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CCT: STANDARDS OF CARE

PURPOSE To provide parameters for the standard of care for all patients transported by IU Health

Lifeline

SCOPE 1. Standards of care apply to all critical care transport team members, including

subspecialty levels of care unless otherwise explicitly stated by IU Health LifeLine

policy, the LifeLine Director and Medical Director (or authorized designees), or in

the event the standard does not apply to the provider’s scope of practice.

DEFINITIONS

A. Patient – Any person that presents with an apparent or stated need for medical assistance

or care to a LifeLine provider.

B. Protocol – The set of standards approved by the IU Health LifeLine medical director and

director (or either respective entity’s applicable and authorized designee) outlining the

parameters and guidelines for delivery of patient assessment and care.

C. Medical director: LifeLine leadership physician team member or the medical director’s

authorized designee performing the roles and overseeing the responsibilities outlined in

Indiana Administrative Code (IAC) Title 836 in addition to any other related

guidelines/regulations.

D. EMS provider/provider: Any LifeLine team member or participant providing clinical

care for LifeLine patients. This includes, but is not limited to, physicians, advanced

practice providers, nurses, respiratory therapists, paramedics, emergency medical

technicians (EMTs), and EMT-advanced providers. For the purposes of this document,

any references to ‘provider’ or ‘providers’ will be assumed to refer to the definition

pertaining to ‘EMS provider’ given in this document unless otherwise stated.

E. Scope of practice: Tasks/roles that an EMS provider can be reasonably expected and

legally authorized to perform based on:

a. The provider’s assigned clinical role at LifeLine

b. The level of training, expertise, and capabilities that can be reasonably

assumed from the provider’s licensure that enables the provider to practice in

their currently assigned clinical role at LifeLine

F. Credentialed provider: An EMS provider approved by the IU Health LifeLine director

and authorized by the IU Health LifeLine medical director (or either respective entity’s

applicable and authorized designee) to perform the duties and responsibilities that can

reasonably be expected of the provider within his/her scope of practice and at a level that

is commensurate with the provider’s assigned role as an EMS provider at IU Health

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LifeLine AND who possesses the required up-to-date licensures and certifications for

that assigned role.

G. Advanced airway: Advanced airway is defined as a endotracheal tube, laryngeal mask

airway, esophageal-tracheal Combitube, iGel, tracheostomy tube, King Airway,

cricothyroidotomy tube, or equivalent (from GAMUT QI Collaborative v. 05/16/2016).

H. Patient care report: The documentation meeting the requirements outlined in IAC Title

836 including any pertinent information obtained from the patient assessment, care

rendered to the patient, and transport of the patient that is submitted to the medical

record. The patient care report is required to be completed by the provider for every

patient contact.

I. Sentinel event: An unexpected occurrence involving death or serious physical or

psychological injury, or the risk thereof. Serious injury specifically includes loss of limb

or function. The phrase, ‘or the risk thereof’ includes any process variation for which a

recurrence would carry a significant chance of a serious adverse outcome. Note:

definition is from the Indiana Perinatal Quality Improvement Collaborative (IPQIC)

guidelines reaffirmed by October 2018, however this applies to all patients unless

otherwise stated in this document.

GENERAL GUIDELINES

These protocols and guidelines are not intended to be all-inclusive and may not cover every

situation potentially encountered by EMS personnel. An on-line medical control physician

must order any other skills or therapies whenever it is reasonably warranted or whenever a

provider requires additional guidance beyond the scope of this document. Providers may

take reasonable actions not explicitly described in the protocols/guidelines; however the

provider must ensure that:

o She/he is appropriately trained and licensed to perform the action

o He/she is credentialled and sanctioned to perform the action by LifeLine medical

direction

o The action is within the provider’s scope of practice

o The action is clinically indicated and does not pose unnecessary risk to the patient,

other crew members, or the public

o The action and rationale for it are thoroughly documented in the patient care report

EMS providers must be trained in the skills or therapies they practice, be credentialled by

medical direction to perform the skills, and be practicing within their scope of practice.

