scc 7

Santa Clara county hospitals
El Camino Hospital of Los Gatos

LGH ( Los Gatos)

Out of county Hospitals
Hazel Hawkins Hospital

HHH (Hollister)

Santa Clara county hospitals
Good Samaritan Hospital

GSH (San Jose)

Santa Clara county hospitals
El Camino Hospital of Mountain View

ECH (Mountain View)

Santa Clara county hospitals
Kaiser Foundations Santa Clara

KSC (Santa Clara)

Santa Clara county hospitals
O'Connor Hospital

OCH (San Jose)

Santa Clara county hospitals
Palo Alto Veterans Administration Hospital

PAV (Palo Alto)

Santa Clara county hospitals
Regional Medical Center of San Jose

RSJ (San Jose)

Santa Clara county hospitals
Saint Louise Regional Medical Center

SLH (Gilroy)

Santa Clara county hospitals
Santa Clara Valley Medical Center

VMC (San Jose

Santa Clara county hospitals
Stanford University Medical Center

SUH (Palo Alto)

Santa Clara county hospitals
Kaiser Foundation San Jose

STH (San Jose)

Out of county Hospitals
Kaiser Foundation Fredmont

KFF (Fremont)

Out of county Hospitals
Kaiser Foundation Redwood City

KRC (Redwood City)

Out of county Hospitals
Sequoia Hospital

SEQ (Redwood City)

Out of county Hospitals
Washington Township Hospital

WTH (Fremont)

Prehospital Providers Advisory Committee

Made of representatives from each provider agency, hospitals, law enforcement, etc. that focuses on the logistics and operations of EMS

Emergency Medical Services Committee (EMSCo.)

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)

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

A diverse group of emergency service responders who focus on development and implementation of MCI plans and procedures

Clinical Practice Advisory Committee (CPAC)

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

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

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

Report within 7 business days

Trauma Center Service Areas
SUH Catchment Zone

Northern border of SCC to De Anza Blvd in Cupertino and through the center of Sunnyvale

Trauma Center Service Areas
VMC Catchment Zone

South of De Anza Blvd in Cupertino and south of Sunnyvale-Saratoga Road to East Remington/Fair Oaks Ave in Sunnyvale

Eastern border is North First Street/Monterey Highway from San Jose (Alviso) to the southern boundary at the intersection of highway 101 and 85 in SJ

Patients requiring transport from areas south of 101/85 and West of 101 extending to the southernmost border of the county will be transported to VMC

Trauma Center Service Areas
RSJ Catchment Zone

Extends from all areas east of North First Street/Monterey Highway (includes Milpitas) to the southern boundary at the 101/85 intersection in SJ. The northern border is SF Bay

Patients requiring transport from areas south of 101/85 interchange and east of 101 extending into the southernmost borders of the county shall be transported to RSJ

Trauma Center Service Areas
at border of zones

Incidents that occur on the border of any of these zones shall be transported in accordance with the
paramedics' discretion

Hospital Radio Reports
Ring-down

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

1. Demographics (Unit ID (agency, type, number),ETA, Patient's Age, Patient's Sex)
2. Chief complaint / Ems providers impression
3. Any pertinent medical history, pertinent medications, pertinent allergies, and any other significant findings from physical assessment
4. Vital signs (Explain and report abnormal findings
Or, state "within normal limits" (WNL))
5. treatment provided

Hospital Radio Reports
Specialty Center

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

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
2. Not currently suicidal
3. Is not on a psychiatric hold (5150)

Field Pronouncement of Death Criteria
In addition to any specific criteria for withholding or discontinuing
resuscitation contained within individual treatment protocols, resuscitative efforts may be withheld, discontinued, and/or death determined under the following circumstances (BLS

1. Any of the Five signs of Immediate DOA
2. A pulseless and/or apneic patient with a valid Do Not Resuscitate (DNR) directive
3. A pulseless and/or apneic patient who has exercised his/her right to die under the End of Life Option Act

