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Emergency Medical System 2021 Patient Treatment Protocols
2021 Patient Treatment Protocols Effective January 1, 2021 CONTENTS Table of Contents Preface Section ...........................................................................................................00.000 EMS Provider Scope of Practice and Nomenclature .....................................................00.010 Death in the Field ........................................................................................................00.020 Dying and Death, POLST, Do Not Attempt Resuscitation Orders ..............................00.030 Medical Control for Drugs and Procedures ..................................................................00.040 Treatment ......................................................................................................... Section 10.000 Abdominal Pain ...........................................................................................................10.010 Altered Mental Status and Coma ..................................................................................10.020 Anaphylaxis and Allergic Reaction ................................................................................10.030 Burns ...........................................................................................................................10.040 Cardiac Arrest ..............................................................................................................10.050 Emergency Medical Responder/EMT Paramedic/EMT-Intermediate Quick Reference to Pediatric Drugs Cardiac Dysrhythmias ..................................................................................................10.060 -
Talking Points
DEPARTMENT OF HEALTH & HUMAN SERVICES Centers for Medicare & Medicaid Services 7500 Security Boulevard, Mail Stop S2-12-25 Baltimore, Maryland 21244-1850 Center for Medicaid and State Operations/Survey and Certification Group Ref: S&C-07-19 DATE: April 26, 2007 TO: State Survey Agency Directors FROM: Director Survey and Certification Group SUBJECT: Provision of Emergency Services - Important Requirements for Hospitals Memorandum Summary • All hospitals are required to appraise medical emergencies, provide initial treatment and referral when appropriate, regardless of whether the hospital has an emergency department. • A hospital is not in compliance with the Medicare Conditions of Participation (CoPs) if it relies on 9-1-1 services as a substitute for the hospital’s own ability to provide services otherwise required in the CoPs. This means, among other things, that a hospital may not rely on 9-1-1 services to provide appraisal or initial treatment of individuals in lieu of its own capability to do so. In this memorandum we affirm and explain current regulatory requirements pertaining to a hospital’s ability to meet the emergency needs of individuals. Any hospital participating in Medicare, regardless of the type of hospital and regardless of whether the hospital has an emergency department must have the capability to provide basic emergency care interventions. Requirements Applicable to All Hospitals (except Critical Access Hospitals) The following Medicare hospital Conditions of Participation (CoP) apply to all participating hospitals (except Critical Access Hospitals) and provide a foundation for safe care for all persons, including those with emergency care needs. Critical Access Hospitals (CAHs) are governed by regulations separate from those governing hospitals, and may be found at 42 CFR 485.618. -
MASS CASUALTY TRAUMA TRIAGE PARADIGMS and PITFALLS July 2019
1 Mass Casualty Trauma Triage - Paradigms and Pitfalls EXECUTIVE SUMMARY Emergency medical services (EMS) providers arrive on the scene of a mass casualty incident (MCI) and implement triage, moving green patients to a single area and grouping red and yellow patients using triage tape or tags. Patients are then transported to local hospitals according to their priority group. Tagged patients arrive at the hospital and are assessed and treated according to their priority. Though this triage process may not exactly describe your agency’s system, this traditional approach to MCIs is the model that has been used to train American EMS As a nation, we’ve got a lot providers