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LA COUNTY TEST GRIND-WITH COMPLETE
SOLUTIONS 2026 GRADED A+
EMT personnel may immediately transport hypotensive trauma patients with life threatening, penetrating injuries to the torso to the closest trauma center, not the MAR,
- The legal obligations to report sexual assault in California, including how, when and to whom to report. . EMS personnel shall notify the local law enforcement agency of sexual assault patients regardless of whether the patient complains of physical injuries. EMS personnel shall document on the EMS Report Form to whom the incident was reported. - The importance of the Sexual Assault Response Team (SART) evaluation for victims of sexual assault and which patients may be released to law enforcement for direct transport to a SART center. Increased rate of conviction The definition of BRUE Brief Resolved Unexplained Event (BRUE): A brief episode characterized by any one of the following (for children 12 months of age or younger): absent, decreased, or irregular breathing; color change (usually cyanosis or pallor); marked change in muscle tone (usually limpness or hypotonia, may also include hypertonia); altered level of responsiveness. EMT personnel shall transport 9- 1 - 1 patients deemed stable and requiring only basic life support (BLS) to the MAR regardless of its diversion status ( When would EMT personnel not transport patients to the MAR? exception: internal disaster). Transport personnel shall take into consideration what kind of factors for transport? traffic, weather conditions, or other factors that may influence transport time in identifying the most accessible facility.
final authority for patient destination rests with the base hospital handling the call EMT personnel may honor patient requests to be transported to other than the MAR provided that the patient is deemed stable, requires basic life support measures only, and the ambulance is not unreasonably removed from its primary area of response. In order to facilitate this, EMT personnel may transfer care of a patient to another EMT team if necessary. In life-threatening situations (e.g., unmanageable airway or uncontrollable hemorrhage) in which the estimated time of arrival (ETA) of the paramedics exceeds the ETA to the MAR, EMTs should exercise their clinical judgment as to whether it is in the patient's best interest to be transported prior to the arrival of paramedics. Destination of Restrained Patients
. Restrained patients shall be transported to the MAR within the guidelines of this policy. . Restrained patients shall be transported to the MAR within the guidelines of this policy. Allowable exceptions
- Patients without a medical complaint, with a 5150 order written by a designated Department of Mental Health Team, when transport to a psychiatric facility has been arranged . 2. A law enforcement request for transport other than the closest may be honored with base concurrence Patient requests for transport to hospitals that are not 9- 1 - 1 Receiving Facilities may be honored by EMT or paramedic personnel provided:
- made aware that the requested hospital is not a 9 - 1 - 1 receiving facility;
- The Base hospital or EMS provider contacts the requested facility and ensures that the hospital has agreed to accept the patient;
- If transport requires additional transport time, the patient's condition is considered sufficiently stable to tolerate Ref 500 TRANSPORTATION / PATIENT DESTINATION Ref 502 Patient destination Ref 503 Guidelines for Hospitals Requesting Diversion of ALS Patients
elder abuse is considered (age) for persons 65 or older mandated reporter Anytime abuse is suspected reporting for abuse elder abuse written 48 hours or 2 business days child abuse must be reported in 36 hours ama is ref 834 minors can be released to themselves only if they are in an appropriate place for the child Injury to the spinal column associated with acute sensory or motor deficit requires trauma center transport yes or no? Yes Blunt injury to chest with unstable chest wall (flail chest) requires trauma center transport yes or no? YEs Diffuse abdominal tenderness requires trauma center transport yes or no? Yes Suspected pelvic fracture (excluding isolated hip fracture from a ground level fall) requires trauma center transport yes or no? Yes What are the 4 points of criteria for transporting an Extremity injury to a trauma center?
