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When a member suspects that they have has a biological exposure (incident) while on duty or during an off duty fire or emergency that they have responded to within the City of New York, the member shall notify their company officer as soon as possible. Upon receiving notification of the exposure incident, the company officer shall: which is the correct point?

A) Review the MD-X3 for accuracy and completeness.

B) Fax only the completed MD-X3 to the Medical Officer on emergency duty through the Medical Leave Desk and to the OSHA office.

C) If unable to complete transmission of the MD-X3 via fax, email the Bureau of Health Services.

D) All are correct

A) Review the MD-X3 for accuracy and completeness.

(CFR-D Ch 3, 4.2)

B - Fax completed MD-X3 AND RESPECTIVE PCR.

C - If unable to fax MD-X3 then CALL BHS.

1

Body Substance Isolation is an approach to infection control whereby all human blood and all human body fluids are considered potentially infectious; therefore precautions must be taken to avoid any contact with blood, body fluids, and all other potentially infectious materials. Which is the most correct procedure from the list below in regards to BSI?

A) Members shall wash their hands as soon as possible after the removal of gloves or other PPE.

B) Members shall avoid contact with contaminated sharps (contaminated objects that can penetrate the skin)

C) Eating, drinking, smoking, applying cosmetics or lip balm, and handling contact lenses are prohibited in work areas where there is a reasonable likelihood of occupational exposure.

D) Members are not permitted to wear sneakers or sneaker types of shoes while on duty.

E) All of the above are correct

E) All of the above are correct

(CFR-D 3, section 12)

2

Which point about the hazardous waste (Red bag) disposal policy for CFR-D Companies is incorrect?

A) CFR-D Companies shall drop off Red Bag waste at their CFR-D Depot.

B) Citywide pickups for Red Bag waste shall be at CFR-D Depots.

C) CRF-D Depot Officers shall contact Solid Waste Technologies, Inc. to have the Depots Red Bags picked up for proper disposal.

D) In the event of a missed pickup of Red Bags, the CFR-D Depot Officer shall contact the Resource Center. A work order will be generated and automatically sent to the OSHA Unit who will contact the vendor to expedite pickup.

E) The CFR-D Depot Officer should retain the work order number until the Red Bags have been picked up. The Red Bags should be placed outside company quarters until pickup.

E) The CFR-D Depot Officer should retain the work order number until the Red Bags have been picked up. The Red Bags should be placed outside company quarters until pickup. (INCORRECT)

(CFR-D 3, 12.16)

* DO NOT place Red Bags outside under any circumstances

3

Which is an incorrect procedure for disposable body bags used by fire suppression units?

A) Body bags may be obtained from the Battalion Chief on the scene. If a Battalion Chief is not on the scene, the IC shall call a Battalion Chief to the scene.

B) The victim shall be placed in a disposable body bag and as an additional precaution that bag shall be placed inside another disposable bag.

C) The disposable bags have no handles; they must be placed inside a heavy duty, non-disposable body bag for transport.

D) When the body is inside the transport vehicle, the outer bag shall be removed.

A) Body bags may be obtained from the Battalion Chief on the scene. If a Battalion Chief is not on the scene, the IC shall call a Battalion Chief to the scene. (INCORRECT)

(CFR-D 3, 13.10.1)

* Body bags may be obtained from the DIVISION CHIEF on scene. If a
DEPUTY CHIEF is not on scene, the IC shall call a BC to the scene

4

Infection control personal protective equipment (PPE) shall be worn by members during those incidents where members could be potentially exposed to blood and other potentially infectious materials. Which is an incorrect item from the list below in regards to infection control PPE?

A) Company commanders shall insure that all members are aware of the location of the infection control equipment on the apparatus.

B) Company Officers, at roll call, shall have members check the location of infection control equipment on the apparatus and the quantity of supplies on hand. A record of this inspection shall be incorporated in the roll call entry.

C) If the location or status of this equipment changes during the tour, the officer shall make a Company Journal Entry to this effect.

D) Home laundering of department issued infection control PPE is permitted.

D) Home laundering of department issued infection control PPE is permitted. (INCORRECT)

(CFR-D 3, 13)

* DO NOT take infection control PPE home.

5

At the start of each tour, the officer shall make out the riding list that includes each member's CFR-D assignment along with his firefighting assignment and riding position. Which assignment is correct?

