member of the Milford Ambulance team.
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FTP Situations Manual – Basic
January 1, 2004
Second Edition
Milford Ambulance Service Field Training Program
Situations Manual - BASIC
Protocols / Policies
1. You are a basic EMT and riding with a partner who is an EMT-I.
You are on 20A2, the second ambulance, and the paramedic is all
ready out of town on another call. A tone goes out for a person
who is in and out of consciousness at the middle school. You and
your partner respond and meet the school nurse in the office. She
is there with a male child who is 13 years of age. She tells you
that he has a history of diabetes. He has taken some medication
this morning but has not had anything to eat. He is only semiconscious at this time and will need some assistance in
maintaining his airway. You take the patient’s vital signs and your
partner checks the blood sugar with the glucometer. It shows a
reading of 40. Your partner wants to start an IV and give D50.
You are not sure if he should do that since this patient is under
the age of 18 and not an adult. Your partner tells you that this is
an emergency and that the patient may die if he does not get the
D50 right away. What should you do in this situation to help
guide your partner and the ultimate treatment of this patient?
ANSWER: All though this is an emergency, your partner should not
establish an IV line on a pediatric patient. Any patient that is under the
age of fifteen (15) years old is considered to be a “pediatric” according
to MAS and SNHMC protocols. There are two options that are available
to you and your partner. You can either run the patient to the Milford
Medical Center to be stabilized or call for a paramedic intercept.
Otherwise, continue to support the patient with vitals, oxygen,
monitoring, and transport.
2. You and your basic partner are toned to the Pillsbury home for a
75 year old female who is experiencing difficulty breathing. Upon
your arrival you find the patient sitting in their bedroom with
distress. They are unable to speak in full sentences and have a
history of asthma. You listen to lung sounds and determine that
there are wheezes in all fields. The paramedic is all ready out on a
call and unable to respond to your location. One of the “care
givers” at the facility states that the patient does have a prescribed
inhaler but that it ran out yesterday. The inhaler medication is
albuterol. The “caregiver” further states that she also has asthma
and has an albuterol inhaler of the same dose. She states that she
has given the inhaler to your patient before in the past, and hands
you the inhaler. You look at the patient again and decide that she
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FTP Situations Manual – Basic
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Milford Ambulance Service Field Training Program
Situations Manual - BASIC
is in severe distress and that this is the only medication that you
can give. What should you do?
ANSWER: All though the patient has an inhaler and prescription for
albuterol, the fact remains that the medication has run out. It is not
appropriate to administer someone else’s medication to this patient. If
the patient were to have some sort of a reaction to the medication the
liability would rest with the ambulance crew. This patient should be
taken to the Milford medical center in town, a paramedic intercept form
another community should be called, or an EMT-I intercept from Milford
should be toned. EMT-I’s, per protocol, area able to asses the patient
and administer albuterol nebulizer treatments.
3. You and your intermediate partner respond to a call for a possible
fractured leg at the football field. Upon your arrival you find a 16year-old male who is sitting in the middle of the field. The coach
tells you that he was running with the ball when he was struck
from behind and fell to the ground. A “snap” was heard and the
patient’s right leg shows deformity in the tib/fib area. The patient
is splinted but complains of severe pain. He states that it is a 9 on
a 1-10 scale. As a basic you have no medications that you can give
this patient. What facility should you go to with this injury and
what else could you do to provide the patient with comfort or other
medications to help with the pain?
ANSWER: The best location for the patient is the Milford medical center
in town. They can administer the pain medications and, if necessary,
can have the patient transported down to a hospital in Nashua for
further treatment and follow-up care. Provide splinting care and
treatment to include O2, Vitals, and transport in the interim.
4. You and your basic partner are toned to a residence in town for a
woman in her 30’s having a seizure. Upon your arrival you find a
30ish female on the floor unresponsive. Her husband states that
she had a violent shaking episode at least two times within the last
five minutes. She never regained consciousness in between the
episodes. He further states that she has a history of seizures but
has not had one in the past 2 years. You begin your assessment
and determine that the patient is no longer violently jerking
around but that her pinky finger on her left had is “twitching” back
and fourth. As a basic what does this mean to you and what kind
of medical condition is the patient suffering from?