All EMS personnel are expected to be proficient in: life support for patients of all ages, acute

trauma resuscitation, and securing/managing airways, breathing, and circulation in a manner

that is commensurate with their scope of practice and assigned role at LifeLine and also the

required certifications related to life support required for the provider’s credentialing at

LifeLine (examples may include ACLS, PALS, NRP, PHTLS. Refer to LifeLine policies for

a more detailed description). Exceptions, where applicable, do apply to specialty team

members when applicable and approved by the medical director.

This document is NOT meant to be a teaching tool. Providers are expected to know how to

perform the therapies and procedures described herein. If a provider is unfamiliar with any

condition, treatment, medication, skill, or procedure contained herein, it is that individual’s

responsibility to seek the needed education.

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Once contact is made with a patient, the patient remains the provider’s responsibility until

one of the following occurs (all of which must be documented):

o Care is transferred to receiving facility staff

o Care is transferred to an appropriate healthcare provider

o The patient is deemed non-viable (reasons/rationale for non-viability must be

thoroughly documented)

o A valid refusal of transport is obtained

Refusal of transport does not preclude the provider’s obligation to complete

a patient care report. A patient care report must be completed for all patient

contacts.

Transfer of care at the receiving facility is not complete until a verbal report is given to an

appropriate medical care provider. It is also required that a written patient care report be

submitted to the receiving facility staff unless the EMS provider is sent on an emergency

response. When this occurs, the written patient care report must be made available as

promptly as possible.

Patient care reports must be completed within 24 hours of transfer of care.

Throughout these protocols and unless otherwise specified, adults are anyone 15 years of age

and older, a child is 1 up to 15 years old, infant is 1 month up to 1 year of age, and newborn

is birth up to 1 month old.

Anywhere throughout this protocol manual where medications are to be administered, it is

required that the medication be verified prior to administration.

GUIDELINES

A. All providers will offer comprehensive and compassionate care to the best of their ability

to every patient.

B. All providers will operate within their Scope of Practice when making clinical

decisions.

C. All providers will use sound reason evaluating all of the information available to apply

the appropriate Protocol.

D. All providers will honor patient Advance Directives, Indiana Physician Order for Scope

of Treatment (POST), or statements made in reference to personal wishes for care to the

best of their ability whenever applicable and always in compliance with any related

laws and/or guidelines.

GENERAL

1. Body Substance Isolation (BSI)/Universal Precautions will be followed on all patients

encountered by LifeLine Care Providers.

2. An identifying name band should be utilized to identify patients prior to transport for

interfacility transfers. A hospital generated ID band is the preferred identification

band. For patients in which the identity is known, the ID band must include name

and DOB at a minimum. Providers must confirm patient identity prior to treatment or

intervention with consent for treatment/transport whenever reasonably applicable.

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3. All necessary equipment to maintain level of care will be available at all times while

the patient is in the care of LifeLine providers.

4. Patient care can only be released to an equal or higher level of care.

5. All appropriate therapies initiated by a facility, service or other provider prior to care

being assumed by LifeLine care providers will be continued unless contraindicated or

clinical circumstances warrant alterations. In both cases, these changes should be

described and the rationale explained in the patient care report. Changes made to

therapies initiated by prior care providers are to be made per appropriate Protocol

whenever applicable. In the absence of a protocol and when there is inability to

contact medical control within reason, the crew may use sound clinical judgment

(with clear documentation including rationale) in the decision to change or stop any

therapies or interventions.

6. All patients should be secured during transport as follows:

1. Pediatric and neonatal patients will be restrained using the appropriate

pediatric restraint

device.

2. 5-point restraint system on the ambulance stretcher

3. All combative patients will be further restrained by an appropriate method

prior to transport.

4. Secure restraint is to be maintained throughout transportation. Patient care

should not be inhibited by patient restraint. Patients should be transported

with considerations for privacy, humility, and in a position of comfort unless

otherwise dictated by patient condition or other orders.

7. All patients will be transported to the most appropriate facility. The most appropriate

facility is the closest appropriate facility capable of providing the level of care that is

immediately necessary, has been ordered/arranged by the sending physician, or is the

patient’s stated choice (within reason and assuming the patient has capacity to make

medical decisions).