- Neurological/vascular compromise and/or crushed, degloved, or mangled extremity
- Amputation proximal to the wrist or ankle
- Fractures of two or more proximal (humerus/femur) long-bones
- Bleeding not controlled
faLLS require trauma transport for a pediatric patient Pediatric patients from heights greater than 10 feet, or greater than 3 times the height of the child faLLS require trauma transport for an adult when an require trauma transport for an adult when an Adult patients from heights greater than 15 feet trauma criteria for passenger space intrusion Passenger space intrusion of greater than 12 inches into an occupied passenger space trauma criteria if Ejected from vehicles (partial or complete) yes or no? N. Auto versus pedestrian/bicyclist/motorcyclist thrown, run over, or with significant (greater than 20 mph) impact O. Unenclosed transport crash with significant (greater than 20 mph) impac yes penetrating trauma asystole is 814 blunt trauma, asystole, vfib or vtach is 814 (PEA transport) Trauma criteria for an pedestrian versus auto Auto versus pedestrian/bicyclist/motorcyclist thrown, run over, or with significant (greater than 20 mph) impact unenclosed transport trauma criteria Unenclosed transport crash with significant (greater than 20 mph) impact trauma criteria Patients 15 years of age or older with 2nd (partial thickness) and 3rd (full thickness) degree burns involving equal to or greater than 20% Total Body Surface Area (TBSA) trauma criteria Patients ≤ 14 years of age with 2nd (partial thickness) and 3rd (full thickness) degree burns involving equal to or greater than 10% TBSA
. Trauma Guidelines - Mechanism of injury and patient history are the most effective methods of selecting critically injured patients before unstable vital signs develop. Paramedics and base hospital
yes trauma guidelines is trauma center is advisable for: Patients requiring extrication yes trauma guidelines is trauma center is advisable for: Vehicle telemetry data consistent with high risk of injury yes trauma guidelines is trauma center is advisable for: Injured patients (excluding isolated minor extremity injuries): 1. on anticoagulation therapy, other than aspirin-only 2. with bleeding disorders yes Patients in blunt traumatic full arrest who, based on a paramedic's thorough patient assessment, was not found apneic, pulseless, and without organized ECG activity (narrow complex supraventricular rhythm) upon the arrival of EMS personnel at the scene is a? B. Adults age greater than 55 years is a? Special Considerations - C. Systolic blood pressure less than 110 mmHg may represent shock after age 65 years is a? Special Considerations - D. Pregnancy greater than 20 weeks gestation is a? Special Considerations - Special Considerations - Consider transporting injured patients with the following to a trauma center: ref 508 SEXUAL ASSAULT PATIENT DESTINATION dose of lidocaine 40mg in 2mls and 20mgs in 1ml Sexual Assault Patient: A person who states they were sexually assaulted or a person suspected by the 9- 1 - 1 personnel to have been the victim of a sexual assault SART:
Sexual Assault Response Team - A sexual assault response team a coordinated interdisciplinary intervention model between law enforcement, crime laboratory, District Attorney's Office, medical and advocacy experts to meet the forensic needs of the criminal justice system and the medical and emotional needs of the sexual assault patient. SART Center: A licensed general acute care hospital, a licensed basic or comprehensive emergency department or a hospital sponsored program clinic that has met the specific requirements approved by the County of Los Angeles to receive patients who are victims of sexual assault. Sexual assault patients who deny physical injuries and who do not meet base hospital contact and transport criteria may be released at the scene to the local law enforcement agency for appropriate follow-up. Emergency Department Approved for Pediatrics (EDAP): A licensed basic or comprehensive emergency department that is designated by the Emergency Medical Services (EMS) Agency to receive pediatric patients via the 9- 1 - 1 system. Pediatric Medical Center (PMC): A licensed acute care hospital that is approved by the County of Los Angeles EMS Agency to receive critically ill pediatric patients via the 9- 1 - 1 system based on guidelines outlined in this policy. These centers also provide referral services for critically ill pediatric patients. Pediatric Trauma Center (PTC): A licensed acute care hospital that is designated by the EMS Agency to receive critically injured pediatric patients via the 9- 1 - 1 system based on guidelines outlined in this policy. These centers provide tertiary- level pediatric care and serve as referral centers for critically injured pediatric patients. Patients who require transport, and do not meet guidelines for transport to a PMC or PTC shall be transported to the most accessible EDAP. Patients meeting medical guidelines for transport to a PMC:
- Shall be transported to the most accessible PMC if ground transport is ≤30 minutes.