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FTP Situations Manual – Basic
January 1, 2004
Second Edition
Milford Ambulance Service Field Training Program
Situations Manual - BASIC
ANSWER: This would indicate that seizure activity is still active and –
present in the patient. This would classify as a “status epileptics” patient.
The fact that the patient’s finger is still twitching indicates that they are
still having a generalized seizer or grand maul seizure. Their muscles
have become too tired to keep up the full body jerking movement. This is a
life threatening condition and could result in brain injury.
5. You and your intermediate partner have been toned to an
industrial location for a report of a possible electrocution. Upon
your arrival you find a 50ish year old male sitting on the floor
conscious and breathing. He states to you that he as working on
an overhead fluorescent light and though the power was off. He
made contact with a “live” portion of the light with his metal
screwdriver and felt a jolt that knocked him off his aluminum
ladder. He did not hit his head nor did he fall from any height
greater than his own. He never lost consciousness and complains
of no head, neck, or back injury. His vitals are all within normal
ranges but he does complain of a burn to his right thumb and
index finger. Upon inspection you see a third degree burn to those
area where he was holding onto the screwdriver. What should
your treatment be of this patient?
ANSWER: This patient is suffering from an electrocution injury and
should be considered for full spinal immobilization, O2, Vitals, IV
therapy, and transport to the nearest trauma center. A trauma team
activation should be considered also due to the internal damage that
may have been caused by the electrical current to many body systems
and organs.
6. You and your basic partner are toned to a motor vehicle accident
on Rte. 101A. Upon your arrival you find a 16-year-old female who
was the driver of a 1996 dodge spirit. It is a minor accident with
minimal front-end damage. The patient was wearing a seatbelt.
There is no spidering of the windshield. The patient was traveling
around 30mph when she struck the back of a stopped motor
vehicle. She complains of no injuries and no pain. She did not
lose consciousness. He vitals signs are all within normal limits
and she has no past medical history. She is not on any
medications. She is 16 years old and with a friend of her’s who is
22 years old. She states that she does not want to be transported
to the hospital. You are unable to speak with her mother at the
scene. What should you do?
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FTP Situations Manual – Basic
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Second Edition
Milford Ambulance Service Field Training Program
Situations Manual - BASIC
ANSWER: Although it may be possible to clear the c-spine with the cspine clearance protocol, this patient will still need to be transported to
the nearest and appropriate medical facility until such time as a parent
or legal guardian can be notified and respond to sign the refusal form.
As a person who is under the age of eighteen (18) years old, this patient
is considered to be a juvenile and thus cannot sign or enter into any
type of contract in New Hampshire.
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FTP Situations Manual – Basic
January 1, 2004
Second Edition
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Situations Manual - BASIC
Medical / Legal situations
7. You and your intermediate partner are toned to respond to a
residence for a report of a patient having chest pains. Upon your
arrival you find a 70-year-old patient who is describing chest pain
and pressure under the sternum. They are pale and diaphoretic.
The patient’s pulse is increased and respirations are labored and
difficult. The patient has vomited. The patient wants you to
transport them to the hospital but does not want an IV or any
medications such as nitro, O2, or aspirin. As hard as you try you
cannot convince the patient to take any treatment other than
transport and the heart monitor. What should you do?
ANSWER: All though you know that the most appropriate treatment
would be to provide the above medications and skills, you cannot force
first aid or treatment upon anyone. The best thing to do is to continue
with informing the patient of the benefits of the treatments in hopes that
they will give you informed consent to provide such skills and
medications. Otherwise, provide the care that you can, transport to the
nearest and appropriate facility and document everything that
occurred.
8. You and your basic partner are toned to a home residence for a
report of a child having seizures. Upon your arrival you find a 17month-old female infant who is unresponsive from an apparent
seizure. The airway is secure and clear, the infant is breathing on
their own and vital signs are within normal ranges at this time.
