ALS and BLS Ambulance Providers Base and Receiving Hospitals Continuing Education Providers ...

62 Pages·2009·1.27 MB·English

TO: ALS and BLS Ambulance Providers
Base and Receiving Hospitals
Continuing Education Providers
Fire Departments
Training Centers
Other Interested parties

FROM: Karen Petrilla, EMS Specialist

RE: Protocol, Policy and Procedure Manual Update

DATE: September 1, 2009

Attached are the new and updated EMS policies that will go into effect on October 1, 2009.
These polices have been reviewed and approved by Humberto Ochoa, MD, the EMS Agency Medical
Director, and Bruce Barton, EMS Agency Director.

Please distribute to your personnel and schedule training as necessary/required within the next 30 days.
Existing copies of these policies should be discarded and replaced with the enclosed policies in your
Riverside County Emergency Medical Services Protocol, Policy and Procedures Manual.

Included with the policies are a synopsis of all the changes and an updated Table of Contents for your
policy manual.

This update packet will be available on-line at our website - - www.rivcoems.org - - within a few days.
You will find it under the Important News column. It will be integrated into the Policy and Procedure
Manual pull-down prior to its effective date.

Should you have any questions on these policies, please contact me at the EMS Agency office - -
(951) 358 – 5029.

Attachments
Fall 2009 Policy and Procedure Update
All policies effective October 1, 2009 unless otherwise noted

1700 - Service Providers
two new STEMI centers added, both in San Bernardino Co --
LLUMC and San Antonio Community Hospital
RCRMC listed as an adult (only) trauma center
REACH added as a new air provider

1800 - Policy Review
total restructuring of this policy (approved by PMAC 11-08)

4000 - EMT-I Training
as approved by the training agencies -- minor wording changes, and
new #7 added

4300 - CE Provider
minor grammar and wording changes to more closely align with T22

4400 - EMT-P Training
new policy -- as approved by the training agencies

5110 - Initial Responder Policy
restoration of omitted verbiage 4.3.3 -- no date change

5130 - EMS Aircraft Ops, Equipment, and Personnel
deletion of 4.2.2.3 and 4.2.2.4

5215 - D & E List for ALS Emergency Apparatus
3.n. - size 5 Fr. pharyngeal suction catheter removed
7.e. add meconium aspirator(s) to the optional equipment list

5220 - D & E List for ALS Ambulances
3.n. - size 5 Fr. pharyngeal suction catheter removed
7.e. add meconium aspirator(s) to the optional equipment list

5225 - PPE for Ambulances
addition of the federally-required hi visibility safety vests

5350 - BLS Transport after ALS Assessment
new policy

5500 - Consent and Refusal of Medical Treatment
1.2 - verbiage changes to coincide with policy 5100 (PMAC 11-08)

7000 - Intro to ALS Policies
Two lines added for clarification of BH contact and transportation
Fall 2009 Policy Update
Page 2 of 2

7200 - Cardiac Chest Discomfort
change of BP minimum for NTG and MS administration
wording changes to clarify the need for 12L: and completion of the
STEMI assessment

7260 - Asystole
clarification of IO access

7270 - PEA
clarification of IO access

7300 - Burns
change of BP minimum for MS administration

7440 - Non-Traumatic Shock
clarification of IO access

7500 - Altered Level of Consciousness
typographical corrections --- no date change

7710 - Beta Blockers - Ca++ Channel Blockers
clarification of IO access

7750 - Narcotics - Sedatives
clarification of IO drug use
clarification of ET use

7850 - Acute Pulmonary Edema
change of BP minimum for NTG and MS administration

25 - King Airway
new policy -- This skill is to be implemented only after adoption by the
provider agency and approval/confirmation by the EMS Agency