- If ground transport time to a PMC is >30 minutes, the patient may be transported to the most accessible EDAP. Patients meeting trauma criteria/guidelines for transport to a PTC:
- Shall be transported to the most accessible PTC if the transport time is ≤30 minutes.
require transport to a PMC: Post cardiopulmonary arrest in whom return of spontaneous circulation (ROSC) is achieved yes or no? yes require transport to a PMC: yes or no? yes ref 510 Pediatric Patient Destination ref 511 Perinatal Patient Destination ref 512 Burn Patient Destination ref 513 St Elevation Myocardial Infarction Patient Destination Perinatal: Refers to patients who are at least 20 weeks pregnant. Perinatal Center: Refers to a general acute care hospital with a basic emergency department permit and obstetrical service. This terminology is not intended to indicate the absence or presence of a neonatal intensive care unit (NICU). Perinatal patients should be transported to the most accessible facility appropriate to their needs. This determination will be made by the base hospital physician or Mobile Intensive Care Nurse (MICN) after consideration of the guidelines established in this policy. Final authority for patient destination rests with the base hospital handling the call. agitated delirium consider this drug in addition to versed sodium bicarbonate The following perinatal patients should be transported to the most accessible perinatal center: A. Patients who appear to be in active labor, whether or not delivery appears imminent B. Patients whose chief complaint appears to be related to the pregnancy. Patients who appear to be having perinatal complications C. Injured patients who do not meet trauma criteria or guidelines
D. Patients with hypertension (blood pressure 140/90 mmHg or greater) Post-partum patients (up to 6 weeks) with hypertension (blood pressure 140/90 mmHg or greater) shall be transported to a perinatal center. Perinatal patients who have delivered prior to arriving at a health facility should be transported to the most accessible perinatal center which is also an EDAP (consider a perinatal center with a NICU) Perinatal patients meeting trauma criteria and/or guidelines should be transported to a trauma center. Perinatal patients for whom transportation to a perinatal center would exceed 30 minutes should be transported to a receiving facility which is also an EDAP. The following perinatal patients should be transported to the most accessible receiving facility: A. Patients in acute respiratory distress B. Patients in full arrest C. Patients whose chief complaint is clearly not related to the pregnancy ST-Elevation Myocardial Infarction (STEMI): An acute myocardial infarction that generates ST-segment elevation on the prehospital 12-lead electrocardiogram (ECG). STEMI Receiving Center (SRC): A facility licensed for a cardiac catheterization laboratory and cardiovascular surgery by the Department of Public Health, Health Facilities Inspection Division, and approved by the Los Angeles County EMS Agency as a SRC If the 12-lead ECG demonstrates STEMI (or manufacturer's equivalent), transmit the 12- lead ECG to the receiving SRC. In general, patients with a STEMI 12-lead ECG, (including hypotensive patients with signs and symptoms consistent with cardiogenic shock) shall be transported to the most accessible open SRC if ground transport is 30 minutes or less regardless of service area boundaries. STEMI patients should be transported to the most accessible SRC regardless of ED Diversion status If the closest SRC has requested SRC Diversion (as per Ref. No. 503), STEMI patients should be transported to the next
b. Grip c. Arm Strength If mLAPSS is positive, calculate LAMS (score from 0-5) from the mLAPSS motor items: 1. Facial droop Total Possible Score = 1 a. Absent = 0 b. Present = 1
2. Arm drift Total Possible Score = 2 a. Absent = 0 b. Drifts down = 1 c. Falls rapidly = 2 3. Grip strength Total Possible Score = 2 a. Normal = 0 b. Weak grip = 1 c. No grip = 2 Primary Stroke Center (PSC): A 9- 1 - 1 receiving hospital that has met the standards of a Center for Medicaid & Medicare Services (CMS) approved accreditation body as a Primary Stroke Center and has been approved as a Stroke Center by the Los Angeles (LA) County Emergency Medical Services (EMS) Agency. Comprehensive Stroke Center (CSC): A 9- 1 - 1 receiving hospital that has met the standards of a CMS approved accreditation body as a Comprehensive or Thrombectomy Capable Stroke Center and has been approved as a Comprehensive Stroke Center by the LA County EMS Agency. CSCs have subspecialty neurology and neurointerventional physicians available 24 hours a day and 7 days a week who can perform clot-removing procedures (i.e., thrombectomy) Last Known Well Time: The time (military time) at which the patient was last known to be without the signs and symptoms of the current stroke or at his or her prior baseline Local Neurological Signs: Signs and symptoms that may indicate a dysfunction in the nervous system such as a stroke or mass lesion. These signs include: speech and language disturbances, altered level of consciousness, unilateral weakness, unilateral numbness, new onset seizures, dizziness, and visual disturbances. Transport to the CSC: Patients with suspected acute onset stroke symptoms and a LAMS of 4 or greater, if transport time is less than 30 minutes. If transport time to the CSC is greater than 30 minutes, the patient shall be transported to the most accessible PSC.