A) "A" - Airway - FF responsible for manually stabilizing the patients spine (if trauma is suspected) while opening the airway, maintaining the airway, and administering oxygen if needed.

B) B - "Boss" - The Officer in charge, who must complete the PCR.

C) C - "Checker" - FF responsible for conducting the patient assessment and performing any hands on care. In response to a cardiac arrest, this FF begins ventilations and carries the oxygen bag.

D) "D" - Defib - In response to a cardiac arrest, this FF checks the pulse and begins compressions.

E) The chauffeur must always remain with the apparatus.

A) "A" - Airway - FF responsible for manually stabilizing the patients spine (if trauma is suspected) while opening the airway, maintaining the airway, and administering oxygen if needed. (INCORRECT)

(CFR-D 2, 2.1)

A - Correct

B - The Officer in charge ENSURES PCR is completed.
Defib/Documentor fills out PCR.

C - Checker takes pulse, begins compressions

D - Defib hooks up defibrillator and fills out PCR.

E - Chauffeur or NON CFR TRAINED MEMBER stays with rig. (ECC
may need to be inside performing CFR if he is one of two certified
members)

6

While discussing proper staffing of CFR-D units, members made several comments. Which comment was incorrect?

A) Officer shall ensure that at least 2 CFR-D FFs will be working each tour. Officers shall notify their Battalion for needed details prior to the start of the tour.

B) In order to be in service as a CFR-D unit, there shall be a minimum of 2 trained members with current CFR-D certification.

C) If during the tour, a CFR-D unit staffing is reduced to one trained FF and one trained Officer, the company will be out of service for CFR-D responses.

D) If during the roll call, the Officer in charge determines that their dis not at least 2 CFR-D certified members, the company shall not respond to any CFr-D calls. The company may still be dispatched for calls received directly from the public to assist civilians.

E) If during the roll call the Officer in charge determines that there are not at least 2 CFR-D certified members, the Officer shall notify the dispatcher and Battalion and enter the event in the company journal.

C) If during the tour, a CFR-D unit staffing is reduced to one trained FF and one trained Officer, the company will be out of service for CFR-D responses. (INCORRECT)

* The company will remain available with one CFR-D trained FF and
one CFR-D trained Officer.

* MUST BEGIN TOUR WITH AT LEAST 2 CFR FFS

* ONCE TOUR STARTS, IF ONE MEMBER TAPS OUT, YOU CAN STILL RESPOND TO EMS CALLS AS LONG AS YOU HAVE ONE CFR-D TRAINED FF AND ONE CFR-D TRAINED OFFICER.

7

While approaching the scene of a reported person unconscious on a street corner, the Officer in charge took several actions. Which one was wrong?

A) The scene was observed for the safety of the crew. The safety of the patients and bystanders was not considered, because it was the responsibility of the NYPD.

B) The number of patients involved was identified.

C) The Officer ensured that Body Substance Isolation (BSI) procedures were used and personal protective gear was on.

D) The need for additional resources was determined.

A) The scene was observed for the safety of the crew. The safety of the patients and bystanders was not considered, because it was the responsibility of the NYPD. (INCORRECT)

(CFR-D 2, 3.6.1)

* Observe safety of crew AS WELL AS BYSTANDERS AND PATIENTS.

8

Engine 100 receives an EMS response for a person with chest pains in Apartment 5G at 220 Smith St. When Engine 100 arrives at the location of the call, they notice an FDNY EMS ambulance parked in front of the "H-Type" MD. A police officer on scene tells the Officer of Engine 100 transmits a 10-91 via Dept. Radio and returns to quarters. Were the actions of Engine 100 in accordance with FDNY policy?

A) Yes, because the Officer ensured that Engine 100 had responded to the same location as EMS.

B) No, because the Officer did not confer with EMS to ensure both units had responded to the same incident.

C) Yes, because units will always receive the MDT message "EMS on scene, enter 10-91 and go 10-8" whenever EMS has arrived prior to the CFR-D unit for any CFR response.

D) No, because the Officer did not confer with EMS to ensure both units had responded to the same location.

B) No, because the Officer did not confer with EMS to ensure both units had responded to the same incident.

(CFR-D 2, 3.8.1)

* INCIDENT (not location)

9

Members encounter a patient in respiratory arrest, with a CUPS status of C, and an ambulance is not on the scene. Which action would not be required in this instance?