The mother states that the child went unresponsive and began
“twitching” for about 30 to 60 seconds. That is when she called.
The infant is on no medications. When you suggest transporting
the child to the hospital the mother refuses transport. She states
that she only wanted you to respond to see if the infant was “ok”
and does not want any further treatment or transport. What
should you do?
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FTP Situations Manual – Basic
January 1, 2004
Second Edition
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Situations Manual - BASIC
ANSWER: If you believe that the infant is in imminent danger and that
further injury will occur if there is no transport or that transport is
delayed, you should contact the police department and request an
officer to respond to the scene. The officer can take the child into
protective custody and allow you to transport the child to the nearest
and appropriate medical facility. Otherwise, the mother is the child’s
legal guardian and we cannot transport the child against the wishes of
the mother. You should make your best attempts to inform the mother
of the severity of the condition and attempt to get an informed consent
from her.
9. You and your intermediate partner are toned for a report of a
motorcycle accident on Rte. 13 north. Upon your arrival you find a
23-year-old male who was involved in a crash at a speed of about
50 mph. The patient was not wearing a helmet and has a swollen
area on his forehead. Further more you detect that the patient has
consumed some alcohol. The patient’s vital signs are within
normal ranges but you detect slurred speech and a total lack of
coordination. The police ask you if you can check the patient out
because they would like to check him for DWI. While assessing the
patient he refuses transport to the hospital. What should you do?
ANSWER: Since there is a positive mechanism for injury to the head,
neck, or back and since the signs and symptoms that are presenting
can either be taken for intoxication or a closed head injury, you must
inform the police that the patient must be transported to the hospital.
The patient cannot refuse care at this time due to the potential for the
head injury, which indicates that he is incapable of making a solid
judgment that is rational and of sound mind. You will inform the
patient of the same and may use force to restrain the same.
10.
You and your basic crew, which consists of 2 other
attendants, have been toned to a home residence for a report of an
unresponsive person. Upon your arrival you find a 25-year-old
male who is indeed unresponsive lying on their side. The patient
has vomited once and your partner is assessing vitals at this time.
You are obtaining a medical history and another male witness at
the scene states that they were experimenting with acid and LSD.
He feels as though the patient may have overdosed or gotten some
“bad stuff”. The witness is very worked up and slightly hostile.
You call for the police to respond. Upon their arrival the single
officer is speaking with the witness. The witness becomes agitated
and the officer escorts him out of the immediate room that you are
your patient are in. As you and your partners are working on the
patient, securing the airway and establishing an IV, you hear a
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FTP Situations Manual – Basic
January 1, 2004
Second Edition
Milford Ambulance Service Field Training Program
Situations Manual - BASIC
small scuffle taking place in the other room. You get up and see
that the officer is struggling with the witness and attempting to
handcuff him in the other room. The witness clearly does not want
to be cuffed and continues to struggle. What should you do?
ANSWER: It must be understood that you are at the scene as an
ambulance attendant and not a police officer. You should not get
involved with the situation unless the officer specifically requests your
assistance. This is with the understanding that assistance can refer to
calling for back up on the radio to get other police officers on scene. You
primary goal is patient safety and care.
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FTP Situations Manual – Basic
January 1, 2004
Second Edition
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Situations Manual - BASIC
Ambulance equipment
11.
While performing the morning rig check of the ambulance
you note that the heart monitor fails the self-test. What should
you do?
ANSWER: The director should be notified ASAP and the monitor may
have to be taken out of service until such time as it has been repaired.
This should also be noted on the daily rig check sheet and documented.
12.
While doing the morning rig check, of the ambulance, you
begin checking the first in bag. You have noted that there are only
4 band-aids in the kit and all though that is all the check sheet
calls for you feel as though there should be more in the kit in case
you need them. What should you do?