Transport to the closest stroke center: Patients with suspected acute onset stroke symptoms and a LAMS of 3 or less. Destination for patients with a positive mLAPSS whose LKWT is greater than 24 hours will be determined by the base hospital. administer meds how many minutes prior to extrication 5 minutes If there are no stroke centers (PSC or CSC) that are accessible by transport within the maximum allowable time of 30 minutes, the patient shall be transported to the most accessible receiving facility. Conservator: Court-appointed authority to make health care decisions for a patient. End of Life Option Act: This California state law authorizes an adult, eighteen years or older, who meets certain qualifications, and who has been determined by his or her attending physician to be suffering from a terminal disease to make a request for an "aid-in-dying drug" prescribed for the purpose of ending his or her life in a humane and dignified manner Pronouncement of Death: A formal declaration by a base hospital physician that life has ceased. Base hospital physicians may pronounce death based on information provided by the paramedics in the field and guidelines set forth in this policy. determination of death
- Decapitation
- Massive crush injury
- Penetrating or blunt injury with evisceration of the heart, lung or brain
- Decomposition
- Incineration 6 Pulseless, non-breathing victims with extrication time greater than fifteen minutes
- Penetrating trauma patients found apneic, pulseless, asystolic, and without pupillary reflexes
- Blunt trauma patients found apneic, pulseless, and without organized ECG due to traumatic mechanism
- Pulseless, non-breathing victims of a multiple victim incident where insufficient medical resources preclude initiating resuscitative measures.
- Drowning victims greater than one hour.
- drug therapy
- other life saving measures Advance Health Care Directive (AHCD): A written document that allows an individual to provide healthcare instructions and/or appoint an agent to make healthcare decisions when unable or prefer to have someone speak for them. AHCD is the legal format for healthcare proxy or durable power of attorney for healthcare and living will Aid-in-Dying Drug: A drug determined and prescribed by a physician for a qualified individual, which the qualified individual may choose to self-administer to bring about his or her death due to terminal illness. The prescribed drug may take effect within minutes to several days after selfadministration The POLST must be signed and dated by the physician, and the patient or the legally recognized decision maker. No witness to the signatures is necessary Base Hospital Medical Director: A physician who is providing oversight for prehospital operations at a Base Hospital who meets the criteria outlined in Ref. No. 308, Base Hospital Medical Director The POLST is designed to supplement, not replace an existing AHCD. If the POLST conflicts with the patient's other health care instructions or advance directive, then the most recent order or instruction governs. The following physicians may direct paramedics in advanced life support procedures at the scene of a medical emergency: the Medical Director and Assistant Medical Director of the EMS Agency, Provider Agency Medical Director, Medical Director of an approved Los Angeles based Paramedic Training School, Base Hospital Medical Director, or EMS Fellow in a Los Angeles based fellowship program. EMS Fellow: A physician who is participating in an accredited postgraduate sub-specialty training program (i.e., EMS/Disaster/Research) following successful completion of a residency program in emergency medicine. Neglect: The negligent treatment or maltreatment of a child by a person responsible for the child's welfare under circumstances indicating harm or threatened harm to the child's health or welfare. The term includes both acts and omissions on the part of the responsible person. within 36 hours of child abuse make a report too
Compete and submit the Suspected Child Abuse Report (SS8572), that is accessible on the DCFS web site at http://dcfs.lacounty.gov OR
