Download Emergency Medical Services Protocols and Procedures in Santa Clara County and more Exams Pediatrics in PDF only on Docsity!
Santa Clara county hospitals
Baseline Vital Signs/ early change signs (assessed every 10 minutes for stable, every 5 minutes for unstable patients) - โ โ 1. Glasgow Coma Scale
- Blood Pressure (first should be obtained via manual cuff)
- Respiratory Rate
- Pulse Rate (obtained via palpation)
- Pulse Oximetry (if unit is equipped)
- Temperature Standard Protocols Routine Medical Care (Adult/Pediatric) Advanced Vital Signs - โ โ 1. Blood Glucose (via Fingerstick, or IV start)
- Cardiac Monitoring (ECG)
- Capnography (expiratory CO2 levels Standard Protocols Routine Medical Care (Pediatric)
Pediatric Patient Defined - โ โ 1. Neonate: Considered between 0-4 months of age 2.Infant: Considered between 1 month to 1 year of age 3.Child: Considered older than 1 year of age 4.Pediatric: Defined as under 15 years of age a.If this is not specified, Pediatric status is less than 6 years old Standard Protocols Infectious Disease Control Measures Universal/Standard Precautions (PPE) - โ โ 1. Nitrile Gloves
- Eye Protection
- Hand washing after every patient contact
- If hand washing not possible, use waterless hand sanitizer Standard Protocols Infectious Disease Control Measures
Standard Protocols Infectious Disease Control Measures Airborne Transmission - โ โ Occurs through the inhalation or absorption of air that contain pathogens, such as: a. Tuberculosis b. Measles c. Chickenpox
- Universal Precautions, with the addition of an N95 respirator or P100 particle respirator, should be used. Face shields and impermeable gowns may be used if indicated Standard Protocols Infectious Disease Control Measures Aerosolized Transmission - โ โ 1. May occur when bodily fluids/secretions are aerosolized during certain procedures (i.e. nebulizer treatments, suctioning, and intubation)
- Universal precautions, along with N95 or P100. Face shields and impermeable gowns should be used if indicated Standard Protocols
El Camino Hospital of Los Gatos - โ โ LGH ( Los Gatos) Out of county Hospitals Hazel Hawkins Hospital - โ โ HHH (Hollister) Santa Clara county hospitals Good Samaritan Hospital - โ โ GSH (San Jose) Santa Clara county hospitals El Camino Hospital of Mountain View - โ โ ECH (Mountain View) Santa Clara county hospitals Kaiser Foundations Santa Clara - โ โ KSC (Santa Clara) Santa Clara county hospitals O'Connor Hospital - โ โ OCH (San Jose) Santa Clara county hospitals Palo Alto Veterans Administration Hospital - โ โ PAV (Palo Alto) Santa Clara county hospitals Regional Medical Center of San Jose - โ โ RSJ (San Jose) Santa Clara county hospitals
Emergency Medical Services Committee (EMSCo.) - โ โ A diverse group of representatives of all provider levels (field paramedics, EMTs, city managers,etc.) that provide recommendations to the Agency and Health Advisory Commission Medical Directors Advisory Committee (MDAC) - โ โ Comprised of various physician groups (South Bay Medical Directors Association, provider agency Medical Directors, etc.) that focus on clinical care issues and integration of patient care resources Multi-Casualty Incident (MCI) Committee - โ โ A diverse group of emergency service responders who focus on development and implementation of MCI plans and procedures Clinical Practice Advisory Committee (CPAC) - โ โ Made of various system stakeholders (field personnel, physician, nurses, etc.) who provide recommendations related to the clinical aspects of EMS system. This includes protocols, orders, quality assurance and improvement, etc Level A Variance Any incident that results in a threat to public safety, patient, bystander or responder harm - โ โ Report immediately
to the EMS Duty Chief via County Communications and submit the EMS System Variance Report (Form #903) to the EMS Agency within 24 hours Level B Variance Any incident that does not result in patient harm, but is a deviation from EMS Agency protocols, policies, and procedures - โ โ Report to EMS Agency within 5 business days Level C Variance Incidents where responders provided outstanding care and went above and beyond expectations of responders - โ โ Report within 7 business days Trauma Center Service Areas SUH Catchment Zone - โ โ Northern border of SCC to De Anza Blvd in Cupertino and through the center of Sunnyvale Trauma Center Service Areas VMC Catchment Zone - โ โ South of De Anza Blvd in Cupertino and south of Sunnyvale-Saratoga Road to East Remington/Fair Oaks Ave in Sunnyvale
Hospital Radio Reports Ring-down - โ โ Standard hospital notifications shall occur via cell phone or service dispatch centers
MTV (Major Trauma Victim) alerts, STEMI alerts, Stroke alerts, and critical transports, transporting Code 3, to the hospital and when cell phone contact is not possible shall be transmitted via self-initiated radio on EMS Command 92
IFT notifications are not to occur on SCC EMS Communication System frequencies Hospital Radio Reports Format - โ โ 1. Demographics (Unit ID (agency, type, number),ETA, Patient's Age, Patient's Sex)
- Chief complaint / Ems providers impression
- Any pertinent medical history, pertinent medications, pertinent allergies, and any other significant findings from physical assessment
- Vital signs (Explain and report abnormal findings
