Colchester Fire Department

EMS Procedures

EMS Procedures

Who: All MRT's and EMT's sponsored by CHFD

What: 2003 ECEMS Regional EMS Guidelines

When: Two (2) Times a year with EPI & Defib Refreshers

Eastern BLS Guidelines

Trauma Alert

Trauma Alert Activation

ETA > 10 mins requires a second call to update receiving facility

When making a 2nd patch it MUST contain a set of vitals

Trauma Alert – Criteria

* Hemodynamic instability – Systolic BP < 90* Respiratory Distress or Airway Problems

* Altered Mental Status GCS <13* Quadriplegia or Paraplegia

* Penetrating Injury to Head, Chest or Abdomen

Trauma Alert

* Patient with Flail Chest* Major Electrical or Thermal Burns

* Amputation of Limb* Two or More Long Bone Fractures

* Significant Injuries above and below the diaphragm

Trauma Alert

To Request an Alert

•Contact the ED by Radio or Phone•537-0883 / 887-6095

•State Specifically you have a victim of a trauma

* Give Pt. Age, Sex, LOC, Mechanism of Injury and which of the criteria the PT meets

*Vital signs (don’t delay Alert if not obtained)* Give update as soon as possible

ETA

Documentation

Patient Care Reports…

“Non-Patient” Runs and “Refusals” MUST have full documentation.

Canceled En Route

In the event an EMS response is canceled while the EMS unit is en route to the call, the ambulance crew should complete an

approved Patient Care Report (PCR) detailing the following information.

Date of ServiceTime of:

CallDispatchActivationCancellationAvailable

Identity of Caller (by Name or Agency)Incident LocationIncident Type (MVA, Medical, Medical Alarm, Welfare Check, etc.)Identity of ‘Cancelor’ (by Name or Agency)

No Patient On Scene

In the event an EMS response is initiated and after arrival of the ambulance it has been determined that there is no patient on-scene, the ambulance crew should complete an approved Patient Care Report (PCR) detailing the following information:

No Patient On Scene

Date of ServiceTime of:

CallDispatchActivationCancellationAvailable

Identity of Caller (by Name or Agency)Incident LocationIncident Type (MVA, Medical, Medical Alarm, Welfare Check, etc.)Narrative of On-scene Conditions (What was found on-scene, who

provided information, etc.)Names and Service Numbers of Responding EMS PersonnelSupport Services On-Scene

Police, Fire, Visiting Nurse, etc.Signature of Person(s) Completing Report

Patient On Scene – No ComplaintThe EMS provider must follow good medical judgment in these situations. A typical scenario would be the EMS response to an

MVA and on arrival, they find a patient without medical complaint.

However, if there is a mechanism of injury, and in the judgment of the EMS provider the patient should be medically evaluated, every attempt should be made to convince the patient to allow ambulance transportation to a local medical facility. should the patient refuse this offer of transport, a refusal against medical

advice should be obtained .

In either event, a full PCR should be completed following the format described in Procedure #1.

Patient Refusal - Adult

One of the most challenging situations we face as EMS providers is when a patient who you believe needs to be

taken to a medical facility for definitive care refuses ambulance transportation.

There may be numerous reasons a patient may refuse medical care, but by addressing the patient’s concerns

and by presenting ourselves as medical professionals, we can usually convince the patient that allowing medical

care is in the patient’s best interests.

Patient Refusal - Adult

Mental Compentency Defined:Only Mentally Competent Adults are able to

refuse medical care.Patient needs to be fully conscious and alert,

and aware of their surroundings.

Patient Refusal - Adult

Contact Medical Control, if, in your opinion, the patient still needs medical care.

1) Offer transport at least three (3) Times2) Fully Explain Medical Consequences3) Ask Direct Questions of what to do4) Advise the Pt of Alternate Treatment Resources

Patient Refusal - Minors

DefinitionA MINOR is a person under the age of 18.

Not authorized to make decisions regarding medical treatment.

If a guardian is ON SCENE, the guardian can sign the refusal as the responsible party

Procedure – Crime Scene / Police

If EMS personnel are delayed or precluded from making an appropriate physical examination by law or fire officials protecting the integrity of the scene, they

shall so note on their patient care form.

If subsequent access to the patient is allowed, then EMS personnel shall proceed according to this

protocol. EMS personnel are required to provide documentation

of the patient’s physical condition only to the extent of the physical examination they performed.

Psych Transports

If it is OBVIOUS there is no Immediate threat or danger to life, KX will attempt a non-emergency

transfer from AASI. (if available in timely manner)

Dispatch will make notification to an officer, or request a R1 Response.

Psych Transports

If patients condition is questionable, KX will dispatch the call as normal. Arriving responders will make determination as to emergency or non-

emergency transport.

A qualified Medical Responder SHALL remain on scene with the patient awaiting arrival of

transport if necessary

Restraints

Current CHFD SOP

* Only EMS Approved Restraints to be used*Officer to follow immediately

– not “meet you there”

•If PD REQUIRES Handcuffs or Leg Irons, an officer MUST immediately follow the ambulance

* Out of control – CSP's responsibility to restrain.

Taser victims

● All patients that we respond to that have been tased MUST be transported– Patients will be transported to Backus Hospital

● DO NOT remove barbs from the patient– They are considered a penetrating injury– If they fall out remember that the are now sharps and

should be handled with care and disposed on in sharp waste!!

Determination of Death● Determination of Death Guidelines

● All patients of cardiac arrest shall receive the appropriate care unless contraindicated by one of the following exceptions.

– Traumatic injury or body condition clearly indicate biological death (irreversible brain death) including but not limited to…

Decapitation Decomposition Transection of the torso Incineration – 90% of BSA *******************************************

*** The following require additional

assessment and/or conformation

Dependent lividity with rigor Injuries incompatible with life

Traumatic injury of body condition

Procedures

Contact an Officer