RIVERSIDE COUNTY EMS AGENCY
POLICY, PROTOCOL, and PROCEDURE MANUAL

TABLE of CONTENTS

POLICY NO. TITLE EFF. DATE

Section 1000 ADMINISTRATION: The Organization

1000 Riverside County EMS Agency: Mission and Values Statement 4/1/97
1100 Overview of Riverside County EMS 4/1/97
1200 State Emergency Medical Services Framework 4/1/97
1300 Pertinent EMS Legislation 12/1/05
1400 EMS Agency Organizational Structure 4/1/97
1500 EMS Agency Roles and Responsibilities 11/1/08
1510 Emergency Medical Services Director 11/1/03
1515 Emergency Medical Services Assistant Director 11/1/03
1520 Emergency Medical Services Medical Director 11/1/03
1530 Emergency Medical Services Specialist / Senior Specialist 11/1/03
1540 Trauma Coordinator 11/1/03
1550 Disaster Preparedness Planner 8/1/02
1560 Office Assistant I / II / III 4/1/97
1620 Emergency Medical Care Committee (EMCC) 12/1/05
1630 Prehospital Medical Advisory Committee (PMAC) 5/1/04
1700 Service Providers 10/1/09
1800 Policy Review Procedure 10/1/09

Section 2000 ADMINISTRATION: Quality Assessment / Improvement

2000 Quality Assessment / Improvement Responsibilities 8/1/02
2100 EMS Agency 4/1/97
2110 Emergency Medical Dispatch (EMD) Provider Agencies 12/1/05
2120 EMT-I and First Responder Provider Agencies 2/1/05
2130 Defibrillation Medical Oversight 11/1/07
2140 ALS Provider Agencies 4/1/97
2150 Base Hospitals 4/1/97
2200 Confidential Incident Review Process 4/1/97
2300 Certificate Review Process 7/1/06
2400 Trauma Audit Committee 12/1/05
2450 Trauma Program Managers Committee 11/1/07
2500 Receiving Hospital Trauma Patient Registry 7/1/06

Section 3000 ADMINISTRATION: Certification

3000 Fee Schedule 2/1/04
3100 Continuing Education (CE) For EMS Personnel 1/1/05
3200 EMT-I Certification 6/1/08
3210 EMT-I Recertification 6/1/08
3220 EMT-I Certification by Challenge 6/1/08

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POLICY NO. TITLE EFF. DATE

3400 EMT-Paramedic Accreditation 8/1/02
3410 EMT-Paramedic Continuing Accreditation (Reverification) 2/1/04
3500 Mobile Intensive Care Nurse (MICN) 11/1/03
3510 Mobile Intensive Care Nurse (MICN) Reauthorization 11/1/03
3520 Mobile Intensive Care Nurse (MICN) Authorization by Challenge 2/1/05

Section 4000 ADMINISTRATION: Program Approval

4000 Emergency Medical Technician-I (EMT-I) Training 10/1/09
4110 EMT AED Service Provider 2/1/05
4120 First Responder – Defibrillation Provider Agency 2/1/05
4130 EMT-I Skills Competency Verification 1/1/05
4200 Emergency Medical Dispatch (EMD) Training 12/1/05
4210 Emergency Medical Dispatch (EMD) Provider Agency 12/1/05
4300 Continuing Education Provider 10/1/09
4400 Emergency Medical Technician-Paramedic (EMT-P) Training 10/1/09

Section 5000 OPERATIONS: General Policy (BLS/ALS)

5100 Authority for Medical Emergency Scene Management 9/1/06
5110 Initial Responder Policy 7/1/06
5120 ALS Responder 4/1/97
5130 Emergency Medical Services Aircraft Operations, Equipment, and Personnel 10/1/09
5205 Equipment and Supplies for First Responder / EMT-I Emergency Apparatus 2/1/05
5210 Equipment and Supplies for Basic Life Support Ambulances 6/1/08
5215 Equipment and Supplies for Advanced Life Support Emergency Apparatus 10/1/09
5220 Equipment and Supplies for Advanced Life Support Ambulances 10/1/09
5225 Personal Protective Equipment (PPE) for Ambulances 6/1/07
5230 Radio Communication Standard 6/1/08
5300 ReddiNet Operations 11/1/06
5310 Ambulance Diversion 11/1/08
5320 Cancellation / Reduction of Ambulance Equipment At Scene 4/1/97
5325 Utilization of BLS Ambulance When Primary ALS Ambulance is Delayed 7/1/06
5330 EMT-P Non-Acceptance of Patient Care Responsibility 11/1/08
5350 BLS Transport After ALS Assessment for Rural Transport Providers 10/1/09
5410 Crime Scene Management 4/1/97
5500 Consent and Refusal of Medical Treatment 10/1/09
5510 5150 Transport 7/1/99
5520 Restraints 7/1/99
5600 Withholding Resuscitation Efforts 11/1/08
5610 Withdrawal of Resuscitation Efforts 11/1/08
5620 Do Not Resuscitate (DNR) 11/1/08
5700 Prehospital Medical Destination 6/1/08
5710 Trauma Triage Indicators and Destination 11/1/06
5720 Burn Patient Destination 6/1/08
5730 STEMI Receiving Centers 11/1/07
5800 Multiple Casualty Incident (MCI) Scene Management 6/1/07
5890 Utilization of Mobile Basic & Advanced Life Support Caches 11/1/06
5900 Self-Treatment with Mark-I Kits 11/1/07
5910 Self-Application (Protection) with an Emergency Escape Hood 6/1/05
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POLICY NO. TITLE EFF. DATE

