Title: EMS DEPARTMENTAL BULLETIN REVIEW
1- EMS DEPARTMENTAL BULLETIN REVIEW
2Walking 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
3Ambulance 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
6Patient 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 -
9Inter-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. -
13LAFD 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
20Witnessed 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
22Transport 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
-
26Medical 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
30Controlled 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