ANSWER: What you personally feel should be on the ambulance may
differ from what others think should be there. The rig check sheet has
been set up with minimum requirements that are in accordance with the
State of New Hampshire EMS checklist requirements. By adding more
equipment to the ambulance, MAS will lose the standardization and
uniformity between the two ambulances.
13.
You and your basic partner have been toned to the scene of
a minor motor vehicle accident. You have the patient loaded and
you are driving the patient to the Milford Medical Center. As you
are backing up you bump another vehicle behind you. It is parked
and the owner is nowhere around. There is only very minimal
damage to the ambulance and a scratch on the bumper of the
vehicle that you struck. What should you do?
ANSWER: You must not leave the scene of an accident. You can
contact the local police department to report the accident and, if it is not
severe and no injury, the police may release you from the scene to
continue transporting to the hospital. Otherwise, contact the second
ambulance and have them respond to the scene to take and transport
to the hospital.
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FTP Situations Manual – Basic
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Situations Manual - BASIC
IV establishment
14.
You are an intermediate and are toned for a 40-year-old
female patient who has a possible fractured leg. The patient was
hiking in the woods and slipped and fell. She thought she heard a
snap. Her vital signs are stable and no other significant history or
injuries are noted. Should you establish an IV?
ANSWER: Yes. Due to the possibility that there is a fracture, an IV
would be warranted. There may be a lengthy extrication as well as
pain medications that can be given.
15.
You are an intermediate and you are toned for a person who
has a history of stroke. Upon your arrival you find a 50-year-old
male whose only complaint was that he could only look to the right
side. This condition came on suddenly within the past hour. He
has had a history of TIA’s but not for the past 2 years. The
patient’s vital signs are within normal ranges and there is not SOB
or difficulty breathing. Should you establish an IV?
ANSWER: Yes. This could be a sign of another TIA, that could worsen
within the next few moments or hours. There is no way of telling, thus
an IV would be warranted in case the patient takes a turn for the worse
or needs a port for medication administration. Bloods can also be
drawn for this patient.
16.
You are an intermediate and are toned for a female patient
who has fallen off her back deck. She is 45 years old and she has
been consuming alcohol. She states that she only has a minor
headache and no other complaints. She has positive csm’s in all
extremities and states that she did lose consciousness for a few
minutes prior to the ambulance arriving. Should you start an IV?
ANSWER: Yes. Due to the possibility that the patient has a closed
head injury and the loss of consciousness, an IV would be warranted.
Bloods can also be drawn for this patient.
17.
You are an intermediate and toned to a home residence for a
subject sitting on the front porch complaining of feeling dizzy and
light headed. Upon your arrival you find a 58-year-old male who
tells you that he was driving himself to the hospital because he
was feeling lightheaded. As he was driving he began feeling dizzy
and pulled over at this residence. His vital signs are within normal
ranges but he just does not feel right. He has a history of cardiac
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FTP Situations Manual – Basic
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Situations Manual - BASIC
issues and stroke. He has no paralysis and no chest pain. He is
not short of breath. Should you start an IV?
ANSWER: Yes. Due to the fact that the patient has a history of stroke
and is feeling ill, an IV would be warranted to provide a medication port
for medication administration, blood draw access, and a fluid bolus
depending on what the patient’s blood pressure is. Further
examination would be required to see if there are other medical issues
present with the patient that would further warrant the IV.
18.
You are an intermediate and have been toned to the scene of
a minor motor vehicle accident. Upon your arrival you find a 17year-old male who was operating a small sports car (red with two
white racing stripes) and lost control of the vehicle when it
hydroplaned into a banking off the side of the road. There is
damage to the vehicle and the male was not wearing a seat belt.
He slid forward in the seat and struck his chest on the steering
wheel. He complains of only minor pain to the area and slight
SOB. His vital signs are within normal ranges. He denies any loss
of consciousness. Should you start an IV?
ANSWER: Yes. Due to the nature of the injury and the impact to the
chest, an IV would be warranted for the potential internal injuries or
chest injuries. Since the patient is still relatively young, his body may
be compensating well and the true severity of the injuries may not be
readily apparent at this time.