for decades. Unfortunately—especially in of trailers with backboards mass violence incidents involving patients with time- and colored tape out there critical injuries and ongoing threats to responders and patients—this model may not be feasible and may result and that’s not what the focus in mis-triage and avoidable, outcome-altering delays of mass casualty response is in care. Further, many hospitals have not trained or about anymore. exercised triage or re-triage of exceedingly large numbers of patients, nor practiced a formalized secondary triage Dr. Edward Racht process that prioritizes patients for operative intervention American Medical Response or transfer to other facilities. The focus of this paper is to alert EMS medical directors and EMS systems planners and hospital emergency planners to key differences between “conventional” MCIs and mass violence events when: • the scene is dynamic, • the number of patients far exceeds usual resources; and • usual triage and treatment paradigms may fail. -
Accident Knowledge and Emergency Management
Ris0-R-945(EN) DK9700056 Accident Knowledge and Emergency Management Birgitte Rasmussen, Carsten D. Gr0nberg Ris0 National Laboratory, Roskilde, Denmark March 1997 VOL 2 p III 1 2 Accident Knowledge and Emergency Management Birgitte Rasmussen, Carsten D. Gr0nberg Ris0 National Laboratory, Roskilde, Denmark March 1997 Abstract. The report contains an overall frame for transformation of knowledge and experience from risk analysis to emergency education. An accident model has been developed to describe the emergency situation. A key concept of this model is uncontrolled flow of energy (UFOE), essential ele- ments are the state, location and movement of the energy (and mass). A UFOE can be considered as the driving force of an accident, e.g., an explosion, a fire, a release of heavy gases. As long as the energy is confined, i.e. the location and movement of the energy are under control, the situation is safe, but loss of con- finement will create a hazardous situation that may develop into an accident. A domain model has been developed for representing accident and emergency scenarios occurring in society. The domain model uses three main categories: status, context and objectives. A domain is a group of activities with allied goals and elements and ten specific domains have been investigated: process plant, storage, nuclear power plant, energy distribution, marine transport of goods, marine transport of people, aviation, transport by road, transport by rail and natural disasters. Totally 25 accident cases were consulted and information was extracted for filling into the schematic representations with two to four cases pr. specific domain. The work described in this report is financially supported by EUREKA MEM- brain (Major Emergency Management) project running 1993-1998. -
Integrating Emergency Medical Services in the Fire Department
University of Tennessee, Knoxville TRACE: Tennessee Research and Creative Exchange MTAS Publications: Full Publications Municipal Technical Advisory Service (MTAS) 4-2007 Integrating Emergency Medical Services in the Fire Department Gary West Municipal Technical Advisory Service Follow this and additional works at: https://trace.tennessee.edu/utk_mtaspubs Part of the Public Administration Commons The MTAS publications provided on this website are archival documents intended for informational purposes only and should not be considered as authoritative. The content contained in these publications may be outdated, and the laws referenced therein may have changed or may not be applicable to your city or circumstances. For current information, please visit the MTAS website at: mtas.tennessee.edu. Recommended Citation West, Gary, "Integrating Emergency Medical Services in the Fire Department" (2007). MTAS Publications: Full Publications. https://trace.tennessee.edu/utk_mtaspubs/84 This Report is brought to you for free and open access by the Municipal Technical Advisory Service (MTAS) at TRACE: Tennessee Research and Creative Exchange. It has been accepted for inclusion in MTAS Publications: Full Publications by an authorized administrator of TRACE: Tennessee Research and Creative Exchange. For more information, please contact [email protected]. INTEGRATING EMERGENCY MEDICAL SERVICES IN THE FIRE DEPARTMENT Fire/EMS First Responders: It’s just a matter of time Gary L. West, Fire Management Consultant April 2007 INTEGRATING EMERGENCY MEDICAL SERVICES IN THE FIRE DEPARTMENT Fire/EMS First Responders: It’s just a matter of time Gary L. West, Fire Management Consultant This publication was written with the assistance and editing of Richard F. Land, Tennessee Department of Health, Bureau of Health Licensure and Regulation, Division of Emergency Medical Services, Nashville, Tennessee. -