Or, state "within normal limits" (WNL))
- treatment provided Hospital Radio Reports Specialty Center - โ โ Trauma, STEMI, Stroke
Transmitted via self-initiated ring-down on EMS Command 92
Should occur prior to departure from scene
Include MOI and Anatomic & Physiologic Criteria Patient Consent and Refusal for EMS Services Individuals legally authorized to refuse care is - โ โ 1. An adult who has capacity, A minor legally authorized to consent to medical treatment and who has capacity, A legal representative of the patient who has capacity
- Not currently suicidal
- Is not on a psychiatric hold (5150) Field Pronouncement of Death Criteria
- Provide appropriate comfort and care to bystanders
- Complete PCR documenting care, actions taken, including reason for pronounced death. All communications noted and necessary times provided Physician at Scene Procedures (regarding individual on scene stating they are a physician) - โ โ Identification(Valid Forms)
- valid CA physicians medical license
- other ID that indicates physicians CA medical license # and business address Physician at Scene Physical Involvement (Patient must be conscious and give consent) - โ โ 1. May relinquish care, but physician will remain responsible for care provided until another MD takes over. Patient now under crew medical care under directions from base hospital
- May assist in patient care, but physician shall be advised by prehospital personnel (Patient care is still under control of standing orders (EMS Medical Director) and online medical control (base hospital))
Physician at Scene Manage Patient Care - โ โ May manage care, but ultimately accepts responsibility for patient. Must accompany crew and patient in ambulance Physician at Scene Documentation(along with PCR) - โ โ 1. Physicians Name
- CA medical License #
- Business Phone #
- Level of patient care involvement
- All procedures and treatments performed at scene SCCO Specialties Trauma - โ โ Adult: RSJ, SUH, BMC Pediatric: SUH, VMC SCCO Specialties Psychiatric: - โ โ ECH, VMC, EPS, PAV, SUH SCCO Specialties Burn - โ โ VMC SCCO Specialties
and that is not on internal disaster (can override diversion) EMS Patient Destination Special Circumstances EMS Surges/ Multiple patient events - โ โ 1. All destinations will be assigned by county communications
- may be transported to out of county hospital, or Mobile Field Hospitals with approval EMS Patient Destination Special Circumstances Diversion - โ โ 1. Only one hospital may be on ambulance diversion (red) at any given time in a Diversion zone
- May divert for 90 minutes per occurrence, but must allow for another 90 minutes before next diversion Diversion zones - โ โ 1. North:SUH, ECH, KSC
- Central: RSJ, VMC, OCH
- Southern: GSH, STH, SLH Do Not Resuscitate / Advanced Directives Proper DNR documents - โ โ 1. Physicians Orders for Life Sustaining Treatment (POLST) form stating No CPR
- EMSA and CMA approved Emergency Medical Services, Prehospital DNR form
- CA approved DNR medallions
- Durable Power of Attorney for Health Care (DPAHC) Do Not Resuscitate / Advanced Directives Procedure - โ โ If EMS personnel arrive, patient is pulseless and apneic:
- Establish DNR/ Advanced Directives/ Code Status 2.May withhold resuscitative efforts if: a. Provides a valid DNR form, no code chart order, DNR medallion, POST, or DPAHC that clearly states Do Not Resuscitate
- If no forms provided, continue resuscitative efforts until such form is provided
If patient is conscious and states he/she wishes for resuscitative efforts, the POLST or DNR order is ignored, but document the request.
choose one of the 3 options:) - โ โ 1. Transport to pre- arranged destination
- Return to point of departure
- Transport to closest ED of an acute care facility Prehospital Transfer of Care - โ โ 1. The scene of an emergency shall be managed by the appropriate public safety agency having primary investigative authority.
- Provides full list of information, via report, regarding patient history, medical assessments, critical changes, as well as any treatments provided transfer of care may be: - โ โ 1. Paramedic to Paramedic a. Fire medic to county medic b. In "load and go" situations, with no time to transfer care, initial paramedic will maintain medical control
- Paramedic to ALS Flight crew
- Paramedic to BLS a. mainly in MCI activations b. cannot occur if paramedic level interventions are performed
- Prehospital personnel to hospital staff
BLS Utilization Interfacility Transportation - โ โ Hospital to SNF, Hospital to residence, MD appointments, dialysis, etc BLS Utilization Emergent Patients encountered by EMT's - โ โ 1. Emergent=life or limp threatening condition requiring immediate definitive care
- Respiratory Distress, Airway Compromise, Neurological changes from baseline, signs of actual or impending shock, or meet Major Trauma criteria
- May be transported to nearest ED with red lights or sirens, if the time from arrival on scene to arrival at hospital is LESS THAN 10 minutes a. crew must inform county communications and request a County EMS event number
- If on scene to hospital is greater than 10 minutes, 911 must be called for ALS assistance
- If immediate transport is necessary and no paramedic ambulance is available, first arriving paramedic unit shall accompany the BLS crew using the ALS equipment from first response unit