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FTP Situations Manual – Basic
January 1, 2004
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Situations Manual - BASIC
Trauma Case Study
20A1 and the medic are returning from Nashua, from a chest pain
call when 20A2 and the police are dispatched to the scene of an
attempted suicide with shots fired. Apparently a family member
who was called by the patient threatening to do harm to himself
with a handgun received the call. The police arrive moments
before you and advise that the scene is secure (safe) and that you
should respond directly to the scene, which is a private home.
Upon arrival, you find a 45-year old male lying prone with his face
in a pool of blood. He is moaning and his chest and abdomen
appear to be moving as he breathes. After donning protective
gloves, mask, and goggles, both you and your partners carefully
provide manual stabilization of the neck and log roll the patient
onto a long board.
What you reveal is a mandible and tongue that are severely
lacerated and the mouth and nose are bubbling with blood as the
patient attempts to breathe.
19.
How should you open the airway of this patient?
ANSWER: You would open the airway with the modified jaw thrust due
to the potential for a head or neck injury.
20.
Does this patient need to be suctioned?
ANSWER: Yes, in order to maintain the airway properly and keep from
moving the head excessively, suctioning must be performed.
21.
If so, what is the maximum amount of time to accomplish
this procedure?
ANSWER: No more than fifteen (15) seconds.
22.
Should an airway adjunct be used on this patient?
ANSWER: Yes, both an oral and nasal adjunct should be used.
23.
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If so, what is your 1st choice and then your 2nd choice for a
patient who has a
gag reflex?
FTP Situations Manual – Basic
January 1, 2004
Second Edition
Milford Ambulance Service Field Training Program
Situations Manual - BASIC
ANSWER: The oral airway and then the nasal.
Once the patient’s airway is opened and cleared, you need to oxygenate
this patient. He has no other obvious injuries, yet you are treating him
for a possible spinal injury due to the impact of the bullet and his
backward fall from his desk chair during the incident. The police think
that this is why he shot his chin instead of his brain during the suicide
attempt. You evaluate the patient’s breathing rate as 28 shallow and
labored and his pulse as 120 weak and regular.
24.
What device should be used to administer oxygen to this
patient?
ANSWER: A BVM with 100 percent oxygen.
25.
What is the proper liter flow to set the regulator?
ANSWER: 15 to 25 lpm
26.
Your portable D cylinder was full at the beginning of the shift
and this is your first call. How many liters are in the tank?
ANSWER: 2000
27.
How much pressure is in the tank?
ANSWER: 2000psi
27.
As you prepare to transport the patient, you continue to
suction him making sure not to exceed ____ seconds per attempt.
ANSWER: 15 seconds.
29.
This is because as you suction you are also removing
______.
ANSWER: Oxygen
30.
Which would be better to use, a Yankauers tip or a whistle
tip catheter?
ANSWER: Yankauers.
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FTP Situations Manual – Basic
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31.
What is the difference between a Yankauers and whistle tip
catheter?
ANSWER: The Yankauers is a rigid tipped suction device where as
the whistle tip is a soft tip device used for small mucus.
32.
The patient has a BP of 100/70 so you decide his priority is
[high or low?]
ANSWER: High priority.
33.
The major problem with this patient is his _______.
ANSWER: His airway management.
34.
He should be transported [right away or in a few minutes].
ANSWER: Right away.
35.
He should be brought to [MMC or trauma team in Nashua?}
ANSWER: If the airway can be properly secured and the patient is
oxygenating well, you should go to Nashua, otherwise you should go
to MMC to stabilize the patient.
36.
What ALS treatment might be helpful to this patient if the
paramedic in 20A1 can intercept you on his return from Nashua?
ANSWER: Endotracheal intubation.
37.
What should you do if you hear hissing or bubbling around
the mask as you ventilate?
ANSWER: Reposition the mask and get a better seal around the
airway.
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Situations Manual - BASIC
Milford Ambulance Service
Field Training Program
Main Streets and Back Roads of Milford Exam
Trainee Name: _________________________________________________
1. What
a.
b.
c.
d.
landmark is closest to Capron Road?