Emergency Ambulance and First Responder Staffing, Medications, Medical Equipment, and Supplies
POLICY NO: EQP 1 DATE ISSUED: Apr. 2021 EMERGENCY AMBULANCE AND FIRST RESPONDER STAFFING, MEDICATIONS, MEDICAL EQUIPMENT, AND SUPPLIES I. PURPOSE This policy establishes requirements for emergency ambulance and first responder staffing, medications, equipment, and supplies for emergency ambulances, first responder apparatus, and EMS supervisor vehicles. This policy further defines restocking requirements of medications, medical supplies, and equipment. II. AUTHORITY California Health and Safety Code, Division 2.5, §1798 III. DEFINITIONS Advanced Life Support (“ALS”) Ambulance [or “Paramedic Ambulance”]: An ambulance authorized by LEMSA to provide ALS emergency services within San Mateo County. Advanced Life Support (“ALS”) First Responder Unit (“FRU”): A fire department first responder authorized by LEMSA to provide ALS emergency services within San Mateo County. Basic Life Support (“BLS”) Ambulance: An ambulance authorized by LEMSA to provide BLS emergency services within San Mateo County. Basic Life Support (“BLS”) First Responder Unit (“FRU”): A fire department first responder authorized by LEMSA to provide BLS emergency services within San Mateo County. Emergency Medical Services Agency (“LEMSA”) [or “Agency”]: The San Mateo County EMS Agency. IV. STAFFING REQUIREMENTS A. ALS ambulance shall be staffed with a minimum of one currently licensed and LEMSA accredited paramedic and one currently California certified EMT. B. ALS first responder apparatus shall be staffed with a minimum of two personnel, at least one of whom is a currently licensed and LEMSA accredited paramedic. C. BLS first responder apparatus shall be staffed with a minimum of two personnel, at least Page 1 of 6 one of whom is a currently California certified EMT. D. EMS Supervisor vehicles shall be staffed with a minimum of one currently licensed and LEMSA accredited paramedic. -
Evaluation of Physiologic Alterations During Prehospital Paramedic-Performed Rapid Sequence Intubation
Prehospital Emergency Care ISSN: 1090-3127 (Print) 1545-0066 (Online) Journal homepage: http://www.tandfonline.com/loi/ipec20 Evaluation of Physiologic Alterations during Prehospital Paramedic-Performed Rapid Sequence Intubation Robert G. Walker, Lynn J. White, Geneva N. Whitmore, Alexander Esibov, Michael K. Levy, Gregory C. Cover, Joel D. Edminster & James M. Nania To cite this article: Robert G. Walker, Lynn J. White, Geneva N. Whitmore, Alexander Esibov, Michael K. Levy, Gregory C. Cover, Joel D. Edminster & James M. Nania (2018): Evaluation of Physiologic Alterations during Prehospital Paramedic-Performed Rapid Sequence Intubation, Prehospital Emergency Care, DOI: 10.1080/10903127.2017.1380095 To link to this article: https://doi.org/10.1080/10903127.2017.1380095 © 2017 The Author(s). Published with license by Taylor & Francis© Robert G. Walker, Lynn J. White, Geneva N. Whitmore, Alexander Esibov, Michael K. Levy, Gregory C. Cover, Joel D. Edminster, James M. Nania. Published online: 03 Jan 2018. Submit your article to this journal View related articles View Crossmark data Full Terms & Conditions of access and use can be found at http://www.tandfonline.com/action/journalInformation?journalCode=ipec20 Download by: [104.129.200.76] Date: 03 January 2018, At: 10:18 EVALUATION OF PHYSIOLOGIC ALTERATIONS DURING PREHOSPITAL PARAMEDIC-PERFORMED RAPID SEQUENCE INTUBATION Robert G. Walker, BA ,LynnJ.White,MS , Geneva N. Whitmore, MPH, Alexander Esibov, BS, Michael K. Levy, MD , Gregory C. Cover, MD, Joel D. Edminster, MD, James M. Nania, MD, FACEP ABSTRACT (9%), and cardiac (1%). The overall intubation success rate (95%) and first-attempt success rate (82%) did not dif- Objective: Physiologic alterations during rapid sequence fer across diagnostic impression categories. -
