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EMS DEPARTMENTAL BULLETIN REVIEW

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2. Only done if patient's condition or scene safety ... Isolated Minor Extremity Trauma Only (No Compromise) ALS ... by LAPD, Officer Shall Ride ... – PowerPoint PPT presentation

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Title: EMS DEPARTMENTAL BULLETIN REVIEW


1
  • EMS DEPARTMENTAL BULLETIN REVIEW

2
Walking Patients To Ambulances (Departmental
Bulletin 06-15)
  • Walking Patients
  • 1. Strongly discouraged
  • 2. Only done if patients condition or scene
    safety issues are
  • Present
  • 3. Document deviation from policy

3
Ambulance Transportation Policy (Departmental
Bulletin 08-11)
  • All Patients Shall Be Offered Transport by
    Department Ambulance Except
  • 1. Isolated Minor Extremity Trauma Only
    (No Compromise)
  • ALS Transportation Policy Based On
  • 1. Patient Request (Unless Medical
    Condition Prohibits) - 30 min.
  • EMS Captain / OCD Floor Captain
    Approval
  • 2. Need For Specialty Hospital (i.e.
    Trauma Center, EDAP etc.)
  • 3. Service Area Hospital
  • OTHERWISE
  • 4. MAR (Extremis Patients-Obstructed
    Airway, Or Other Condition
  • Where Base Station Determines Need)

4
  • (Ambulance Transport Policy Continued)
  • BLS TRANSPORTATION POLICY
  • 1. Patient Condition Designates BLS Policy
  • (Not ALS/BLS Unit Designation)
  • 2. BLS Patients Go To MAR Regardless of
    Closure Status
  • Unless
  • Service Area
  • EDAP Due To Age
  • Consider other reasons, i.e.
    Patient Requests

5
  • (Ambulance Transport Policy Continued)
  • ADDITIONAL CONSIDERATIONS
  • IF Requested, Family Shall Normally Go Along,
    Normally Front Right Seat
  • Ambulance Cost Information Shall Not Be Use To
    Leverage A Patients Decision To Go With Us
  • If You Vary From Policy, Through Documentation
    Notification To EMS Captain

6
Patient Refusal of Treatment/Transport Against
Medical Advice (Departmental Bulletin
05-03)
  • Goal of the Bulletin to Allow Patients to
    Reconsider Decision to Refuse
  •  
  • We are Expected to Provide a Level of Service
    that we would want Provided to our Family
  •  
  • Patients Must be AOx3 but Also Competent to
    Refuse Capacity to Understand
  •  

7
  • (Patient Refusal Policy contd)
  • AMA Procedures
  • 1. Determine Orientation/Competency
  • 2. ALS Unit Only, No Paramedic working on a
    BLS Unit May
  • Handle AMA
  • 3. Perform a Complete Patient Assessment
  • 4. Explain need for Treatment, Consequences
    of Refusal,
  • Ability to Re-Contact 911
  • 5. Make Base Contact while with Patient,
    Encourage Base to Speak
  • to Patient
  • 6. Have Patient Sign, if Possible with a
    Witness

8
  • (Patient Refusal - AMA Continued)
  • 7. If Patient Refuses, Document In
    Comments Section
  • 8. If Patents Refusal Due To His / Her
    Choice Of Hospital, Base Concurs, Transport
    Shall Be initiated Provided the Patient Is Stable
    , Efforts To Accommodate Should Be Made. IF 30
    min Request EMS Captain. EMS OCD will Determine
    If Transport Is Approved
  • 9. If Paramedics Uncomfortable With Any
    Aspect of AMA Or Requested Destination Call EMS
    Captain LAPD As Necessary

9
Inter-facility Transport/Response Protocol
(Departmental Bulletin 07-06)IFT PROTOCOL

  • 1. EMT/ALA Anti-Dumping Law
  • 2. Doctor / Doctor Contact for Authorization
  • 3. 911 Accessed / OCD Dispatch Resources
    EMS Captain
  • 4. EMS Captain Facilitates Trans/Coord
    between Hospital/RA
  • 5. BLS RA At Discretion of EMS Captain
  • 6. If Critical Request Additional
    Resources
  • 7. LAFD Personnel Operate Within Scope of
    Practice

