Last updated 10.2006

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TITLE: Definition of Prehospital Health Care NUMBER: 100.1

SECTION: General Policies

EFFECTIVE DATE: 9/1/99REVISED/REVIEWED: 10/1/06

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PURPOSE: To define Emergency Medical Services rendered to a patient on the scene and during transport prior to initiation of in-hospital patient care.

To define and differentiate between Basic Life Support (BLS) and Advanced Life Support (ALS) care.

DEFINITIONS:

A. Prehospital Care

Prehospital Care means those emergencies medical services rendered to emergency patients for analytic, resuscitative, stabilizing or preventive purposes, precedent to and during transportation of such patients to and between hospitals.

B. Basic Life Support (BLS)

Basic Life Support (BLS) services means the rendering of basic level of prehospital and interhospital emergency care, including but not limited to airway management, cardiopulmonary resuscitation, control of shock and bleeding and splinting of fractures, as outlined in a basic emergency care course approved by the Department and meeting the current national curriculum of the United States Department of Transportation.

C. Advanced Life Support (ALS)

Advanced Life Support (ALS) means an advanced level of prehospital and interhospital emergency care that includes basic life support functions (including cardiopulmonary resuscitation (CPR)), plus cardiac monitoring, cardiac defibrillation, electrocardiography, intravenous therapy, administration of medications, drugs and solutions, use of adjunctive medical devices, trauma care and other authorized techniques and procedures, initiated for the treatment of real or potential acute life threatening conditions under the direction of the EMS medical director in a Department approved advanced life support EMS system, under the written or verbal direction of a physician licensed to practice medicine in all of its branches or under the verbal direction of an Emergency Communication Registered Nurse.

 

TITLE: Requirements of Community Commitment NUMBER: 100.2

SECTION: General Policies

EFFECTIVE DATE: 9/1/99REVISED/REVIEWED: 10/1/06

PURPOSE:

POLICY:

GUIDELINES:

A letter of commitment from each ambulance provider will include the following:

TITLE: Back-Up Ambulance Coverage NUMBER: 100.3

SECTION: General Policies

EFFECTIVE DATE: 9/1/99 REVISED/REVIEWED: 10/1/06

PURPOSE: To provide backup coverage for the second emergency call when the primary EMS vehicle is in service.

POLICY: Each community must provide backup service for a second emergency call when its primary vehicle is responding to a first emergency. This may be accomplished through a second vehicle within the community or through mutual aid. It is highly desirable but not mandatory that the second vehicle be equipped to provide an equal level of support as the first responding vehicle. The second vehicle must have the capability of providing coverage for the service area within 4-6 minutes. All emergency vehicles must be staffed with a minimum of two licensed EMTS at all times.

There are a number of approaches to Emergency Medical Service response available to the communities that have committed themselves to 24-hour coverage. The chosen response must be indicated in the community commitment papers submitted to the Loyola EMS Office as part of the EMS System Plan.

1. Communities whose only vehicle is an Advanced Life Support (ALS) unit:

2. ALS Response - Non-transporting service:

3. Communities who have ALS response and who also have BLS vehicles.

4. Communities are encouraged to periodically evaluate their back-up coverage protocols to determine the efficacy of patient care. Modifications to protocols must have prior approval from the EMS System Medical Director or may require a change to the System Program.

SECTION: General Policies

EFFECTIVE DATE: 9/1/99 REVISED/REVIEWED: 10/1/06

PURPOSE:

As a means of quality assurance and to provide for the best patient care by prehospital caregivers, the Resource Hospital has the authority to monitor telemetry calls of its Associate Hospitals.

TITLE: Ambulance Inspections NUMBER: 100.5

SECTION: General Policies

EFFECTIVE DATE: 9/1/99 REVISED/REVIEWED: 10/1/06

PURPOSE:

1. Medications: Minimum number, standard packaging, required doses and expiration dates.

2. Equipment: Minimum recommended equipment in working order.

3. Knowledge of on duty licensed pre-hospital provider regarding location of equipment and drugs, use of equipment and drugs and system policies and procedures.

4. Vehicle compliance as per Illinois Department of Public Health standards:

An ambulance inspection form will be completed for every inspection. A copy will be placed in the EMS System office files.

 

SECTION: General Policies

EFFECTIVE DATE: 9/1/99REVISED/REVIEWED: 10/1/06

PURPOSE: To provide standardized and adequate staffing for ALS vehicles.

POLICY: All ALS vehicles will be staffed with a minimum of two licensed paramedics who will function at the scene of the emergency and en route to the hospital.

EXCEPTIONS:

REQUEST FOR WAIVER:

TITLE: Staffing of BLS Vehicles NUMBER: 100.7

SECTION: General Policies

EFFECTIVE DATE: 9/1/99REVISED/REVIEWED: 10/1/06

PURPOSE: To standardize staffing of vehicles to provide optimum patient care.

POLICY: All BLS vehicles will be staffed with a minimum of two licensed EMT-Bs who will function at the scene of the emergency and en route to the hospital.

TITLE: Quality Control Communication Report NUMBER:100.8

SECTION: General Policies

EFFECTIVE DATE: 9/1/99 REVISED/REVIEWED: 10/1/06

PURPOSE:

1. 1. To serve as a tool to improve the quality of patient care and the functioning of the EMS System.

2. To facilitate expedient resolutions to issues raised within the System and provide feedback to all involved participants.