California Emergency Services
CALIFORNIA EMERGENCY SERVICES ACT CALIFORNIA DISASTER ASSISTANCE ACT EMERGENCY COMPACTS • INTERSTATE CIVIL DEFENSE AND DISASTER COMPACT (1951) • EMERGENCY MANAGEMENT ASSISTANCE COMPACT (2005) CALIFORNIA DISASTER AND CIVIL DEFENSE MASTER MUTUAL AID AGREEMENT Edmund G. Brown, Jr. Governor 2015 Edition Publishing Information This document was produced by: California Governor’s Office of Emergency Services 3650 Schriever Avenue Mather, CA 95655 Phone: (916) 845-8510 The statutes contained in this publication may also be searched at: www.caloes.ca.gov (Laws and Regulations) or www.leginfo.ca.gov The State of California makes no warranty, express or implied, and assumes no liability for omissions or errors contained within this publication. Table of Contents California Emergency Services Act..................................... 1 Article 1 – Purpose....................................................................1 § 8550. Findings and Declaration ................................................ 1 § 8551. Short title ........................................................................ 2 Article 2 – General Definitions ...................................................2 § 8555. Definitions governing construction ................................ 2 § 8556. “Governor” defined ........................................................ 2 § 8557. Definitions....................................................................... 2 § 8558. Conditions or degrees of emergency; “state of war emergency”, “state of emergency”, and “local emergency” defined........................................................................................ -
Treatment-Protocols-2018.Pdf
EMERGENCY MEDICAL SERVICES PRE-HOSPITAL STATEWIDE TREATMENT PROTOCOLS OFFICIAL VERSION 2018.1 Complete Version January 29, 2018 Commonwealth of Massachusetts Department of Public Health Bureau of Healthcare Safety and Quality Office of Emergency Medical Services Statewide Treatment Protocols – Version 2018.1 Legend Definition FR First Responder (FR)-- Found only in protocols 2.2A, 2.2P, 2.9, and 2.14 E Emergency Medical Technician (EMT) A Advanced Emergency Medical Technician (AEMT) P Paramedic CAUTION – Red Flag topic Medical Control Orders Pediatric-specific protocol Clinical notes boxes show important assessment or treatment considerations. EMT level protocols are designated by colors (see above), and labels, and EMTs are responsible for providing Routine Care to all patients, and for their level of care, and those above on the protocol page. These protocols are developed and approved by the Department of Public Health, based on the recommendations of Emergency Medical Care Advisory Board (EMCAB) and its Medical Services Committee (MSC). For the latest corrections or addenda, see the OEMS website at http://www.mass.gov/dph/oems These are Massachusetts Statewide Treatment Protocols; they are the standard of EMS patient care in Massachusetts. Questions and comments should be directed to: Massachusetts Department of Public Health Office of Emergency Medical Services 99 Chauncy St. 11th Floor Boston, MA 02111 2013 2013 Massachusetts Pre-Hospital Statewide Treatment Protocols 2018.1 TABLE OF CONTENTS (Alphabetical order by section) Protocol ID SECTION 1 – General Patient Care Routine Patient Care……………………………………….……………………..………….1.0 High Quality CPR - Adult………………..………..………………………………………….1.1 SECTION 2 – Medical Protocols Adrenal Insufficiency - Adult/Pediatric………………………………………..……………2.1 Allergic Reaction/Anaphylaxis – Adult……………………………………………..……….2.2A Allergic Reaction/Anaphylaxis – Pediatric……………………………………………...…. -
AMA- State Medicaid Law Definitions of Emergency Medical Condition