A) The Officer asked the dispatcher for an ETA of the responding ambulance.

B) The dispatcher was advised to relay the seriousness of the patient's condition to the responding EMS units.

C) Packaging efforts were begun while the patient received ventilators support.

D) Members performed a focused physical exam.

D) Members performed a focused physical exam. (INCORRECT)

(CFR-D 2, 3.9.3)

* Physical Exam for PATIENTS THAT ARE POTENTIALLY STABLE OR
STABLE (P & S)

10

Which of the following units is back in service for fire duty but not available for CFR-D responses following a CFR-D response?

A) Engine 100, whose Nozzle FF requires decontamination after getting blood on his arm at a CFR-D response.

B) Engine 200, who had its defibrillator malfunction while attempting to revive a patient in cardiac arrest.

C) Engine 300, who used its suction device, and now it required decontamination.

D) Engine 400, who had a member get blood on the sleeve of his bunker coat, which required decontamination.

B) Engine 200, who had its defibrillator malfunction while attempting to revive a patient in cardiac arrest.

(CFR-D 2, 3.16.1)

A, C & D - All require DECONTAMINATION. Any time Decon is
necessary you can't be in service for EMS. Tell Battalion and
Dispatcher you can't go on EMS runs.

11

While responding to a report of a person in carina arrest, Engine 333 is flagged down by a pedestrian who states that his mother is having difficulty breathing. Which action taken by Engine 333 should be corrected?

A) The Officer notified the dispatcher of the verbal alarm.

B) Members followed the pedestrian around the corner to his house, where his mother was sitting on the porch.

C) After determining that woman on the porch was breathing adequately following a patient assessment, Engine 333 transmitted a 10-37-3 and proceeded to the location of the original alarm.

D) Engine 333 remained on the scene of the verbal alarm until relieved by EMS.

C) After determining that woman on the porch was breathing adequately following a patient assessment, Engine 333 transmitted a 10-37-3 and proceeded to the location of the original alarm. (INCORRECT)

(CFR-D 2, 3.18)

* For CFR-D runs, if while responding you are flagged down for a
different EMS run, you will make an effort to contact this second
patient and discontinue responding to the original alarm (Ambulance
will be responding to original call). Once contact has been made and
treatment given, do not leave the scene until relieved by EMS or until
the patient walks away.

* This applies for CFR-D runs, not regular runs.

12

Which situation would not require a CFR-D unit to transmit a signal 10-99?

A) Confirmed cardiac/respiratory arrest (Company performing CPR/Defibrillation)

B) Any situation where the Officer determines that the unit will likely be on the scene for 30 minutes or more.

C) Confirmed choking

D) Any CFR-D response where EMS reports no units available when the CFR-D unit requests an ETA for EMS.

C) Confirmed choking.

(CFR-D 2, 3.19)

* 10-99 not required for confirmed choking

13

Which choice correctly indicates conditions where members would not attempt resuscitation of a non breathing/cardiac arrest patient?

1. Obvious Death
2. Dependent Lividity
3. Rigor Mortis
4. Decomposition
5. Valid Do Not Resuscitate Order (DNR)
6. Living Will presented
7. Upon orders of a Health Care Proxy

A) 1, 2, 3, 6, 7

B) 3, 4, 5, 6, 7

C) 1, 2, 3, 4, 5

D) 1, 2, 3, 4, 5, 6, 7

C) 1, 2, 3, 4, 5

(CFR-D 2, 4.4)

WHEN WOULD UNITS NOT BEGIN RESUSCITATION ORDERS:

"LORD DNR"

L - Lividity
O - Obvious Death
R - Rigor Mortis
D - Decomposition

DNR - Valid DNR

14

Squad 400 responded to a report of a person unconscious in front of 408 Green Street. After searching the area and not finding the patient, Squad 400 took several actions. Which action was wrong?

A) The Officer reviewed the response printout for additional information.

B) After rechecking the information and no patient was located, the Officer verified the information with the dispatcher.

C) After re-verifying the dispatch information, Squad 400 attempted to contact neighbors and the building superintendent of 408 Green Street.

D) After all efforts to locate the patient proved unsuccessful, the Officer entered a 10-91 via the MDT and returned to service. The officer completed a PCR to document the units efforts to locate the patient.