8. Providers should not delay transport to definitive care for procedures, treatments,

tests, medications, or equipment that is not vitally important to the safe treatment and

transport of the patient. If the benefit of delaying transport for the action in question

does not outweigh the benefit of transport to definitive care, then the provider should

strongly consider foregoing the action in favor of expediting transport to definitive

care unless otherwise contra-indicated. Either decision should be thoroughly

documented in the patient care report.

a. Explanation: if an action being considered by a provider will delay transport

to definitive care and does not address an immediate life-threat and is not

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related to any compromise in airway, breathing, or circulatory status of the

patient then the provider should strongly consider initiating/facilitating

transfer to definitive care instead of taking the action unless there is some

other extenuating circumstance present, in which case the circumstance(s) for

delaying transport should be thoroughly documented and justified in the

patient care report.

b. Patients with the following conditions may often require expedited transport

without any delays outside of stabilizing any immediate life-threats related to

airway, breathing, or circulation:

i. Trauma patients requiring trauma specialty services not immediately

available at the patient’s location

ii. Patients with identified surgical emergencies requiring surgical

services not immediately available at the patient’s location

iii. Patients requiring percutaneous intervention (PCI) for cerebrovascular

accident or acute coronary syndrome (ACS) or any related surgical

specialty services not immediately available at the patient’s location

iv. Patients requiring critical care services not immediately available at

the patient’s location

v. Button battery ingestions

9. All patients will be made aware of their rights and responsibilities prior to initiation

of care when not contraindicated by immediate medical need. All patients with

capacity have the right to accept or refuse any or all services offered.

10. Personal belongings of the patient are to be transported with the patient and secured

when possible or appropriate arrangements are to be made prior to transport.

11. All patient encounters will have a completed Patient Care Report with supplemental

documentation attached.

a. All applicable patient paperwork is to be transported with the patient while

ensuring confidentiality of private or protected information.

12. Communications:

1. Providers will give a timely report when relaying patient condition to the

receiving facility or medical control.

2. Lifesaving medical care should not be delayed in order to establish

communication with the control physician.

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3. All communications will be made through contacting LifeLine Communication

Center or designated radio frequency.

4. 10-minute out report:

a. For all patients receiving ground transport to IU Health Methodist EMTC

or Riley Hospital for Children P-EMTC or PICU that are considered for a

time sensitive activation or Level 1 status: The 10-minute out call will be

made via the radio system directly to the EMTC, P-EMTC, or Riley

physicians, respectively.

5. All communication will be appropriately documented in the electronic patient

care record to include name of contact receiving report and time of report.

13. Upon-arrival communications are to be made to the appropriate medical professional,

staff, or receiving party prior to release of patient care.

1. A verbal report detailing any information immediately necessary for continuity of

care will be given to the provider assuming patient care.

2. Pertinent documentation should be left with the provider assuming patient care or

appropriate persons.

ASSESSMENTS AND MONITORING

A. All patients will have an initial assessment and continued monitoring while in the care of

LifeLine Providers.

1. Providers will monitor patient condition by reassessing at appropriate intervals

based on patient condition.

2. Two or more assessments are required to constitute monitoring.

3. For brief patient encounters, assessments by prior care providers are to be noted in

the patient care report.

B. Providers will complete, at a minimum, the following assessments;

1. Evaluation of the scene dynamic relevant to mechanism of injury or factors

contributing to the presenting condition when applicable.

2. Acceptance and interpretation of a verbal report received from the patient care

provider.

3. Receipt and evaluation of written reports, documenting any and all care provided

prior to arrival, history and physical, medication list, lab and diagnostic study

reports, treatments and results of treatments and presenting diagnosis.

4. Primary assessment (Airway, Breathing, Circulation, and critical interventions)

should be completed prior to loading into the transport vehicle.

5. Secondary assessment (focused to specific condition) should be completed prior to

delivery of the patient to the receiving facility.

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C. Appropriate reassessment(s) will be completed for any change in patient condition or

with the initiation or change of any therapy by a LifeLine provider.

