Clinical advice, support and co-ordination: DipIMC practice questions
PHEM curriculum unit 1.9 · Theme 1: Working in Emergency Medical Systems
The DipIMC is blueprinted against phase 1 of the UK Pre-hospital Emergency Medicine (PHEM) curriculum. This page covers unit 1.9, Provide EMS clinical advice, support and co-ordination.
Below are 2 free practice questions from the DipIMC.Ninja bank, in the Part A single best answer format. Every answer names the textbook page, guideline or statute it was written from, so you can check it rather than take it on trust. The bank holds 6 questions on this unit.
Question 1 · Law, Ethics & Human Factors · Moderate
An ambulance crew attends a 30-year-old woman who took a large overdose of tablets about two and a half hours earlier. She is alert, able to swallow and not vomiting. The crew carry activated charcoal. Under JRCALC, what should govern whether charcoal is given?
AThe formulation, with sustained-release tablets extending the window to four hours
BThe one-hour rule alone, which excludes charcoal after an hour whatever advice is given
CAuthorisation by the Clinical Team Leader in ambulance control, given by telephone
DThe crew's own judgement of her ability to swallow safely and protect her airway
EWhether TOXBASE or the National Poisons Information Service advises giving it
Show answer
Answer: E
Whether TOXBASE or the National Poisons Information Service advises giving it
JRCALC's activated charcoal monograph gives two routes to administration: adults and children aged one year and over who ingested the toxin less than one hour before the ambulance clinician's attendance; or, irrespective of the time since ingestion, where TOXBASE or the National Poisons Information Service has been contacted and advises administration. Presenting more than an hour after ingestion is otherwise a contraindication, so at two and a half hours this patient may receive charcoal only on poisons service advice. The monograph adds that TOXBASE or NPIS advice cannot overrule the exclusion criteria except in relation to time and age — it cannot, for example, override vomiting, reduced gut motility or poisoning with substances such as iron, lithium, alcohols or corrosives. Being alert and able to swallow is a necessary safety condition, not an indication, and neither the formulation nor a clinician in ambulance control changes the indication, which JRCALC ties to the poisons service once more than an hour has passed.
JRCALC Clinical Guidelines — Activated charcoalJRCALC / AACE·Indications: TOXBASE/NPIS advice overrides only time and age“Activated charcoal — indications: TOXBASE/NPIS note on time and age”
law-111 · Law, Ethics & Human Factors · EMS Systems · Moderate · v2
Question 2 · Law, Ethics & Human Factors · Hard
A district general hospital refers a patient with an acute aortic dissection for time-critical transfer to the regional cardiothoracic centre through the adult critical care transfer service. Under the NHS England service specification for adult critical care transfer services, how is the decision-making for such a transfer expected to work?
AA consultant-led decision is made jointly and in real time by referring and receiving clinicians, transfer service and specialty team
BThe transfer service consultant decides alone once the referral form is complete, and informs the referring and receiving teams afterwards
CThe referring team secures a bed first, and the transfer service is involved only after written confirmation of acceptance
DThe ambulance control room decides, allocating the patient from the regional bed state to the nearest centre with capacity
EThe receiving specialty consultant decides alone, and the transfer service then provides the vehicle and crew at an agreed time
Show answer
Answer: A
A consultant-led decision is made jointly and in real time by referring and receiving clinicians, transfer service and specialty team
The NHS England Adult Critical Care Transfer Service specification sets out the care pathway for patients needing adult critical care transfer, including real-time consultant-led joint decision-making involving referring and receiving clinicians, the transfer service and specialty teams, to ensure a concurrent and efficient referral process. A sequential model in which a bed is secured first and the transfer service called afterwards, or one in which a single consultant decides and informs others later, is what the joint model is designed to replace. The specification lists escalation (to specialist care not available in the referring hospital, such as cardiac surgery), repatriation, continuation of care and capacity as the reasons for transfer, and notes that a small but important number of escalation patients are time-critical. For each operational shift the service must have a dedicated consultant with appropriate critical care training, competencies and current adult critical care experience to provide coordination, triage and decision support. This sits alongside the ICS/FICM recommendation that the decision to transfer and to accept a patient must be made by appropriate consultants in both the referring and receiving hospitals; the ambulance control room does not own the clinical decision.