Five signs of Immediate DOA

1. Decapitation
2. Total incineration of the body
3. Decomposition of the body
4. Rigor mortis accompanied by post mortem lividity
5. A pulseless patient with total separation and/or obvious destruction of the heart, brain, and/or lungs

Field Pronouncement of Death Criteria
Actions if criteria are met

1.Discontinue/withhold any resuscitative efforts
2. Cancel and prehospital personnel still en-route
3. Provide appropriate comfort and care to bystanders
4. 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)

Identification(Valid Forms)
1. valid CA physicians medical license
2. other ID that indicates physicians CA medical license \# and business address

Physician at Scene
Physical Involvement (Patient must be conscious and give consent)

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
2. 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

May manage care, but ultimately accepts responsibility for patient. Must accompany crew and patient in ambulance

Physician at Scene
Documentation(along with PCR)

1. Physicians Name
2. CA medical License \#
3. Business Phone \#
4. Level of patient care involvement
5. All procedures and treatments performed at
scene

SCCO Specialties
Trauma

Adult: RSJ, SUH, BMC
Pediatric: SUH, VMC

SCCO Specialties
Psychiatric:

ECH, VMC, EPS, PAV, SUH

SCCO Specialties
Burn

VMC

SCCO Specialties
Stroke

Comprehensive:ECH, GSH, RSJ, SUH
Primary: ALL except PAV and EPS

SCCO Specialties
STEMI & ROSC:

ALL except LGH, PAV, SLH, and EPS

EMS Patient Destination
Patient Choice

Patient may be transported to requested facility as long as facility meets medical requirements, barring any EMS system surge and hospital diversion
1. Out of County (HHH, KFF, KRC, SEQ, WTH)

EMS Patient Destination
Routine Patient Destination

patients may be transported to routine emergency department Unless patient meets criteria that requires specialty care

EMS Patient Destination
Special Circumstances

In-Extremis: patient presents with condition that would benefit most from immediate emergency ambulance transportation to the hospital

Patient must be transported to the closest hospital
and that is not on internal disaster (can override diversion)

EMS Patient Destination
Special Circumstances
EMS Surges/ Multiple patient events

1. All destinations will be assigned by county communications
2. may be transported to out of county hospital, or Mobile Field Hospitals with approval

EMS Patient Destination
Special Circumstances
Diversion

1. Only one hospital may be on ambulance diversion (red) at any given time in a Diversion zone
2. May divert for 90 minutes per occurrence, but must allow for another 90 minutes before next diversion

Diversion zones

1. North:SUH, ECH, KSC
2. Central: RSJ, VMC, OCH
3. Southern: GSH, STH, SLH

Do Not Resuscitate / Advanced Directives
Proper DNR documents

1. Physicians Orders for Life Sustaining Treatment (POLST) form stating No CPR
2. EMSA and CMA approved Emergency Medical Services, Prehospital DNR form
3. CA approved DNR medallions
4. Durable Power of Attorney for Health Care (DPAHC)

Do Not Resuscitate / Advanced Directives
Procedure

If EMS personnel arrive, patient is pulseless and apneic:
1. 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
3. 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.

If provided with a DNR form they are unfamiliar with, continue to resuscitate until proper documentation is provided.

If no DNR is confirmed, or if crew believes POLST is not valid due to lack of signatures, patient receives full resuscitative efforts

Do Not Resuscitate / Advanced Directives
Handling decendent will depend on location (Public place)

Local public safety agency hold jurisdiction and responsibility for disposition of decedent

Do Not Resuscitate / Advanced Directives
Handling decendent will depend on location (home)

Local police or fire agency hold jurisdiction and responsibility

Do Not Resuscitate / Advanced Directives
Handling decendent will depend on location (Residential care facility (skilled nursing facility, etc.))