Patient Guidelines

1. All patients being transported by IU Health LifeLine shall have methods utilized to maintain

appropriate body temperature when applicable (blanket, heaters, etc.)

a. Avoid hypothermia in trauma patients as well as infants and neonates

b. Avoid hyperthermia in patients immediately post-ROSC after cardiac arrest

c. All patients shall have a documented temperature

2. Blood glucose check for patients with an altered mental status (GCS < 15 or focal neurological

deficit with suspicion of stroke), change in mental status or who have recently had any

intervention that may alter blood glucose levels (Gamut QI metric #4)

3. All patients will have pain monitored and documented using an age appropriate scale with each

transport (Gamut QI metric #22)

4. Oxygen should be administered during transport to maintain pulse oximetry greater than 90%

unless contraindicated. Any patient whose clinical condition may benefit from supplemental

oxygen should be administered oxygen as indicated (Gamut QI metric #15)

a. If a patient’s pulse oximetry drops below 90% at any time during transport, appropriate

documentation in the patient care report requires 1) a description of any interventions

taken to address the hypoxia and 2) must always include the rationale for any actions

taken or the rationale for not taking any actions regarding the patient’s documented

hypoxia.

5. Providers must only record accurate and appropriately measured vital signs in the patient care

report, which is a part of the patient’s permanent health record and therefore should be made as

accurate as possible.

6. A Cincinnati Stroke Scale must be recorded for all patients with acute neurological deficits

(Indiana regulatory requirement).

7. All medical therapies and interventions existing prior to transport will be monitored per LifeLine

standards and documented in the patient care report.

8. All patients will have continuous cardiac and pulse oximetry monitoring

9. Vital signs will be monitored and documented at a minimum of every 15 minutes; more

frequently if clinically indicated. When applicable this includes blood pressure, heart rate and

pulse, respirations, pulse oximetry, and End-tidal CO2 (ETCO2). ECG strips and ETCO2 will

accompany patient documentation.

10. End-tidal CO2 (ETCO2) continuous waveform capnography will be monitored for all patients

receiving medications for sedation. This may also be monitored for any patient via ETCO2 nasal

cannula based on clinical judgement.

11. ETCO2 continuous waveform capnography will be monitored for all patients being ventilated

through an advanced airway (GAMUT QI metric #8)

12. PRIOR TO LEAVING A REFERRING FACILITY AND/OR SCENE AND ALSO DURING

TRANSPORT, PROVIDERS MUST REGULARLY EVALUATE THE PATENCY OF THEIR

IV/IO ACCESS, ESPECIALLY WHEN THERE ARE ANY THERAPIES INFUSING

THROUGH THE IV/IO ACCESS.

a. Signs of infiltration/compromise must be addressed immediately and these incidences

must be thoroughly documented in the patient care report.

13. All patient care reports must include documented use of a standardized hand-off procedure for

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turning over patient care at the destination hospital whenever applicable (GAMUT QI metric

#27).

14. The following events require reporting in accordance with Indiana University Health policy and

procedure, by utilizing the approved reporting procedure, prior to ending any clinical shift. The

approved procedure is denoted below in brackets and any inability to report by these mechanisms

should be escalated prior to end of shift.

a. Medication administration errors [IU Health Incident Reporting System] (GAMUT QI

metric #10)

b. Unplanned dislodgements of therapeutic devices [IU Health Incident Reporting System]

(GAMUT QI metric #13)

i. Therapeutic devices include: IOs, IVs, UACs/UVCs, central venous lines, arterial

lines, advanced airway, chest tubes, and tracheostomy tubes

c. Serious reportable events or sentinel events [IU Health Incident Reporting System]

(GAMUT QI metric #14 and IPQIC):

i. Includes any unanticipated and largely preventable event involving death, life-

threatening consequences, or serious physical or psychological harm

d. Medical equipment failure(s) impacting patient care [IU Health Incident Reporting

System] (GAMUT QI metric #19)

i. The logistics and/or operations manager should also be notified within 24 hours

e. Adverse drug event: unanticipated drug related event during transport [IU Health Incident

Reporting System] (GAMUT QI metric #20)

f. Patient near-miss or precursor adverse events [IU Health Incident Reporting System]

(GAMUT QI metric #21)

i. Near-miss: ‘deviations from generally accepted performance standards that

occurred but did not “reach” the patient, perhaps because the error was caught’

ii. Precursor adverse event: ‘deviations from generally accepted performance

standards that reach the patient but result in no harm or minimal, temporary

patient harm. Excluded are injuries and deaths related to the medical/surgical

conditions themselves. Examples include patient falls, loose pieces of transport

equipment that fall and strike a patient, injuries suffered in a transport vehicle

accident, etc.’

