Policies Flashcards
Base Hospital Contact Criteria
MAD CAT TTQ
-Minor is/suspected ill or injured
-Abnormal vitals/ALOC
-Drug/ETOH intoxication
-Comprehend/demonstrate understanding of illness/injury
-Age >= 65 with significant mechanism,altered, or any fall
-Trauma Center criteria
-Treatment of ALS skills, meds, except EKG
-Transport including to a destination as a BLS downgrade
-Question regarding treatment or disposition of Pt
BH need not be contacted
PB DOR
-Pt wishes to be released and does not meet BH contact criteria
-BLS Call where ALS treatment is not anticipated
-Discontinuation of CPR in the presence of DNR or POLST
-Obvious death (DRIED)
-Release of a minor who is not/suspected to be ill/injured
S-415 Definitions
> Aid unnecessary- person does not meet criteria for emergency patient
Emergency patient- any person who 911 was activated and meet the following criteria:
1.Has a chief complaint or suspected illness or injury
2.Is not oriented to person, place, time, event
3.Requires or requests field treatment or transport
4.Is a minor not accompanied by parent or legal guardian and who is/ suspected ill or injured
AMA- the refusal of treatment of transport by an emergency patient or his/ her DDM against the advice of medical personnel on scene or of the base hospital.
> DDM- An individual to whom a person has legally given the authority to make medical decisions concerning one’s health care (parent, legal guardian, attorney in fact through a durable power of attorney, agent through advanced health care directive.
> Release- A call outcome where the patient and EMS agree that the illness or injury does not require immediate field treatment or transport by emergency services and the patient does not require the services of a prehospital system.
S-412 Documentation for AMA
RAW EMS PCC
R- Reason for AMA and alternate plan including on scene support (family, friend, etc.)
A- Ability to comprehend and demonstrate understanding injury/ illness
W-Who activated 911
E- Explained fully of risks and potential outcomes (including death) of non-treatment. Patient can verbalize this.
M- May re-access 911
S- Signature- if UTO, state why
P- Presence/ absence of drugs/ ETOH
C- Circumstances pertaining to consent issues
C- Consider having patient/ family recite info listed to MICN/BHP over radio/ telephone
S-412 AMA Policy
S-412 AMA policy
A) All patients will be offered treatment and transport following a complete assessment
B) 1: Adults have the right to accept or refuse prehospital care, provided that the decision is made on an informed basis and that they have the mental capacity to understand the potential impairments of their decisions.
2: DDM decision is to be treated as the patients’ whishes
3: Emergency patients who base hospital contact criteria, who AMA. EMS personnel should make the best efforts to contact the BH prior to PT leaving the scene. If the patient leaves the scene, contact BH for quality improvement and training purposes.
4: EMS personnel should contact BH/MICN/BHPO in any situation involving refusal of Rx/Tx when life threatening risks are present
S-412 Downgrades
Base hospital can authorize a downgrade to BLS following a complete medic assessment and base hospital report. If PT deteriorates during T/x BLS should T/x to closest most appropriate facility at discretion of base hospital
T-460 Trauma Center Criteria
VITAL SIGNS
-GCS <14
- SBP <90
- RR <10 - >29 (adult)
<20 for infant <1 y/o, or need for ventilatory support
- Peds. Abnormal appearance, work of breathing, circulation
ANATOMY
- All penetrating injuries to head, neck, torso, or extremity proximal to elbow or knee
- Chest wall instability/ deformity (flail segment)
- 2 or more proximal long bone fractures
- Crush injury, degloved, mangled or pulseless extremity
- Amputation proximal to wrist or ankle
- Pelvic fractures
- Open or depressed skull fracture
- Paralysis
- Neurologic/ vascular deficit to extremity
- Tourniquet placed on traumatic injury
MOI
- Fall 3x patient height or ≥ 15ft
- High risk auto crash:
1. Intrusion 12 in. roof or 18 in any site
2. Ejection (partial/ complete) from vehicle