3. To facilitate communication between EMS System participants.

POLICY: Prehospital providers or hospital can initiate an EMS Quality Control communication report personnel when any of the following occur:

1. When unusual circumstances are verbalized or documented on the ambulance report form or hospital log sheet or telemetry run tape.

2. When there is an apparent discrepancy in pre-hospital treatment delivery and medical control orders, which may or may not constitute a violation of Standard Operating Procedures.

3. When medical control orders are not carried out by pre-hospital providers.

4. There is interference at the scene, which hampered the pre-hospital providers in the performance of their duties.

5. There is any patient or provider injury sustained at the scene, during the course of treatment, or during transport.

6. There is a question or problem relating to errors in medication administration, missing medications or difficulties encountered in obtaining exchange medications or equipment at an Associate Hospital or Resource Hospital.

7. Any other action or event that seems out of the ordinary, and that the personnel involved feel should be reported.

8. Any equipment malfunction.

PROCEDURE

1. The Associate Hospital (AH) or Resource Hospital (RH) EMS Coordinator receives an EMS Quality Control Communication Report Form or receives information regarding a quality control issues.

2. Additional reference policy number 800.1 as part of the quality improvement process when initiating an EMS Quality control communication report form.

3. The following EMS Quality control communication (EQCC) forms will be forwarded to the RH for investigation/resolution:

a) All EQCC that directly involve the AH EMS Coordinator or EMS Medical Director.

b) When care rendered by a prehospital provider may have resulted in or contributed to a poor patient outcome.

c) Any EQCC alleging the prehospital provider to be impaired by drugs or alcohol.

d) Any EQCC in which, after investigation, any involved party is unsatisfied with the resolution/decision by the AH EMS staff.

e) Any EQCC that involves concerns between two or more AHs related to EMS issues.

f) Any EQCC involving out of System providers and/or hospitals.

g) Any EQCC in which more input is needed.

All other EQCC will be handled by the AH.

4. The EMS Coordinator will conduct an investigation of the incident.

5. The EMS Coordinator will discuss the findings of the investigation with the EMS Medical Director.

6. The EMS Coordinator and/or EMS Medical Director will determine the resolution.

7. The EMS Coordinator will document findings/resolution and communicate that information to all involved participants.

8. The EMS Coordinator will report findings to the RH at the monthly EMS Coordinators meeting.

The EMS Quality Control Communication Form is a Confidential Quality Improvement document. Do not copy it or make reference to its completion in the medical record or prehospital report.

SECTION: General Policies

EFFECTIVE DATE: 9/1/99REVISED/REVIEWED: 10/1/06

PURPOSE: To outline the circumstances under which Standard Operating Procedures may be utilized.

POLICY: Standard Operating Procedures may be implemented as treatment modality guidelines for prehospital personnel under the following circumstances:

1. When field personnel cannot establish radio communications with a Loyola Emergency Medical Services System or Region 8 hospital.

2. When the patient's condition is life threatening, potentially life threatening, or may deteriorate before radio communication can be established. In this instance, radio communications should be established as soon as possible with a Loyola Emergency Medical Services System or Region 8 hospital.

3. Whenever field personnel cannot initiate radio communications at the onset of a multiple victim disaster or a multiple vehicle incident.

Whenever Standard Operating Procedures are implemented, it should be documented on the Ambulance Run Report for quality assurance review by Loyola Emergency Medical Services System staff.

SECTION: Initiation of ALS Care

EFFECTIVE DATE: 9/1/99REVISED/REVIEWED: 9/1/99

PURPOSE: To standardize guidelines in order to identify the situations when ALS care should be initiated by EMT-Ps transporting in ALS vehicles.

POLICY: Advanced Life Support (ALS) care should be initiated according to the following guidelines:

1. Adult patients with abnormal vital signs - regardless of complaints Pulse <60 or >130; or irregular Respirations <10 or >28; or irregular Systolic Blood Pressure >200 or <90

2. Pediatric patients (newborn to 16 years of age) with abnormal vital signs - regardless of complaints.

age	RR	pulse	systolic bp
Infant	>40	<140->160	60-70s
Toddler	>30	<120->140	8-0s
School Age	>25	<90->120	100-160s
Adolescent	>20	<85->110	110-170s

3. Any patient with a potentially life-threatening or limb-threatening condition, which exists or might develop during transport. Examples of situations in which ALS care is usually indicated include but are not limited to:

a. Altered mental status and/or unconscious

b. Chest pain Palpitations

d. Seizures

e. Neurologic Deficit/Stroke Syncope or near syncope Abdominal pain

h. Shortness of breath/difficulty breathing

i. Vaginal bleeding

j. Complications of pregnancy or emergency childbirth

k. GI bleeding

l. Trauma

m. Overdose/Poisoning

n. Burns

o. Cyanosis

p. Failure of child to recognize parents

q. Child with fever with petechiae

4. If scene safety is not a certainty, or if dealing with an uncooperative patient, the requirements to initiate assessment and full ALS service may be waived in favor of assuring that the patient is transported to the appropriate medical facility. Document clearly the reasons ALS care was aborted.

5. Never discontinue ALS care once initiated unless there is prior approval by the Resource or Associate Hospital base station.

6. WHEN IN DOUBT, CONSULT WITH THE RESOURCE OR ASSOCIATE HOSPITAL.