10
  • (IFT PROTOCOL Continued)
  • 8. Above Scope of Practice Request
    Additional Hospital Staff
  • 9. If Appears Non-Emergency EMS
    Captain Direct Contact with
  • Transferring Doctor
  • 10. RA Obtain Both Doctors Name on F902M
  • 11. If Receiving Hospital Not IDd
    Consider Treating As 9-1-1 Call
  • and make Base Contact
  • 12. Take All Copies of Patients Records
  • 13. Ask Treat Staff to D/C
    Infusions/Pumps If Out of Scope Of Practice
  • 14. Continuous Capno/ Base Contact As
    Needed

11
  • IFT DOCUMENTATION
  • F902M
  • 1. Transporting Hospital Name ID
    Number
  • 2. Receiving Hospital Name ID Number
  • 3. Transporting Doctors Name
  • 4. Receiving Doctors Name
  • 5. Name(s) of Additional Hospital Staff
    Participating
  • 6. EMS Unit ID, Time ONS, Time of
    Patient, ID Number,
  • Signature
  • 7. Description of Patient Mgt.
    Activities, Issues, Problems
  • and or Complications

12
  • (IFT Documentation Continued)
  • INTER-FACILITY TRANSFER REPORT
  • 1. EMS Captain Completes and Fax To BES,
    EMS Section BC Within 24hrs. Attach Copy of
    F902, Place in IFT File At EMS Office Keep
    For 3yrs.

13
LAFD Patient Care Policy For Patients In Police
Custody (Departmental Bulletin 05-04)
  • Treat Each As A Patient
  • Patient Can Refuse Care But NOT Transport
  • All Will Be Transported To a Hospital in a
    Department Ambulance Unless Minor Extremity Only
    Requires EMS Captain Dispatch To Scene

14
  • (Patients In Custody Continued)
  • Request EMS Captain For The Following
  • 1. LAFD Members Are Not Going To
    Transport
  • 2. Patient Is Violent Requires
    Departmental Restraints
  • 3. BLS Ambulance Requested To Transport
    Patient To
  • Hospital That Is Not MAR

















































































  • 4. Spit Hood Applied

15
  • (Patients In Custody Continued)
  • Members Transporting Restrained Patients Shall
  • Transport To MAR Unless Base Station Approval
  • If Restraints Applied by LAPDOfficer Shall Ride
  • Never Transport In Prone Position Priority is
    Left Lateral
  • Avoid Vascular Compromise
  • Restrained Extremities Evaluated Every 15 min,
    Document Actions Done Or Not Done Difficult
    Patients

16
  • (Patients In Custody Continued)
  • Requests For Transport To LAC/USC Jail Ward
  • Patient Must Be Medically Stable
  • Not Meet Specialty Center Criteria
  • Base Contact Shall Be Made With USC Base To
  • Approval
  • Once _at_ LAC/USC Patient To Be Triaged In
  • Main ED Either Remain In Care Of ED
    Staff Or
  • Transferred To Jail War On 13th Floor
    By LAPD

17
  • (Patients In Custody Continued)
  • Members Transporting Restrained Patients Shall
  • Transport to MAR Unless Base Station Approval
  • If Restraints Applied by LAPD, Officer Shall Ride
  • Never Transport in Prone Position, Consider Left
    Lateral
  • Avoid Vascular Compromise
  • Restrained Extremities Evaluated Every 15 min,
    Document Actions Done or Not Done Difficult
    Patients
  •  

18
  • (Patients In Custody Continued)
  • Requests for Transport to LAC/USC Jail Ward
  • Patient Must be Medically Stable
  • Not Meet Specialty Center Criteria
  • Base Contact Shall be Made with USC Base to
    Request Approval
  • Once at LAC/USC Patient to be Triaged in Main ED
    either Remain in Care of ED Staff or
    Transferred to Jail Ward on 13th Floor by LAFD
  •  

19
  • (Patients In Custody Continued)
  • EMS Captain on Scene Shall Sign F902M
  • If Conflict Arises Between LAFD/LAPD, a
    Supervisor From Each Shall Determine Course of
    Action. Document Name Serial Number of LAPD
    Supervisor Unit Designation Number on F902M