g. Cardiac arrest during transport [Image Trend ePCR – CPR Procedure or Resuscitation

Discontinued Procedure] (GAMUT QI metric #25)

h. Transport-related patient injury [IU Health Incident Reporting System] (GAMUT QI

metric #24)

i. Transport-related crew injury [IU Health Employee Injury/Exposure – Occupational

Health] (GAMUT QI metric #26)

TREATMENTS AND PROCEDURES

A. All interventional treatments or procedures initiated or continued by LifeLine Providers

will be done within the provider’s Scope of Practice.

B. All interventions should follow common sense and be consistent with best practices

with patient safety always the foremost consideration.

C. All non-invasive or less-invasive procedures are to be considered prior to the initiation

of invasive procedures.

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D. Clinical evidence as indication for any intervention should be apparent and defendable

per applicable Protocol or be within reason if no applicable guidelines exist. Thorough

documentation including rationale is mandatory.

RESPONSE AND TRANSPORT

A. Response to a call is to be determined and dispatched by LifeLine Communications in

consultation with the referring and receiving entity whenever applicable. In some

special circumstances, this authority may be subsumed by an appropriate authority

designated by the LifeLine Director or LifeLine Medical Director (or their authorized

designees) as appropriate.

B. Once a call is dispatched, the assigned responding unit will NOT delay response and is

considered dedicated until the call is completed or the unit is disregarded.

1. Any delays in response must be reported to the LifeLine leadership including

medical direction within 24 hours by the provider and should include a

thorough description of the extenuating circumstances and rationale for delay.

Special Considerations

Medication Safety:

1. Medication Reconciliation Process will be completed on transfer of all medications and

fluids.

a. Medications, including single dose and IV drips, obtained from the referral

hospital will be cross checked prior to transfer of medication to the LifeLine

infusion pump by both the referral RN and a LifeLine provider. The seven rights

of medication administration will be the guidelines for this cross check:

i. Right Patient

ii. Right Medication

iii. Right Dose

iv. Right Route

v. Right Time

vi. Right Documentation

vii. Right to Refusal

b. In addition, a label will be placed on all medications infusing during transport. The label

will include: patient name, medication, medication concentration, and time the

medication was initiated by LifeLine.

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c. It is the standard of care to utilize the existing medication guardrails included in the

infusion pumps for each and every IV medication infusing during transport. Medications,

including single dose and IV drips handed over to the receiving unit staff will be cross

checked by both the appropriate receiving medical professional and the LifeLine

provider. Again, the seven rights of medication administration will be the guidelines for

this cross check. The medication label will also be verified during the cross check.

d. Documentation will include all medications infused during transport. Medication

concentration, dosage, and rate will be included in the documentation.

Intubated Patient Specific Standards

1. A ventilator will be used in patients with advanced airways unless contra-indicated, in

which case thorough documentation including rationale must be included in the

patient care report (GAMUT QI metric #1).

2. All invasively, mechanically ventilated patients will have continuous ETCO2

waveform capnography monitoring (GAMUT QI metric #5). If waveform

capnography is not used, thorough documentation including a rationale must be

included in the patient care report.

a. If at any point in time ETCO2 waveform capnography monitoring

demonstrates a flatline pattern for a sustained period of time (i.e. the

waveform is lost for longer than would be expected given the patient’s

condition), the provider must address the airway and breathing of the patient

to ensure that the patient is still being ventilated appropriately and that there is

NOT: 1) dislodgement/displacement of the airway device, 2) obstruction of

the airway from any cause, 3) pneumothorax, or 4) equipment failure

(occluded capnography sensor from body fluids, for example). The provider

must thoroughly document the troubleshooting process in a manner that also

includes the provider’s rationale.

3. All patients with advanced airways will have the device placement confirmed,

regardless of whether or not the transport team placed the advanced airway

themselves or not, using continuous waveform capnography plus at least one of the

following: direct visualization, chest radiograph, and/or symmetric breath sounds

(GAMUT QI metric #8)

a. Continuous waveform capnography must be monitored throughout the

transport and appropriate interventions should be made for any loss or change

in waveform.