D) After all efforts to locate the patient proved unsuccessful, the Officer entered a 10-91 via the MDT and returned to service. The officer completed a PCR to document the units efforts to locate the patient. (INCORRECT)

(CFR 2, 4.7)

* The Officer should enter a 10-92 because there was NO PATIENT.
Filling out a PCR is not necessary because no patient care was
provided, however a mark in journal should be made.

15

There are situations where a CFR-D unit has located a patient, but cannot gain access. Which of the following is incorrect concerning gaining access?

A) If a unit locates a patient, but cannot gain access, forced entry may be the only option. If forcible entry is used, the Officer should request police response for security and have the dispatcher advise EMS of the situation.

B) If others within the premise deny access to the patient, the Officer shall immediately request police department assistance.

C) If the police department has been requested due to members denied access to a patient, the police department will determine the appropriate action to take.

D) If a unit has performed forcible entry to obtain access to a patient, EMS may be used to safeguard the premises until the arrival of the police department.

D) If a unit has performed forcible entry to obtain access to a patient, EMS may be used to safeguard the premises until the arrival of the police department. (INCORRECT)

(CFR-D 2, 4.8)

* CANT USE EMS to safeguard premises
You are allowed to turn over to PD / Owner / Responsible Person.

16

There are several situations that are infrequently encountered, but it is important that all Officers are familiar with the proper procedure to follow. Which choice is correct concerning these situations?

A) If a patient refuses medical aid (RMA), the CFR-D unit shall leave after ensuring that the patient is alert and oriented. A PCR is not required in this situation.

B) If a patient exhibiting altered mental status or appears to be an EDP refuses medical treatment, the Officer should request police assistance and remain on scene until EMS arrives.

C) If a physician is on scene of a CFR-D response when EMS is not yet on scene and offers his assistance, members should refuse the assistance in a pre-hospital setting.

D) If a physician is on scene and EMS has not yet arrived, members should follow all instructions given by the physician, and can provide any type of medical treatment as long as it is directed by the physician.

B) If a patient exhibiting altered mental status or appears to be an EDP refuses medical treatment, the Officer should request police assistance and remain on scene until EMS arrives.

(CFR-D 2, 4.9)

A - If patient is RMA, CFR-D unit shall WAIT FOR EMS to arrive and a
PCR IS REQUIRED.

B - Correct

C - May ACCEPT a doctors assistance in the pre-hospital setting.

D - Can accept doctors help, however CFR-D Unit CANNOT
PERFORM ABOVE THEIR SCOPE OF TRAINING.

17

A CFR-D unit arrives on the scene of a medical emergency and NYPD ESU has already initiated patient care. Which of the following choices is correct concerning the actions taken by the unit?

A) After ESU told the Officer that Fire Department assistance was not required, the Officer transmitted signal 10-91 and went 10-8.

B) After ESU told the Officer that Fire Department assistance was not required, the Officer ensured a PCR was completed.

C) The CFR-D Unit will assume responsibility for patient care if ESU is not equipped with a defibrillator.

A) After ESU told the Officer that Fire Department assistance was not required, the Officer transmitted signal 10-91 and went 10-8.

(CFR-D 2, 4.13)

B - No patient care provided = NO PCR

C - ESU has a HIGHER LVL OF TRAINING for patient care. If they tell
you that your assistance is not required, then you can leave the
scene.

* If ESU is on scene first, they assume responsibility of patient

* If we are on scene first, we assume responsibility of patient, however
because ESU is a higher level of pre hospital care, we can transfer
responsibility to them. (If they don't have a defibrillator we will retain
patient care responsibilities)

18

A CFR-D unit may telephone a FDNY/EMS telemetry physician if they need medical advice, or a parent refuses to allow treatment to a minor for a non-urgent illness or injury. Which is the incorrect choice concerning the use of this resource?

A) The telemetry phone number shall be posted on the chart holding the CFR-D units PCR forms.

B) Before calling telemetry, the unit shall have completed the primary survey and CUPS status determination.

C) The unit shall note all instructions given by telemetry on the PCR.

D) Telemetry can only be used for medical consultation.

D) Telemetry can only be used for medical consultation. (INCORRECT)

(CFR-D 2, 5.3)

* Telemetry used for medical consultation OR access to international
languages.