- Complete a hard copy according to the instructions on the back of the form (Ref. No. 822.2 and 822.2a, SS8572). The completed form must be mailed to local law enforcement and either mailed to DCFS (1933 S. Broadway Avenue, 5th floor, Los Angeles, CA 90007) or faxed (213) 745-1727 or (213) 745 - 1728 within 2 business days of a suspected elder abuse The Report of the Suspected Dependent Adult/Elder Abuse form SOC 341 (Reference No. 823.1) must be completed and submitted to the agency initially contacted within two business (working) days of the verbal report. The Suspected Dependent Adult/Elder Abuse form SOC 341 (Reference No. 823.1) is available on the EMS Agency website at: http://file.lacounty.gov/SDSInter/dhs/206345_823-1.pdf When the suspected/known abuse occurred in a long-term care facility, state mental health hospital, or state development center, report to either . Local law enforcement agency, or ii. Long Term Care Ombudsman 1527 Fourth Street, Suite 250 Santa Monica CA 90401 Telephone: (800) 334-9473 After Hours: (800) 231-4024 (State Crisis Line) Facsimile: (310) 395- 4090 FLACC Face Legs activity cry consolability APGAR appearance, pulse, grimace, activity, respiration "Treat and Refer": A patient who, after an assessment and treatment by EMS personnel, does not have an ongoing emergency medical condition, does not desire transport to the emergency department for evaluation, and is stable for referral to the patient's regular healthcare provider or a doctor's office or clinic. Patients with a medical complaint, and with the following high-risk features, are not appropriate for Release at the Scene and should be transported or sign a refusal of transport against medical advice:
- Extremes of age (≤ 12 months or ≥ 70 years old)
- Abnormal vital signs - except isolated asymptomatic hypertension
150mg (3mL) IV/IO x1 prn after additional defibrillation x2, maximum total dose 450mg Begin Epinephrine after defibrillation x2: Epinephrine (0.1mg/mL) administer 1mg (10mL) IV/IO Repeat every 5 min x2 additional doses; maximum total dose 3mg ❽
14. For patients with renal failure or other suspected hyperkalemia: ❿ Calcium Chloride 1gm (10mL) IV/IO Sodium Bicarbonate 50mEq (50mL) IV/IO for rosc patients raise head to Raise head of stretcher to 30 degrees if blood pressure allows, otherwise maintain supine Chest compressions are the most important aspect of cardiac arrest resuscitation. Maintaining continuous chest compressions should take priority over any medication administration or transpor ❽ Epinephrine may improve outcomes if given early in non-shockable rhythms, but can worsen outcomes early in shockable rhythms, where defibrillation is the preferred initial treatment. Potential causes that can be treated in the field include hypoxia, hypovolemia, hyperkalemia, hypothermia, toxins tension pneumothorax Hypoglycemia is a very rare cause of cardiac arrest and should not be assessed until after ROSC. If hypothermia is suspected, resuscitation efforts should not be abandoned until the patient is re- warmed, or after consultation with the Base Physician. Post cardiac arrest patients are at high risk for re-arrest during transport. Fluid resuscitation, vasopressor support, and avoidance of hyperventilation are recommended to decrease the risk of rearrest. peds fentanyl dose 1mcg per kg 1.5mcg per kg nasal For chest pain after 12-lead ECG: Nitroglycerin 0.4mg SL prn ❹❺ Repeat every 5 min prn x2, total of 3 doses Hold if SBP < 100mmHg or patient has taken sexually enhancing medication within 48hrs For persistent chest pain after, or contraindication to, nitroglycerin:
Fentanyl 50mcg (1mL) slow IV push or IM/IN Repeat every 5 min prn, maximum total dose prior to Base contact 150mcg Morphine 4mg (1mL) slow IV push or IM Repeat every 5 min prn, maximum total dose prior to Base contact 12mg For suspected hyperkalemia: ❹ Calcium Chloride 1gm (10mL) slow IV/IO push, may repeat x1 for persistent symptoms Albuterol 5mg (6mL) via neb, repeat continuously until hospital arrival CONTACT BASE for obtain order for Sodium Bicarbonate 50mEq (50mL) slow IVP ❺ internal disaster bomb generators out flood hazmat no water (loss of water) For poor perfusion: Atropine 0.5mg (5mL) IV/IO push, repeat every 3-5 min prn, maximum total dose 3mg If IV cannot be rapidly established or if HR ≤ 40bpm in 2nd degree type II or 3rd degree heart block, proceed immediately to transcutaneous pacing ❶ If no improvement after initial dose of Atropine, proceed to TCP CP for HR ≤ 40 with continued poor perfusion Recommended initial settings: rate 70bpm/0mA, slowly increase mAs until capture is achieved CONTACT BASE concurrent with initiation of TCP If TCP will be utilized for the awake patient, consider sedation and analgesia For sedation: Midazolam 2mg (0.4mL) slow IV/IO push or IM/IN May repeat every 5 min, maximum total dose prior to Base contact 6mg For pain management: Fentanyl 50mcg (1mL) slow IV/IO push or IM/IN Repeat every 5 min prn, maximum total dose prior to Base contact 150mcg Morphine 4mg (1mL) slow IV/IO push or IM Repeat every 5 min prn, maximum total dose prior to Base contact 12mg
0. For signs of poor perfusion with HR > 40: CONTACT BASE to discuss appropriateness of TCP morphine min and max min 32mg max 60mg keep narc logs for