20
Witnessed Cardiac Arrests (Departmental Bulletin
08-12)
  • Patients who are Awake and Talking but Rapidly
    Deteriorate Present Emotional Challenges for
    Patients Family Members as well as Pre-Hospital
    Providers.
  • Request An EMS Captain (Non-Emergency) Any Time a
    Patient is Conscious Awake But Deteriorates
    into Respiratory and/or Cardiac Arrest in Field
    or in Route to Hospital. EMS Captain will
  • 1. Review Incident with Members
  • 2. Review Documentation
  • 3. ID Lessons Learned
  • 4. Provide brief Post-Incident Debriefing

21
  • (Witnessed Cardiac Arrests Continued)
  • EMS CAPTAIN POST INCIDENT
    DOCUMENTATION INCLUDES
  • 1. Copy of F902M
  • 2. Copy of the Code Summary From LP 12
  • 3. Significant Incident Report To EMS Section

22
Transport Of Kaiser Health Plan Members To Kaiser
Facilities (Departmental Bulletin 08-14)
  • Goal is to Eliminate Subsequent Transport from a
    Non-Kaiser Facility
  •  
  • Department Members Benefit from Reduced Patient
    Conflicts Concerning Patient Destinations
  •  
  • Effective September 8, 2008 we get 126.82 for
    Patients Transported 3 miles Kaiser Wouldnt
    Have Been the Closest facility
  •  
  • Money Goes Directly to the LAFD is Used to
    Purchase Cell Phones for Ambulances, EMS
    Equipment Medical Supply Trailers
  •  

23
  • (Kaiser Policy Continued)
  • TRANSPORT CRITERIA ARE AS FOLLOWS
  • Patient Stable
  • Consent (Verbal or Implied)
  • Evidence the Patient is a Kaiser Member i.e.
    Kaiser card
  • Does Not Meet Specialty Center Criteria
  • Kaiser Not on Diversion or if it Has Given
    Verbal Telephonic
  • Permission

24
  • (Kaiser Policy Continued)
  • F902M DOCUMENTATION
  • 1. Incident Info-Lines 4 5
  • Enter Three-Digit Kaiser Hospital Number In The
  • Receiving Facility Field
  • Check Health Plan Box Under REASON Section
  • Do Not Check Request

25
  • (Kaiser Policy Continued)
  • 2. Patient Info Line 12
  • Enter KAISER in Insurance Carrier Field
  • Enter the Kaiser Membership Number in Account
    Number
  • Field

26
Medical Supplies (Departmental Bulletin
08-15)
  • Inventory Procedures
  • 1. Each ALS Resource Shall Maintain Minimum
    Inventory as Listed in DHS Ref 703, ALS Unit
    Inventory or DHS Ref 704, Assessment Unit
    Inventory
  • 2. Replenish Immediately Upon Return to
    Quarters
  •  
  • Ordering, Rotating, Storing Supplies
    Medications
  • Order on a Monthly Basis
  • Single Monthly Order for all Units Assigned to
    Same Station

27
  • (Medical Supplies -Ordering Continued)
  • 3. Quantities Ordered Sufficient to
    Replenish What Was Used
  • the Previous Month
  • 4. Immediately Upon Receipt, Verify Station
    Received Items Listed on the SRS Order
    Attached
  • 5. Immediately Report Discrepancies to
    Station Commander Medical Supply Officer
  • 6. Copy Retained in Combined File for 3yrs.
  • 7. Expiration Dates Checked Weekly Properly
    Rotated to Reduce Waste
  • 8. Expired Supplies Exchanged With the Medical
    Supply Officer

28
  • (Medical Supplies Continued)
  • Downgraded Paramedic Resources - Paramedic
    Ambulance to BLS
  • 1. Drug safe, Drug Pouch Containing Controlled
    Medications, Paramedic Equipment Supplies
    Removed Stored In Locked Cabinet With In
    Station
  • 2. Paramedic Signage Shall be Removed or
    Covered
  • 3. Station Commander Confirms Documents In
    Station F-2
  •  
  • Downgraded Paramedic Resources Assessment Engine
    to BLS
  • 1. Same Procedure Except No Controlled
    Medications to Secure