Section 6000 OPERATIONS: Patient Care Policy (BLS)

6000 Introduction to BLS Protocols 6/1/08
6020 Preprescribed Medical Devices 6/1/08
6030 EMT-I Medical Adjuncts Monitoring 6/1/08
6040 EMT-I Interfacility Transport of Patients With IV Lines 6/1/08
6050 BLS Defibrillation Protocol 6/1/08
6060 Axial Spinal Immobilization 6/1/08

Behavioral Emergencies
6100 Assault Victim 11/1/07
6110 Crisis 11/1/07

Cardiac Emergencies
6200 Chest Pain 11/1/07
6220 Cardiac Arrest – Severe Bradycardia 11/1/07

Environmental Emergencies
6300 Burns 11/1/07
6310 Drowning / Near Drowning 11/1/07
6320 Heat Illness / Hyperthermia 11/1/07
6330 Hypothermia / Frostbite 11/1/07

Medical Emergencies
6400 Abdominal Pain 11/1/07
6410 Anaphylaxis 11/1/07
6420 Hypertensive Emergencies 11/1/07
6440 Shock (Non-Traumatic) 11/1/07

Neurologic Emergencies
6500 Altered Level of Consciousness / Coma (Non-Diabetic) 11/1/07
6510 Altered Level of Consciousness / Coma (Complications of Diabetes) 11/1/07
6520 Acute Cerebrovascular Accident / Transient Ischemic Attack (CVA, TIA) 11/1/07
6530 Seizures 11/1/07
6550 Syncope / Near Syncope 11/1/07

OB / Gyn Emergencies
6600 Severe Pre-Eclampsia / Eclampsia 11/1/07
6610 Imminent Delivery (Normal) 11/1/07
6620 Imminent Delivery (With Complications) 11/1/07
6630 Vaginal Hemorrhage without Shock 11/1/07
6640 Vaginal Hemorrhage with Shock 11/1/07
6650 Neonatal Resuscitation 11/1/07

Poisonings
6700 Poisons / Drugs 11/1/07

Respiratory Emergencies
6800 Respiratory Arrest 11/1/07
6810 Acute Respiratory Distress 11/1/07
6830 Airway Obstruction 11/1/07
6840 Croup / Epiglottitis 11/1/07
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POLICY NO. TITLE EFF. DATE

Traumatic Emergencies
6900 Traumatic Arrest 11/1/07
6910 Traumatic Shock 11/1/07
6920 Extremity Trauma 11/1/07
6950 Head-Neck-Facial Trauma 11/1/07

Section 7000 OPERATIONS: Adult Treatment Protocols (ALS)

7000 Introduction to ALS Protocols 10/1/09
7010 Management of Controlled Substances 2/1/05
7020 Physician on Scene 4/1/97
7030 ALS Interfacility Transfers 2/1/04
7040 EMT-P Interfacility Transport of Patient with IV Lines 11/1/07
7045 Intravenous Infusions of Heparin and Nitroglycerin 6/11/97
7050 ALS Unit Reporting Format 6/1/08
7060 Advanced Life Support Guidelines 7/1/06

Cardiac Emergencies
7200 Cardiac Chest Discomfort 10/1/09
7210 STEMI Assessment 2/1/08
7220 Bradycardia 11/1/08
7230 Paroxysmal Supraventricular Tachycardia (PSVT) 6/1/07
7240 Wide Complex Tachycardia or Ventricular Tachycardia with Pulses 11/1/07
7250 Ventricular Fibrillation – Pulseless Ventricular Tachycardia 6/1/07
7260 Asystole 10/1/09
7270 Pulseless Electrical Activity (PEA) 10/1/09