Staff of facility hold jurisdiction and responsibility

Do Not Resuscitate / Advanced Directives
Handling decendent will depend on location (If patient dies en route to destination, withhold BLS/ALS interventions and choose one of the 3 options:)

1. Transport to pre-arranged destination
2. Return to point of departure
3. Transport to closest ED of an acute care facility

Prehospital Transfer of Care

1. The scene of an emergency shall be managed by the
appropriate public safety agency having primary investigative authority.
2. 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:

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
2. Paramedic to ALS Flight crew
3. Paramedic to BLS
a. mainly in MCI activations
b. cannot occur if paramedic level interventions are performed
4. Prehospital personnel to hospital staff

BLS Utilization
Interfacility Transportation

Hospital to SNF, Hospital to residence, MD appointments, dialysis, etc

BLS Utilization
Emergent Patients encountered by EMT's

1. Emergent\=life or limp threatening condition requiring immediate definitive care
2. Respiratory Distress, Airway Compromise, Neurological changes from baseline, signs of
actual or impending shock, or meet Major Trauma criteria
3. 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
4. If on scene to hospital is greater than 10 minutes, 911 must be called for ALS assistance
5. 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

BLS Utilization
Use in the 911 system

1. during times of high call volume, BLS ambulance query's may go out bringing BLS ambulances into 911 system
2. if patient requires ALS assistance, paramedic from ALS first responder shall provide any necessary ALS interventions en-route to hospital

EMS system Field Management

1. Public safety agency (law or fire) having investigative authority for jurisdiction of the incident shall
be responsible for consequence management and mitigation of the incident and scene
2. EMS Duty Chief may serve in the following capacities
3. Liaison between agencies that are requested by Incident Commander
4. May delegate any system roles to the contractors ALS field supervisors
5. Fill in Incident command system i.e. Medical Branch,
transportation, ambulance staging, medical communications, treatment unit leader, etc.
6. Delegate of the county health officer

Private EMS Response to Hazardous Materials
General Procedures

Initial Actions:
1. Safety (of yourself and other around you)
2. Isolate Area and Deny Entry
a.At least 100 ft away for small incidents and 500 ft away for large incidents
Secondary Actions:
1. Establish Command (i.e. incident commander)
2. Identify Hazardous Materials
a.Ask bystanders what they saw, smelled, or heard
b. Refer to DOT guidebook
Supportive Actions:
1. only trained public safety HAZMAT or authorized specialized personnel are allowed to enter "Hot Zone" of a HAZMAT incident
2. EMS providers shall coordinate with on scene HAZMAT specialists to provide receiving hospital's with information (i.e. Chemical names, decon methods, DOT
reference \#, etc.)

Private EMS Response to Hazardous Materials
Patient Handover, Treatment, and Transport

1. Decontaminated patients will be instructed to move to "cold zone" by IC, and will receive medical care in this zone.
2. Both the IC, or their designees, AND the transporting Paramedic must both agree that patient has been properly decontaminated. Then the patient will be cleared for treatment and transport
a. Designees may include HAZMAT Group Supervisor, Safety Officer, or Decon Team Leader.

Private EMS Response to Hazardous Materials
Patient Handover, Treatment, and Transport
Once the decision to transport has been made

Transporting crew will contact receiving hospital, providing the following information:
1. State "DECON ALERT" (Explaining that patient being transported has been Decontaminated after exposure to contaminant)
2. Chemical Name
3. Decontamination Methods used on scene
4. DOT reference \#
5. Any appropriate treatment information/considerations
6. Provide routing patient notification report
7. Request that ED have appropriate representative meet ambulance outside the ED door to evaluate the patient before entry
a. This representative will determine if patient is safe to enter, or must be decontaminated further.

Private EMS Response to Hazardous Materials
Patient Handover, Treatment, and Transport
Accidental exposure

1. Any accidental exposure during any transport by EMS crews shall immediately stop, at the safest location, and notify County Communications that they have been contaminated.
a. Fire Crew will respond
2. If a crew has an exposure at an incident site, they must immediately notify the incident
commander
3. Any responders who are accidentally contaminated at a HAZMAT incident scene SHALL NOT board the transport rig until they have been decontaminated

Prehospital Task Force and Strike Teams

1. Strike teams may be requested by any officer of a system provider agency, EMS duty chief
2. Common uses of Ambulance tasks forces include, but not limited to rescuer rehab functions, civil unrest, aircraft incidents, etc.