29
  • (Medical Supplies Continued)
  • Defibrillators
  • 1. When a Paramedic Ambulance is Staffed One
    One the Defibrillator will Remain on Apparatus
    for use by the Paramedic in Manual mode or EMT in
    AED Mode
  • 2. If Unit Staffed with two EMTs, the
    Defibrillator Shall be Used as an AED in the
    Automatic Mode Only

30
Controlled Narcotics On Rescue Ambulances
(Departmental Bulletin 08-16)
  •  
  • DHS County Hospitals Have Identified a Number
    of Concerns
  • Quantities of Controlled Drugs to be carried on
    ALS Ambulances
  • These are the new numbers as of July 2009.
  • D.B. 08-16 not yet updated
  • Morphine Sulfate, Minimum 32mg Not to Exceed 60mg
    (4mg dose)
  • Midazolam, Minimum 20mg Not to Exceed 40mg
  • Narcotic Inventory Documentation
  • 1. All Members who Have a Narcotic Key Make
    Inventory Count (F903) key Exchange Whenever
    Relieved

31
  • (Controlled Narcotics Policy Continued)
  • Controlled Drug Inventory Procedures
  • 1. Both Paramedics Responsible for Controlled
    Drug Inventory Shall Check Apparatus Inventory
  • At Shift Change
  • Personnel Change
  • Inventory Change (patient use, expired
    medication, re-supply)
  • At a Minimum, Every 24 hrs
  • After Checks Above, Both Paramedics Shall Sign
  • D I C- E (Drug, Integrity, Color/Clarity,
    Expiration Date)
  • 4. F-2 Entry to Include Number of Blue Copies
    Presently on Hand

32
  • (Narcotics Policy - Inventory Procedures
    Continued)
  • First of the Month F-903 Procedures
  • Station Commander Review, Sign F-903,
  • Copy Made and Retained for 3 years.
  • Original Forwarded to EMS Captain.
  • Photocopy of Previous Months F-903s and Copies
    of Pertinent F902Ms Used for that Period Shall
    be Stapled Together Placed in the Units
    Station File for 3 years.

33
  • When Controlled Medications Are Administered
  • F902M to Clearly Indicate Identifying info. of
    the Nurse or Dr. witnessing waste, Clearly
    legible on blue copy if no space in witness
    section use Comment Section or any other Space
  • Make 2 copies of original white copy F902M be
    sure Narcotic Waste portion Nurses
    Signature are Legible on copy

34
  • When Controlled Medications Are Administered
    continued
  • Blue copy remains with the controlled medications
    on the apparatus until re supplied by EMS Captain
  • Notify EMS Captain between hours of 0630 and 0800
  • Provide blue copy and one white copy of F902M to
    EMS Captain in exchange for replacement
    medication

35
  • Narcotic Inventory Discrepancies Procedures
  • 1. Complete Missing/Expired Controlled Drug
  • Pharmacy Reporting Form Ref 702.1 Under
    the
  • Following Circumstances
  • Vial damaged, Lost or Stolen
  • Cloudy Vial
  • Volume Discrepancy
  • Narcotic Documentation Discrepancy
  • Missing Blue Copy

36
  • (Narcotics Policy - Inventory Discrepancies
    Continued)
  • 2. Verbal Report to Station Commander EMS
    Captain
  • 3. Forward F 225 to Commander, BES, Include
    Copy of Original F902M
  • 4. Station Commander Conducts Investigation,
    Forwards Report to Commander, BES
  • 5. EMS Captain within 24 hrs Notifies County
    Pharmacy EMS Section

37
  • (Narcotics Policy Continued)
  • Disaster Pharmaceutical Cache Security
  • 1. Store in a Locked Case
  • 2. Lock Shall Have Identifying Number
  • 3. Lock Checked for Integrity, Number Entered
    on F-903
  • 4. Whenever Lock Changed or Damaged or Number
    Differs From Previously Recorded Number Verbal
    Report to Station Commander, EMS Captain BC
    Then Get New Lock From EMS Captain
  •  

38
  • (Narcotics Policy Continued)
  • Inspector From An Outside Agency
  • 1. Notify Station Commander, EMS Captain BC
  • 2. Check ID
  • 3. Give Access with Department Member
    Accompaniment
  • 4. F-2 entry to include
  • Date/Time of Inspection
  • Name of Person Making Inspection
  • Items Considered Deficient Code Violations
  • Any Other Important Facts or Info

39
THE END
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