19

When a unit finds a minor suffering from life-threatening injuries or illnesses, what would be the correct action to take?

A) Do not provide treatment if the parent/guardian refuses to give consent.

B) Provide treatment if it is apparent that a delay in treatment, even if minimal, would jeopardize the minor's life.

C) Only provide treatment after consulting with FDNY/EMS telemetry.

D) Only provide treatment if EMS is on scene and has assumed the role of higher care provider.

B) Provide treatment if it is apparent that a delay in treatment, even if minimal, would jeopardize the minor's life.

(CFR-D 2, 6.1.1)

A - You WILL PROVIDE TREATMENT to a minor who has life
threatening injuries (even if guardian refuses consent)

B - Correct

C - IF NON-LIFE THREATENING only provide treatment after consulting with FDNY/EMS telemetry.

D - Provide treatment even if EMS is not on scene for life threatening
injuries.

20

Which choice is incorrect concerning Do Not Resuscitate (DNR) Orders?

A) Supplemental oxygen may be provided to a patient with a valid DNR order.

B) A signed order shall be followed unless it has been revoked verbally or in writing.

C) A DNR bracelet is not valid in a pre-hospital setting.

D) A nursing home DNR does not have to utilize the NYS Out Of Hospital DNR form, it only required a physician's signature.

E) A DNR order need not have a current date.

C) A DNR bracelet is not valid in a pre-hospital setting. (INCORRECT)

(CFR-D 2, 6.2.2)

* DNR Bracelet IS VALID.
* Choice A = CFR-D units will not perform CPR on a patient with a DNR
Order, however they may provide other forms of treatment
(supplemental oxygen).

21

Whenever EMS and Fire Units are operating at an incident, the ranking Fire Officer is the IC. In which choice would the IC be operating incorrectly?

A) The IC evaluated the scene for the safety of all patients and operating personnel.

B) The IC was guided by the highest level pre-hospital medical provider for patient care decisions.

C) The IC issued orders regarding patient care to EMS personnel.

D) The IC maintained the responsibility of obtaining accurate patient care information.

C) The IC issued orders regarding patient care to EMS personnel. (INCORRECT)

(CFR-D 2, 8.3)

* IC (Fire Officer) DOES NOT give orders to EMS personnel, WE ARE
GUIDED by highest level of training at the scene.

22

All of the following are accurate statements about resuscitation efforts at a CFR-D response except which one?

A) CFR-D units shall not attempt resuscitation if there are any signs of lividity, obvious death, rigor mortis, or decomposition in the patient.

B) The presence of a valid DNR would prevent CRR-D units from initiating CPR.

C) A PCR must be completed for a DOA to document that the company properly examined the patient.

D) If a DNR is present and no CPR initiated, a PCR need not be completed since there was no care given.

D) If a DNR is present and no CPR initiated, a PCR need not be completed since there was no care given. (INCORRECT)

(CFR-D chapter 2)

* "LORD DNR"

* PCR MUST BE COMPLETED FOR DOA to document patient was
properly examined by CFR-D units.

23

Which point listed below regarding the infection control program is incorrect?

A) A "casual" exposure is contact but without eye, mouth, other mucous membrane, non-intact skin, or parenteral contact (by injection) with blood or other potentially infectious materials.

B) A "non casual" at risk exposure is eye, mouth, other mucous membrane, non-intact skin, or parenteral contact (by injection) with blood or other potentially infectious materials.

C) The fact that a patient is infected or assumed to be infected with a communicable disease is a valid reason to withhold certain medical treatment due to an increased risk of infection.

D) Members are not permitted to wear sneakers or sneaker type shoes while on duty. Members who have open lesions and who have direct patient care responsibilities shall report to their company officer and refrain from patient care activities until evaluated by a BHS physician.

C) The fact that a patient is infected or assumed to be infected with a communicable disease is a valid reason to withhold certain medical treatment due to an increased risk of infection. (INCORRECT)

(CFR-D 3, 3.1)

* NOT A VALID REASON, CFRs must treat all patients.

24

You are a lieutenant working a day tour in E-99. The proby comes to you and tells you that the infectious waste container in the back of quarters is fill and needs to be disposed of. E-98 is the CFR Depot in the battalion. Which action taken is correct?

A) Bring the infectious waste container to E-98s quarters.