Burger King
Good day café
The oval
Hampshire Hills
2. What
a.
b.
c.
d.
landmark is located on Buxton Road?
China Star restaurant
School bus company
State gas pumps
None of the above
3. What
a.
b.
c.
d.
road is Great Brook Road located off from?
West Street
North Street
Ridgefield Drive
Mason Road
4. What
a.
b.
c.
d.
road is River Way West located off from?
Elm Street
Nashua Street
West Street
Westchester Drive
5. What
a.
b.
c.
d.
road is the Milford Police Department located on?
Nashua Street
Elm Street
South Street
Mont Vernon Street
6. What
a.
b.
c.
d.
road is Primary Care of Milford located on?
Franklin Street
Nashua Street
Jones Road
None of the above
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Situations Manual - BASIC
7. What
a.
b.
c.
d.
road are the Granite Square Apartments located on?
Bridge Street
South Street
North River Road
Nashua Street
8. What
a.
b.
c.
d.
road is the town’s transfer station located on?
River way East
Mont Vernon Street
North River Road
Capron Road
9. What
a.
b.
c.
d.
road is the Heron Pond School located off?
Elm Street
Mason Road
Iris Road
Whitten Road
10.
a.
b.
c.
d.
Where is Dr. Diagastino’s office located?
At 161 Bridge Street in the basement
At 28 Jones Road in the back of the building
At the Granite bank on the top floor
At the Milford Medical Center on Nashua Street
a.
b.
c.
d.
What road is Key’s Field located on?
Elm Street
Noon’s Quarry Road
Purgatory Road
Franklin Street
a.
b.
c.
d.
What road is the Pillsbury Home located on?
Franklin Street
High Street
Bridge Street
Buxton Road
a.
b.
c.
d.
What road is Crestwood nursing home located on?
Elm Street
Crosby Street
North Street
Both A and B
11.
12.
13.
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FTP Situations Manual – Basic
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Situations Manual - BASIC
14.
a.
b.
c.
d.
What is the address of the town hall?
1 Mason Road
1 Elm Street
1 Union Square
1 Middle Street
a.
b.
c.
d.
What road leads to Brookline, NH?
Mont Vernon Street
Jones Road
Perry Road
South Street
a.
b.
c.
d.
Summer Street runs off from what road?
Amherst Street
Mont Vernon Street
High Street
Armory Road
a.
b.
c.
d.
The Hitchcock Clinic is located on which road?
Federal Hill Road
Ponemah Hill Road
Willow street
Armory Road
a.
b.
c.
d.
Hampshire Hills is located on what road?
Ponemah Hill Road
Emerson Road
Boxwood Circle
Wellesley Street
15.
16.
17.
18.
19.
If you were dispatched to County Stores what road would it
be on?
a. Alder Street
b. Emerson Road
c. Nashua Street
d. Annanad Street
20.
What would be the fastest way to get to the town center of
Amherst from the Milford Ambulance bay?
a. Nashua Street
b. Amherst Street
c. North River Road
d. Farley Road
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21.
If you were dispatched mutual aid to Mont Vernon to the
Mont Vernon Inn, what road would you take to get there the
fastest?
a. Purgatory Road
b. Amherst Street
c. Chappell Drive
d. Mont Vernon Street
22.
a.
b.
c.
d.
What is the closest landmark to the Milford High School?
Cumberland Farms
Highland Estates
Heritage Estates
Woodland Heights
a.
b.
c.
d.
What road is Woodland Heights located on?
Powers Street
Purgatory Road
West Street
Clinton Street
a.
b.
c.
d.
What road is Westchester Heights located off?
Westchester Drive
Elm Street
Both A and B
Joslin Road
a.
b.
c.
d.
What road is the MCAA athletic fields located on?
Stable Road
Sunset Circle
North River Road
Clark Road
23.
24.
25.
Page 19 of 19
FTP Situations Manual – Basic
January 1, 2004
Second Edition