3. Death in same passenger compartment
4. Vehicle telemetry data consistent with injury
5. Vehicle rollover with unrestrained patient
- Auto vs ped/ bicyclist thrown/ run over/ or with significant impact (>20mph)
- Motorcycle crash ≥20 mph
- Exposure to blast or explosion
- Combination trauma with burns
SPECIAL CONSIDERATIONS
- Aged <5 or >55
- Low impact injury (i.e., ground level fall) ≥ 65
- Bleeding disorders
- Anticoagulant/ antiplatelet therapy (warfarin- clopidogrel) except ASA
- Pregnancy ≥ 20 weeks
- Poor base line severe cardiac and respiratory disease
- Extrication time ≥ 20 min
- EMS provider judgment
If ped and adult trauma and adult more critical transport both to AD trauma center
S-402 Determination of Death Policy
In addition to absence of respirations and cardiac activity
1. Decapitation
2. Evisceration of heart or brain
3. Incineration
4. Rigor
5. Decomposition
Adult traumatic arrest with all of the following:
-No visible signs of life (no spontaneous movement, pulseless and apneic)
-Cardiac rhythm of asystole
-MOI consistent with injury
- -All patients with absent Vitals shall be treated with resuscitation measures unless obviously dead or adult blunt traumatic arrest
S-402 Special Considerations for Death
1) No monitor to determine death on the obviously dead
2) If monitor used. A rhythm other than asystole requires a BHPO to determine death
3) If victim of hypothermia, electrocution, lightning strikes, and drowning do not meet obvious dead, BHPO to pronounce
4) Any situation where there may be doubt about clinical findings of PT, BLS/CPR must be initiated
P-403 Physician on Scene Policy
P-403 Physician on scene policy: The medic may only follow orders from BHP or authorized MICN
If on scene physician chooses to take total responsibility of PT:
- BHPO may request proof of CA licensure to be shown to medics
- BHPO must approve or deny physician on scenes request to take total responsibility
- Medics may assist within their scope under BH
- Drugs and equipment may be made available to physician on scene
- Medics must document physician on scenes name and involvement
- Physician on scene may offer assistance but let medics remain under base hospital control or take total responsibility and accompany PT to hospital until released to hospital physician and sign for all instructions given
S-405 Communication Failure
- If medic on scene and cannot get in contact with MICN or BHP and delay in paint R/x would jeopardize PT outcome initiate EMT-P activity within our scope of practice “standing orders for communication failure” until direct voice contact is established or have reached general acute care hospital.
- File report within 24 hours to BHP and he/she will forward it to county within 72 hours
S-422 Restraints
WRITTE
- Which agency applied restraints
- Reason including prior attempts to control PT
- Info regarding monitoring of circulation and respiration status
- Type of restrain used
- Time restraints were applied
- Extremities restrained
- Must be padded leather or soft restraints and provide for quick release.
Shall not use: - Any device requiring a key to remove
- backboard ect. To sandwich patient
- Devices that restrain people’s hands and feet behind them
- Methods or materials that could cause vascular or neurologic damage
- Hard plastic ties
- Do not restrain in the prone position
- Restraints must not interfere with ventilation, circulation or preclude measures to protect airway
- Check and document PMS every 15 min
If law enforcement applied restraints, they should accompany PT in ambulance
S-413 MCI
S-413 MCI:
- Annex D: is a declaration of a MCI. The annex is intended to assist and direct any agency where an MCI overwhelms their resources.
Procedure:
- While en route responding units and primary dispatch may make early notification to facilitating BH ASAP.
- One person will assume medcom and give a brief size-up to facilitating base
- Use START or jump-START and use triage ribbon
- Medcom will relay to facilitating base hospital the following:
1. PT #
2. Triage color
3. Transporting unit
4. Destination/ ETA
5. If able give age, gender, primary issue