4. Airway management via mechanical ventilator is the expectation for all patients with

an artificial airway. Ventilator checks will be completed and documented every 15

minutes.

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a. Ventilator checks may include (when applicable):

i. Set vent parameters: Rate, Tidal Volume or Pressure Control, PEEP,

FiO2, ventilator mode, I-time, and pressure support.

ii. Patient measured parameters: Rate, Pip, exhaled tidal volume, minute

ventilation, MAP, I;E ratio, and PEEP.

Trauma Patient Specific Standards:

1. Rapid transport to the most appropriate facility with advanced trauma care is essential.

DO NOT delay transport unnecessarily.

2. Initiate or maintain cervical-spine precautions as indicated. Patients will NOT be

transferred from one facility to another on a long spine board.

3. Control bleeding.

4. Observe for signs of seizures and treat per seizure protocol. Be aware that paralyzed and

sedated patient may still be experiencing seizure activity.

5. Do not remove impaled objects unless absolutely necessary for airway control or

extrication.

6. When establishing IV access, use large bore catheters. Use principles of balanced

resuscitation for blood product transfusion (attempt to maintain an equal balance

whenever possible between packed red blood cells, plasma, and platelets). Additionally,

avoid excessive crystalloid infusion whenever possible in trauma patients.

7. Avoid hypotension and hypoxia in all head trauma patients; intervene as necessary and in

accordance with scope of practice. All interventions or lack thereof related to hypoxia or

hypotension in head trauma patients must be documented in the patient care report with

the corresponding rationale.

Pediatric Patient Specific Standards:

1. Pediatric patients are defined as:

a. Trauma patients less than 15 years old

b. Patients accepted by a pediatric physician for pediatric care at a pediatric

capable facility

c. Any medical patient less than 18 years old to which neither (a) nor (b) is

applicable

2. All patients under the age of 1 years will have continuous temperature monitoring

whenever possible.

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3. All patients under the age of 1 year will have a blood glucose checked and

documented within one (1) hour of patient contact.

4. During inter-facility transport and when applicable, IV fluids for pediatric patients should

be administered via infusion pump. Additionally, patients under the age of 8 years should

receive fluids at a maintenance rate (minimum) when indicated and contextually feasible.

a. Maintenance IV fluid rate is calculated usingthe “4-2-1” Rule:

i. For first 0-10kg: +4mL/kg/hr

ii. For the 10-20kg after (i) above: +2mL/kg/hr

iii. For all additional weight over 20kg: +1mL/kg/hr

Obstetric Patient Specific Guidelines:

1. All pregnant patients > 20 weeks gestational age shall have signs of fetal well-being

documented for each fetus every 30 minutes during transport.

2. All patients in active labor or being administered IV tocolytics (for example, MgSO4,

terbultaline) are to have FHR documented at least every 15 minutes. Continuous FHR

monitoring should be accomplished with a cardiotocography (CTG) if possible. FHR should

also be measured with each contraction until the contraction stops to assess for decelerations

that do not return to baseline.

3. Patients receiving magnesium must have deep tendon reflexes (DTR’s) checked documented

every 15 minutes. Providers should also regularly assess level of consciousness and respiratory

status to evaluate for signs of magnesium toxicity.

4. Left lateral decubitus patient positioning is preferred whenever feasible.

5. Monitor and record frequency, intensity, and duration of uterine contractions if present.

6. DO NOT initiate transfer unless a recent (within one hour if in the latent phase of labor -or-

within fifteen minutes if in the active or transition phase of labor) vaginal examination has been

performed to determine the degree of cervical dilation, effacement, presenting part, and the

degree of descent of the fetus. This exam should be done by the referring hospital staff. The

LifeLine provider must document in the patient care report the name and credentials of the

individual performing the exam and the findings communicated to the LifeLine provider.

i. Exceptions to this guideline may include placenta previa patients when indicated.

Any questions/concerns should be clarified with the HROB medical control physician

prior to initiation of transport.