Types of prehospital Strike Teams/ task Forces

1. Ambulance Task Force \#1:
Three ALS ambulances and one EMS Field Supervisory,
mainly for MPMP activation
2.Ambulance Task Force \#2:
Five ambulances, two of which must be ALS ambulances, one EMS Field Supervisory, mainly for MPMP activation
3. State Type 1 Ambulance Strike Team:
Five (5) ALS ambulances, with
EMT/Paramedic,
one strike team unit leader with separate vehicle, and State DMSU (Disaster Medical Supply Unit)
4. Type II Ambulance Strike Team:
Five (5) BLS ambulances, with two EMTs,
one strike unit leader with separate vehicle, and State DMSU
5. State Medical (Out of County) Strike Team:
mixed assembly of ambulances (BLS, ALS, CCT), one task force unit leader, and State DMSU

EMS Personnel Markings and Protective Gear
Standard ID

All EMS personnel shall wear uniforms that identify the agencies they work for when attached to EMS calls. (i.e. company Uniform, ID badge visible at all times)

EMS Personnel Markings and Protective Gear
Protective gear

1. protective gear shall be worn when directed by the IC, public safety personnel, county or EMS field supervisor, as well as when OSHA requirements call for such gear
a. High Visibility jacket and Helmets/goggles with three letter company identifier

EMS Personnel Markings and Protective Gear
Indications

1. Federal Aviation Admin. (FAA) alerts
2. MPMP Activations
3. Actual/Suspended HAZMAT Events
4. Incidents on roadways or freeways
5. Working with aircraft
6. Mutual or automatic aid responses
7. When the need for clear ID and/or recognition exists due to multi-agency response, environmental conditions, and/or general safety

EMS Life Safety Procedures
Assessing the Scene

1. If first unit to arrive on scene is an ambulance, one crewmember assumes the role of IC and the other be responsible for overall incident safety
2. IC assumes responsibility for incident management, requires C.A.N. Report for county
communications, or any responder that arrives on scene
a. Conditions: what is observed
b. Actions: what the IC plans to do
c. Needs: what additional resources are needed
3. Fire dept. or law enforcement can have IC role transferred to them once they arrive on scene (County Communications should be notified of this change)

EMS Life Safety Procedures
Life Hazard Zones (LHZ): an area containing a process or condition that would likely cause serious death or death to exposed

1. LHZ should be isolated by the IC with identifying barriers
2. A LHZ shall be marked with THREE HORIZONTAL STRANDS OF RED AND WHITE BARRIER TAPE
with "Do Not Enter" printed in large lettering
3. If red tape unavailable, any area barricaded with three horizontal strands of barrier tape in any color or pattern is to be considered a LHZ until proven otherwise

EMS Life Safety Procedures
some LHZ conditions

1. Fallen power lines
2. Energized electrical equipment
3. Collapsed zones, or area around damaged structure that would be covered in debris if structure collapsed
4. Large unprotected holes, ditches, tranches, pools, or sewer access points
5. A damaged vessel containing any pressurized liquid or gas
6. Ammunition or explosives such as gun powder, blasting caps, and dynamite
7. Presence of suspected or actual HAZMAT, including fuel spills from traffic collisions

EMS Life Safety Procedures
Lookouts, Communications, Escape Routes, and Safety Zones (LCES)

1. All ambulance crews should prioritize situational awareness, especially while staging, in order to identify any possible danger, communicate with the IC as quick as possible, and advice County Communications in order to communicate to responding units that are
not yet on scene
2. Escape routes shall be identified for every emergency scene to allow for rapid retreat if
necessary.
3. IC shall designate safety zones that are areas that can be used for staging or an area of safe refuge

EMS Life Safety Procedures
Emergency Vehicle Positioning

1. Positioning emergency vehicles to form a barrier between an emergency scene and any flowing traffic or other hazards. (With emergency lights on)
a. Any vehicle used to create this barrier is to be UNOCCUPIED Patients are not to be loaded into these vehicles
2. If a scene has already been protected, additional arriving ambulances should position themselves beyond the scene to create a safe location for crews and patients to be loaded into ambulance, report to staging, or repot to location assigned by IC