Environmental Emergencies
7300 Burns 10/1/09
7320 Heat Illness 12/1/05
7330 Hypothermia – Frostbite 4/1/97

Medical Emergencies
7410 Allergic Reaction 4/1/97
7430 Hypoglycemia – Diabetic Ketoacidosis 4/1/97
7440 Non-Traumatic Shock 10/1/09

Neurologic Emergencies
7500 Altered Level of Consciousness 12/1/05
7520 Acute Cerebrovascular Accident 11/1/08
7530 Status Seizure 12/1/05

OB / Gyn Emergencies
7600 Eclamptic Seizures 11/1/07
7615 Childbirth 7/1/99

Poisonings
7710 Beta Blockers – Calcium Channel Blockers 10/1/09
7730 Caustics – Corrosives 4/1/97
7740 Cyclic Antidepressants 12/1/05
7750 Narcotics – Sedatives 10/1/09
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POLICY NO. TITLE EFF. DATE

7760 Organophosphates 6/1/08
7770 Dystonic Reactions to Phenothiazine Drugs 4/1/97

Respiratory Emergencies
7800 Respiratory Arrest 4/1/97
7820 Chronic Obstructive Pulmonary Disease – Asthma – Bronchospasm 6/1/08
7830 Airway Obstruction 8/1/02
7850 Acute Pulmonary Edema 10/1/09

Trauma
7900 Traumatic Arrest 7/1/06
7910 Traumatic Shock 4/1/97
7920 Abdominal Trauma 4/1/97
7930 Chest Trauma 4/1/97
7940 Extremity Trauma 11/1/07
7950 Head – Neck – Facial Trauma 4/1/97

Section 8000 OPERATIONS: Pediatric Treatment Protocols (ALS)

8000 Principles of Pediatric Treatment 11/1/03

Cardiac Emergencies
8220 Bradycardia 6/1/08
8230 Tachycardia with Pulses 11/1/08
8250 Ventricular Fibrillation – Pulseless Ventricular Tachycardia 11/1/06
8260 Asystole 10/1/00
8270 Pulseless Electrical Activity (PEA) 2/1/05

Environmental Emergencies
8300 Burns 2/1/05
8320 Heat Illness 12/1/05
8330 Hypothermia – Frostbite 4/1/97

Medical Emergencies
8410 Allergic Reaction – Anaphylaxis 4/1/97
8440 Non-Traumatic Shock 4/1/97

Neurologic Emergencies
8500 Altered Level of Consciousness 12/1/05
8530 Status Seizure 6/1/08

OB – Newborn
8600 Newborn Resuscitation (less than 24 hours of age) 12/1/05

Poisonings
8730 Caustics – Corrosives 4/1/97
8740 Cyclic Antidepressants 12/1/05
8750 Narcotics – Sedatives 6/1/08
8760 Organophosphates 6/1/08
8770 Dystonic Reactions to Phenothiazine Drugs 4/1/97

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POLICY NO. TITLE EFF. DATE

Respiratory Emergencies
8800 Respiratory Arrest 11/1/03
8810 Respiratory Distress 10/1/00
8830 Airway Obstruction 7/1/06

Trauma
8900 Traumatic Arrest 6/1/08
8910 Traumatic Shock 4/1/97
8920 Abdominal Trauma 4/1/97
8930 Chest Trauma 4/1/97
8940 Extremity Trauma 11/1/07
8950 Head – Neck – Facial Trauma 4/1/97

APPENDIX

10 End-Tidal CO Monitoring Devices 4/1/97
2
17 Endotracheal Introducing Stylet 2/1/05
19 Intranasal Administration of Medications 12/1/05
20 Intraosseous Infusions 11/1/06
25 King Airway 10/1/09
28 Multi-Lumen Airway Intubation 2/1/05
30 Nasopharyngeal Airway Insertion 4/1/97
40 Nasotracheal Intubation 4/1/97
45 Needle Cricothyrotomy 4/1/05
50 Needle Thoracostomy 4/1/97
60 Pediatric Intubation 4/1/97
67 Transcutaneous Pacing (TCP) 8/1/98
70 Transtracheal Instillation of Medication 6/1/08
80 Twelve Lead (12L) EKG 7/1/06

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