7. Consultation with HROB medical control must be made prior to the initiation of transport if the

patient has entered the active or transition phases of labor or for significant cervical changes

since the previous exam.

8. For obstetrics patients dilated beyond 4 cm strong consideration should be made to the option of

delivering at the sending facility with subsequent isolette transfer of the neonatal patient(s) to an

appropriate receiving facility. Any concerns or uncertainly should be clarified with HROB

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medical control prior to the initiation of transport.

9. Patient demonstrating signs of imminent vaginal delivery should be delivered at the sending

facility as described in (8) above. Any concerns or uncertainly should be clarified with HROB

medical control prior to the initiation of transport. Signs that suggest imminent vaginal delivery

may include:

i. Crowning

ii. Regular forceful contractions and the urge to push

iii. Rapid progression of cervical examination from previous

iv. Marked cervical dilation

10. All reasonable efforts should be made to avoid delivery during transport. Note: the federal law

‘Emergency Medical Treatment and Active Labor Act’ specifically addresses the care of

pregnant women prior to and during the course of transport.

i. If there is insufficient time for transfer before delivery or if the transfer may pose a

threat to the health or safety of the child, the patient should not be transferred prior to

delivery unless the patient requests transfer and understands the risks and benefits

thereof (Young et. al 2016). This should all be thoroughly documented in the patient

care report including rationale. Any questions should be referred directly to the

HROB medical control physician.

11. Portable ultrasound, if available, should be utilized by credentialled providers on all HROB

transports to verify fetal movement, heart flicker, and intrauterine pregnancy.

Neonatal Patient Specific Standards

1. All patients under the age of 30 days will be considered a neonatal unless otherwise

indicated by a medical control physician.

2. Hypothermia should be avoided in all neonatal patients. Unintentional hypothermia

should be reported to the LifeLine quality assurance program upon completion of the

patient care report (GAMUT QI metric #3)

3. All patients must be secured with an appropriate and approved restraint device during

transport.

4. All patients under the age of 30 days will have a blood glucose documented within one

(1) hour of patient contact. If the blood glucose is treated for any patient, repeated blood

glucose levels should be done every 30 minutes until the blood glucose is stabilized.

5. Walk-in Patient Specific Standards:

1. In the event that a patient presents to a LifeLine facility seeking medical care, the on-site

personnel will provide the level of care based on scope of practice and transport to the

appropriate facility. In the event of a patient refusal once care has been initiated, contact

the shift operations supervisor and completely fill out the patient refusal form. A patient

care report must be completed for all patient contacts.

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2. In the event that a patient presents to a LifeLine facility seeking medical care and there is

no in-service unit available, the on-site personnel will call 9-1-1 and request appropriate

EMS response.

a. When indicated, LifeLine personnel will provide basic stabilizing treatment until

EMS providers arrive on scene in a manner that is commensurate with the

provider’s scope of practice and provide care in a manner that is in good faith

commensurate with what could reasonably be expected of the provider given

his/her training, resources, credentials, and the context of the situation.

References:

Commission on Accreditation of Medical Transport Systems (CAMTS). Accreditation Standards

of the Commission on Accreditation of Medical Transport Systems. 11th edition, October 2018.

Published by CAMTS: Sandy Springs, SC.

Young J. Maternal Emergencies After 20 Weeks of Pregnancy and in the Postpartum Period. In:

Tintinalli JE, Stapczynski J, Ma O, Yealy DM, Meckler GD, Cline DM. eds. Tintinalli’s

Emergency Medicine: A Comprehensive Study Guide, 8e New York, NY: McGraw-Hill; 2016.

http://accessmedicine.mhmedical.com.proxy.medlib.uits.iu.edu/content.aspx?bookid=1658&secti

onid=109431050. Accessed July 11, 2019.

GAMUT QI Collaborative Consensus Quality Metrics (v. 05/16/2016).

http://gamutqi.org/metrics.html. Accessed July 11, 2019.

Bartkus, E., Bence, R., Kaufmann, M.A., Gardner, S.M., O’Donnell, D., Russell, M., Weinstein,

E., Armbruster, J., Faris, G., and Lardaro, T. The Greater Indianapolis Area EMS Medical

Directors Council Out-of-Hospital Care Guidelines. January 1, 2019.