Imminent Danger definition

any threat or hazard that could be reasonably expected to cause immediate death or serious physical harm to a responder

EMS Life Safety Procedures
Imminent Danger : Scene staging

1. Crews may be advised by dispatch of any imminent danger, and to stage and wait for further instructions
2. When staging for 10+ minutes, contact the IC to identify ways to safely and quickly access the patient, take additional actions to identify ways to quickly access the patient, and document all actions taken in PCR

EMS Life Safety Procedures
Imminent Danger: Scene Security

1. EMS personnel may not enter any scene where imminent danger exists (i.e.HAZMAT entries, Water Rescue, High/Low Angle rescue, etc.), even if
accompanied with law enforcement
2. in the event that EMS responders arrive on scene and are subsequently faced with imminent danger, the responders may retreat to a safe area to stage until
the scene is safe while making a reasonable effort to evacuate the patient with them
3. If crew retreats, crews must advise county communications and the IC to request the appropriate resources needed to secure the scene
4. any retreat shall be documented thoroughly, and should complete a System Variance report

EMS Life Safety Procedures
Risk Refusal

1. A "turn down" is a situation where an EMS responder has determined that due to safety concerns, they cannot undertake or negotiate a safe alternate solution (based on assessments of risk and the ability of the individual to control the risk. Including, but not limited to:
a. Violation of safe work practices
b. Environmental conditions make the work unsafe
c. Individual lacks necessary qualifications or experience
d. Defective equipment is being used
e. The assignment violates federal, state, or local law or regulation
f. Assignment violate established policies, procedures, or treatment protocols
2. If Assignment is turned down, inform the EMS field supervisor and complete a System
Variance report

EMS Life Safety Procedures
Personnel Accountability Reporting (PAR)

1. 800MHz
2. A PAR is a periodic welfare check to verify safety and security of responders
3. PAR includes all personnel assigned or in the care of the EMS unit (i.e.ride-alongs, trainees/interns, patients, assisted allied responders, etc.)
4. When a crew receives a request for a PAR, the crew shall:
a. Visualize all personnel assigned to the unit
b. Determine without a doubt they are present and safe
c. State over the radio:
1. Unit ID
2. Has PAR or does not have PAR
3. Number of assigned crew present
4. number of non-crew personnel present
5. the assignment and last known location of any personnel who are not present or visible
6. Unit assignment and location

End of Life Option
Aid-in-Dying Drug

Drug determined and prescribed by physician for a qualifying individual, which can be self-administered

End of Life Option
Final Attestation

Form that the patient must complete 48 hours prior to self-administering the Aid-in-Dying drug

End of Life Option
Procedure

1. Every attempt should be made to verify the patient matches the one denoted in the Final Attestation, including valid photo ID or family/witness ID
a. If possible, retain a copy with PCR
2. If Final Attestation is present, withhold resuscitative measures if patient is in cardiac arrest
3. Provide supportive and comfort measures appropriately, and/or airway ventilation measures when applicable.

Standard Protocols
Routine Medical Care (Adult/Pediatric)
Baseline Vital Signs/ early change signs (assessed every 10 minutes for stable, every 5 minutes for unstable patients)

1. Glasgow Coma Scale
2. Blood Pressure (first should be obtained via manual cuff)
3. Respiratory Rate
4. Pulse Rate (obtained via
palpation)
5. Pulse Oximetry (if unit is equipped)
6. Temperature

Standard Protocols
Routine Medical Care (Adult/Pediatric)
Advanced Vital Signs

1. Blood Glucose (via Fingerstick, or IV start)
2. Cardiac Monitoring (ECG)
3. Capnography (expiratory CO2 levels

Standard Protocols
Routine Medical Care (Pediatric)
Pediatric Patient Defined

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)

1. Nitrile Gloves
2. Eye Protection
3. Hand washing after every patient contact
4. If hand washing not possible, use waterless hand sanitizer