B) Call the resource center to arrange a pickup.

C) Call the private contractor to arrange a pickup.

D) Place the red bags outside of quarters for the Dept. Of Sanitation to pick up.

A) Bring the infectious waste container to E-98s quarters.

(CFR-D 3, 12.16)

A - Correct

B - Resource center = CFR-D Depot calls if there's a missed pickup

C - Private contractor = CFR-D Depot calls to arrange pickup

D - NEVER place red bags outside of quarters.

25

After operating at an EMS run where a person was hit by a car, the members of E-99 are gathering their equipment when they notice that the trauma bag and Halligan tool have blood on them. The officer of E-99 directs his members to place the trauma bag and halligan tool in a red bag until they can be decontaminated. Do you agree with this stament?

A) Agree

B) Disagree

B) Disagree

(CFR-D 3, 12.16 Note)

* Red bags = ONLY put disposable wastes inside (throw away)

* Halligan and trauma bag need to be DECONNED (not thrown away)

26

Which point below made during a study group meeting is not correct?

A) Company Officers at roll call, shall have members check the quantity of supplies on hand. A record of this inspection shall be made in the roll call entry.

B) If a members PPE or work duty clothing is contaminated with blood, blood products, or other bodily fluids they may take them home or to a commercial laundry facility for cleaning.

C) If a Motorola portable radio/HT becomes contaminated with blood or other bodily fluid, it shall be decontaminated in quarters. These radios may be completely immersed in fluid.

D) Tech services will distribute bleach packets. These packets are mixed with 1 gallon of water for an effective disinfection solution. Mixtures remaining after 24 hours will be disposed of in the slop sink.

B) If a members PPE or work duty clothing is contaminated with blood, blood products, or other bodily fluids they may take them home or to a commercial laundry facility for cleaning. (INCORRECT)

(CFR-D 3, 13.1.4)

* DO NOT take home PPE or work duty uniforms to wash if
contaminated. (They must be sent out for Decon)

27

During a CFR-D refresher class at Fort Totten, tuberculosis and rabies were being discussed. A sharp student should respectfully correct the instructor in which point made about these topics?

A) Tuberculosis is an airborne disease that is spread through the air when a person with active tuberculosis coughs and releases tuberculosis into the air.

B) Tuberculosis is most easily transmitted in crowded, congested, and poorly ventilated areas. It is very difficult to acquire tuberculosis in locations such as restrooms, subways and stores.

C) Rabies is an acute viral infection of the central nervous system that effects mammals. The virus can live a few hours outside the body in saliva and body fluids.

D) During BISP at hospitals, shelters, or prisons, where the risk of tuberculosis is high, it is necessary to enter all rooms as a visual inspection is not sufficient to detect fire prevention violations.

D) During BISP at hospitals, shelters, or prisons, where the risk of tuberculosis is high, it is necessary to enter all rooms as a visual inspection is not sufficient to detect fire prevention violations (INCORRECT)

(CFR-D 3, ADD 1)

* IT IS NOT NECESSARY to enter all rooms on these inspections. Wear
an N95 and peek in to visually inspect.

28

E-287 responded to a patient with difficulty breathing. They placed him on supplemental oxygen. The patients son shows you a valid DNR and requests that your members cease all care. You would be most correct to?

A) Have your members continuing giving proper care.

B) Verify the validity of the DNR before discontinuing all patient care.

C) Stop all patient care and give the DNR to EMS.

D) Special call an EMS supervisor to verify the DNR.

A) Have your members continuing giving proper care.

(CFR 2, 6.2.1)

* Continue to give appropriate care BUT NOT CPR.

29

A PCR should be filled out in all but which of the following situations?

A) A ladder company that stabilized a patient's neck while assisting an EMS ambulance.

B) Anytime a CFR-D Engine is 10-84 on an EMS run

C) Verbal alarm where the CFR-D unit initiated history taking

D) Patient care is provided by a CFR-D firefighter at an all hands fire.

B) Anytime a CFR-D Engine is 10-84 on an EMS run (INCORRECT)

(CFRD 5, 1.2.2)

* Patient contact or patient care = PCR

* Patient contact = visualized or approached a patient.
Communicated with or took a patient's history

* Just because you are 10-84 at an EMS run, you do not have to fill out
a PCR if there was no patient contact or care given. (Ex: 10-91)