EMD - Emergency Medical Dispatch Dispatch Life Support Instructions Questions and Answers 1 — Questions and Answers
Question 1: A caller reports a 3-year-old child is choking on a small toy. The child is conscious but not making any sounds and appears to be turning blue. According to Dispatch Life Support (DLS) protocols, which set of instructions is most appropriate for the EMD to provide?
- Instructions for adult abdominal thrusts (Heimlich maneuver).
- Instructions for a combination of back blows and chest thrusts. (Correct answer)
- Advise the caller to perform a blind finger sweep of the child's mouth.
- Tell the caller to lay the child down and begin chest compressions immediately.
Correct answer: Instructions for a combination of back blows and chest thrusts.
For a conscious choking infant or small child, standard DLS protocols, reflecting guidelines from organizations like the American Red Cross, recommend a 'five-and-five' approach. This involves administering five firm back blows between the shoulder blades followed by five chest thrusts. Adult abdominal thrusts are not recommended for small children due to the risk of internal injury. Blind finger sweeps are dangerous as they can push the object further down the airway. Chest compressions are for patients who are unconscious and not breathing.
Question 2: Which of the following best distinguishes Pre-Arrival Instructions (PAIs) from Post-Dispatch Instructions (PDIs)?
- PDIs are given before dispatching units, while PAIs are given after.
- PAIs are for life-threatening emergencies like choking or cardiac arrest, while PDIs are general safety instructions for most chief complaints. (Correct answer)
- PDIs are always optional for the caller to follow, whereas PAIs are mandatory.
- PAIs focus on gathering patient information, while PDIs focus on providing medical treatment.
Correct answer: PAIs are for life-threatening emergencies like choking or cardiac arrest, while PDIs are general safety instructions for most chief complaints.
Pre-Arrival Instructions (PAIs) are specific, scripted instructions for managing immediate, life-threatening situations such as cardiac arrest, choking, and childbirth before responders arrive. Post-Dispatch Instructions (PDIs) are more general, cautionary instructions given after dispatch for a wide range of chief complaints to ensure scene safety and provide basic care until help arrives.
Question 3: An EMD is providing CPR instructions to a caller for an adult patient in cardiac arrest. The caller is untrained and hesitant to perform mouth-to-mouth ventilations. What is the EMD's best course of action based on current DLS standards?
- Insist that ventilations are essential and refuse to provide further instructions until the caller agrees.
- Terminate the call and wait for responders to arrive on the scene.
- Instruct the caller to perform chest compressions only. (Correct answer)
- Tell the caller to find a bystander who is willing to perform ventilations.
Correct answer: Instruct the caller to perform chest compressions only.
Current international consensus guidelines and recommendations support providing chest-compressions-only CPR instructions (CCOIs) when a bystander is untrained, unwilling, or unable to perform mouth-to-mouth ventilations. This approach simplifies instructions and encourages immediate intervention, which is critical for survival.
Question 4: During a call for an imminent childbirth, the caller, who is with the mother, exclaims that the baby's head is crowning. Which of the following is a critical instruction the EMD must provide from the scripted protocol?
- Tell the mother to push as hard as she can to speed up the delivery.
- Instruct the caller to pull on the baby's shoulders as soon as they appear.
- Advise the caller to find a sterile clamp to cut the umbilical cord immediately.
- Instruct the caller to support the baby's head and tell the mother to pant and take short, quick breaths. (Correct answer)
Correct answer: Instruct the caller to support the baby's head and tell the mother to pant and take short, quick breaths.
Childbirth protocols guide the EMD to provide specific, step-by-step instructions. A key instruction when the baby is crowning is to have the caller support the emerging head without pulling and to coach the mother to pant through the contraction rather than pushing forcefully. This helps prevent tearing and allows for a more controlled delivery. Pulling on the baby or rushing to cut the cord are dangerous and not part of DLS instructions.
Question 5: The 'Emergency Rule' in emergency medical dispatch allows for the suspension of certain DLS instructions under specific circumstances. However, this rule NEVER applies to which set of critical events?
- Falls, fractures, and minor bleeding.
- Seizures, diabetic problems, and allergic reactions.
- Cardiac/Respiratory Arrest, Choking, and Childbirth. (Correct answer)
- Traffic collisions, assaults, and sick persons.
Correct answer: Cardiac/Respiratory Arrest, Choking, and Childbirth.
The Emergency Rule may be enacted during situations of extreme over-capacity, such as a mass casualty incident, allowing an EMD to suspend certain PAIs or PDIs. However, protocols explicitly state that this rule does not apply to situations where life-saving instructions are necessary, which are defined as cardiac/respiratory arrest, choking, and childbirth. For these calls, the EMD must stay on the line and provide instructions.
Question 6: A caller reports a severe arterial bleed from a deep laceration on a person's arm. After dispatching units, what is the MOST critical DLS instruction the EMD should provide?
- Ask the caller to find a cloth and begin cleaning the wound immediately.
- Tell the caller to elevate the arm and apply firm, direct pressure to the wound with a clean cloth. (Correct answer)
- Instruct the caller to apply a tourniquet using a belt just above the wound.
- Advise the caller to give the patient aspirin to prevent clotting.
Correct answer: Tell the caller to elevate the arm and apply firm, direct pressure to the wound with a clean cloth.
For severe bleeding, standard DLS and first aid protocols prioritize bleeding control. The most important initial instruction is to apply firm, direct pressure over the wound with a clean cloth or dressing and, if possible, to elevate the extremity. While some protocols include dispatcher-instructed tourniquet application, direct pressure is the fundamental first step. Cleaning the wound or administering medication is not the immediate priority.
EMD - Emergency Medical Dispatch Dispatch Life Support Instructions Questions and Answers 1
A caller reports a 3-year-old child is choking on a small toy.
The child is conscious but not making any sounds and appears to be turning blue.
According to Dispatch Life Support (DLS) protocols, which set of instructions is most appropriate for the EMD to provide?