Standard Protocols
Infectious Disease Control Measures
Contact Transmission

1. Occurs through contact with pathogens on the patients skin or other surfaces the patient has touched, OR pathogens contained in bodily fluids/substances/secretions
a. Vomit, feces, urine
b. Draining wounds
c. Secretions (Saliva, semen, sweat, breast milk)
2. Universal precautions, with the addition of an impermeable gown should be used to prevent contact transmission

Standard Protocols
Infectious Disease Control Measures
Droplet Transmission

Occurs through inhalation or absorption of bodily fluid/substance droplets that contain pathogens such as:
a. Respiratory viruses (i.e. influenza, coronavirus, adenovirus, rhinovirus)
b. Pertussis
c. Strep Throat
2. Universal precautions, with the addition of a surgical mask should be used. Faceshields and impermeable gowns may also be considered if indicated

Standard Protocols
Infectious Disease Control Measures
Airborne Transmission

Occurs through the inhalation or absorption of air that contain pathogens, such
as:
a. Tuberculosis
b. Measles
c. Chickenpox
2. 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

1. May occur when bodily fluids/secretions are aerosolized during certain procedures (i.e. nebulizer treatments, suctioning, and intubation)
2. Universal precautions, along with N95 or P100. Face shields and impermeable gowns should be used if indicated

Standard Protocols
Ventricular Assist Device (VAD)

1. A VAD us a device that supplements or replaces the cardiac ventricle in pumping blood to the body
2. Patients with VADs present prehospital providers with unique assessment difficulties
a. Unable to palpate pulse
b. Unable to read blood pressures
c. Unable to obtain pulse-oximetry readings
3. EMS providers should rely on patients level of consciousness, skin signs, capillary refill,etc. to make any clinical decisions
4. VAD patients also have implanted cardioverter-defibrillator (ICD) and/or a pacemaker/ICD

Standard Protocols
Special considerations with VAD patients

1. VADs are currently only done at SUH and KSC
2. CHEST COMPRESSIONS ARE CONTRAINDICATED IN PATIENTS WITH VADs

Procedures
Spinal Motion Restriction (SMR

1. SMR will be applied to all patients that have, or may have sustained a significant MOI and have an abnormal spinal injury assessment
2. Begins with manual stabilization and immobilization of the cervical spine, followed by
proper application of the following devices:
a. Properly sized cervical collar
b. Long plastic spine board
c. Web belt or strapping device
d. Lateral head support device

Modified Spinal Motion Restriction

1. Begins with the manual stabilization and immobilization of the cervical spine, followed by the
application of, at minimum, a rigid cervical collar and is utilized for a less acute patient with a simple mechanism of injury.
2. Modified SMR is utilized for patients that exhibit para-vertebral pain or soft tissue tenderness and has an unremarkable spinal injury assessment

Spinal Injury Assessment (FSA)
If potential for spinal injury exists, apply manual stabilization and assess patient for following:

1. Determine if there is a language barrier
2. Assess for any distracting injuries and alcohol or drug use
3. Determine if patient is cooperative, alert and oriented
4. Palpate and visualize the entire vertebral column for injury

If the above is abnormal at any step, apply SMR.
If above is unremarkable consider Modified SMR, or omit SMR.

Spinal Injury Assessment
If unremarkable, continue with patient assessment

1. Assess for adequate circulation, motor, and sensation in all extremities (CSMs)
2. Assess flexion and extension in both elbows and wrist
3. Assess finger adduction and abduction in both hands
4. Assess flexion and extension in both knees
5. Assess plantar flexion and dorsiflexion in
both feet

Multiple Patient Management Plan (MPMP)
activation

1. Level 1 Activation
a. Less than 10 patients require ambulance transport
2. Level 2 Activation
a. Up to ten 911-system ambulances are used OR
approximately less than twenty patients require ambulance transport
3. Level 3 Activation
a. Anticipate over 20 patients and up to 100 patients that will require transport
4. Level 4 Activation
a. Anticipate up to 1000 patients that will require transport
5. Level 5 Activation
a. A patient generator event that produces 1000+ patients that require transport

EMS Communications Systems Guide
Authorized Radio Terminology

use of clear-text (plain English) instead of 10 codes
to be in accordance with NIMS