Medicaid – Definition of Emergency Medical Condition and Emergency Medical Services Please note: The information in this document is a summary of state statutes and regulations defining “emergency medical condition” and/or “emergency medical services” within state Medicaid programs or Medicaid managed care programs. The omission of a definition on this chart does not mean the state Medicaid program does not define “emergency medical condition” or “emergency medical services” as these terms may be defined in other Medicaid documents, such as, but not limited to, the state plan, beneficiary guidelines, and provider handbooks. This document does not contain information related to coverage of emergency medical services for noncitizens. This document is meant to serve as an educational tool and does not constitute legal advice. Florida Definitions FSA sec. (10) “Emergency medical condition” means: 409.901 (a) A medical condition manifesting itself by acute symptoms of sufficient severity, which may include severe pain or other acute symptoms, such that the absence of immediate medical attention could reasonably be expected to result in any of the following: 1. Serious jeopardy to the health of a patient, including a pregnant woman or a fetus. 2. Serious impairment to bodily functions. 3. Serious dysfunction of any bodily organ or part. (b) With respect to a pregnant woman: 1. That there is inadequate time to effect safe transfer to another hospital prior to delivery. 2. That a transfer may pose a threat to the health and safety of the patient or fetus. 3. That there is evidence of the onset and persistence of uterine contractions or rupture of the membranes. -
First Responder: National Standard Curriculum
First Responder: National Standard Curriculum United States Department of Transportation National Highway Traffic Safety Administration United States Department of Health and Human Services Maternal and Child Health Bureau First Responder: National Standard Curriculum Instructor's Course Guide --------------------------------------- First Responder: National Standard Curriculum Project Director Walt Alan Stoy, PhD, EMT-P Director of Educational Programs Center for Emergency Medicine Research Assistant Professor of Medicine University of Pittsburgh School of Medicine Principal Investigators Gregg S. Margolis, MS, NREMT-P Thomas E. Platt, NREMT-P Associate Director of Education Coordinator of EMS Education Center for Emergency Medicine Center for Emergency Medicine Medical Directors Nicholas H. Benson, MD, FACEP Herbert G. Garrison, MD, FACEP Acting Chair, Department of Emergency Medicine Assistant Professor of Medicine East Carolina University School of Medicine University of Pittsburgh School of Medicine Curriculum Development Group Michael O'Keefe Bob W. Bailey State Training Coordinator Chief, Office of EMS Vermont North Carolina William E. Brown, Jr., RN, REMT-P Philip Dickison, REMT-P Executive Director Basic Level Coordinator National Registry of EMTs National Registry of EMTs Susan M. Fuchs, MD, FAAP Associate Professor of Pediatrics University of Pittsburgh School of Medicine Contract Number DTNH22-94-C-05123 -------------------------------------- United States Department of Transportation i National Highway Traffic Safety Administration -
Prehospital Endotracheal Intubation: Elemental Or Detrimental? Paul E Pepe1,2*, Lynn P Roppolo1,2 and Raymond L Fowler1,2
Pepe et al. Critical Care (2015) 19:121 DOI 10.1186/s13054-015-0808-x REVIEW Prehospital endotracheal intubation: elemental or detrimental? Paul E Pepe1,2*, Lynn P Roppolo1,2 and Raymond L Fowler1,2 This evolution in out-of-hospital care was especially Abstract remarkable in that the formal training of these non- This article is one of ten reviews selected from the physician personnel included those advanced care Annual Update in Intensive Care and Emergency interventions such as ETI and i.v. drug administration, Medicine 2015 and co-published as a series in Critical interventions traditionally provided in the in-hospital Care. Other articles in the series can be found online at setting by expert physician specialists [1-9]. Paramedic http://ccforum.com/series/annualupdate2015. Further skill portfolios ranged from basic spinal immobilization and information about the Annual Update in Intensive Care extremity splinting to the more advanced skills of electro- and Emergency Medicine is available from http://www. cardiographic (EKG) interpretation, defibrillation attempts, springer.com/series/8901. ETI, i.v. catheter placement and even pericardiocentesis and tracheotomies in some communities [10]. The skill of ETI had become the definitive airway Introduction control for most critically ill and injured patients, be Modern out-of-hospital emergency medical services they in the operating room, in the early phases of an (EMS) systems, as we have come to recognize them intensive care unit (ICU) hospitalization, or in the today, were established