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Home , Basic life support, Medic

Guideline Name: Department: Basic Orange County and Emergency Services Response

Effective Date: Issued: Approval(s): Kim Woodward October 1, 2018 October 1, 2018 EMS Operations Manager

SCOPE

This procedure applies to all members of the Emergency Medical Services (EMS) Division and all prehospital providers franchised to provide BLS 911 services with Orange County Emergency Services.

PURPOSE

To set forth policy and procedure for the proper dispatch, service coverage, safe and consistent operations, and quality assurance of 9-1-1 use of within the service area of Orange County.

DEFINITIONS

Basic Life Support (BLS) is transportation by a ground ambulance vehicle and the provision of medically necessary supplies and services, including BLS ambulance services as defined by the State Office of Emergency Medical Services (OEMS). The ambulance shall be staffed by an individual who is credentialed in accordance with 10A NCAC 13P .0502 and G.S. 131E-159 as an Emergency Medical Technician (EMT).1

Basic Life Support (BLS) Units in Orange County working under the 9-1-1 Service Contract will consist of two North Carolina certified Emergency Medical Technicians who also must be credentialed to practice independently by Medical Direction. There shall be no more than three medical providers dispatched to a 9-1-1 call per ambulance.

DISPATCH

Unit Designations – BLS Unit Designations will be defines by Orange County Emergency Services’ Emergency Communications Division. The BLS unit with be named “BLS” plus the number of the assigned district of coverage. BLS units may be collocated with an unit or in a district in place of a Advanced Life Support unit.

For example, if BLS 1 is assigned in District 1, their response district will be “BLSN”

BLS Unit Designated May Substitute or Enhance 20-Minute Dispatch Area BLS 1 1 BLSN BLS 2 Medic 2 BLSS BLS 3 Medic 3 BLSS 1 Orange County Emergency Services Basic Life Support Ambulance and Response October 1, 2018

BLS 4 Medic 4 BLSN BLS 5 Medic 5 BLSN BLS 6 Medic 6 BLSS BLS 7 Medic 7 BLSN BLS 8 Medic 8 BLSS BLS 9 Medic 9 BLSS

Geo-Fencing - The CAD system will only recommend BLSS and/or BLSN if the geo-fencing based on AVL is within 20-minutes of the call within either the North side or South side. Any distance greater than 20-minutes will be dispatched to the closest ambulance resource regardless of call type or level of service.

Call Types are medical priority codes as part of Medical Priority Dispatch System used to determine appropriate resources. Medical Direction in cooperation with EMS Administration and the Communications Division approved the following call type determinants for dispatch of BLS units.

Dispatch Protocol Determinant Descriptor Determinant Number Level 5 Back Pain Alpha 17 Fall Alpha / Bravo 21 Hemorrhage/Lacerations Alpha / Bravo 26 Sick Call Alpha 29 Traffic/Transportation Incident Alpha / Bravo 30 Traumatic Incidents Alpha / Bravo

Free-Lancing – BLS units may request to respond to any call that they are the closest to regardless of the determinant level. However, under no circumstance shall an Advanced Life Support (ALS) ambulance request a BLS unit to dual respond without the permission of the EMS Supervisor. BLS units shall not request an ALS unit while responding without the permission of the EMS Supervisor. BLS units may request an ALS unit after evaluating the patient and determining ALS is needed. (It is important for the second ambulance dispatched to a be an advanced life support asset)

RESPONSE

During responses to the call determinants above, the BLS unit shall respond to the scene and provide patient evaluation PRIOR to requesting advance life support. Should additional information be obtained during the EMD of the 911 call that indicates a need for ALS level response, an EMS Supervisor will be notified. If a BLS unit is being dispatched to a non-BLS call and there are no ALS units available, the standard response will include the closest ALS Supervisor.

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Once on scene and after the patient is determined to require advanced life support assessment and/or treatment, the BLS unit shall contact the Emergency Communications Division via the appropriate Operations Channel to request ALS assistance. The EMS Supervisor must be aware of all dual dispatch of units. In situations where the ALS unit is not available, the closest EMS Supervisor will respond and serve as the ALS provider .

In most cases, it will be appropriate for the BLS crew to begin packaging the patient and initiate transport to the most appropriate hospital. Prior to leaving the call location, alert the ALS responding unit to determine if transport to the appropriate hospital is closer than the arrival time of the ALS provider or if an intercept would be a better option.

DOCUMENTATION

ESO Solutions have been updated to allow for Basic Life Support units as a designation. It is important to properly log in at the beginning of the shift as the appropriate unit with certification level as well as the correct shift.

As with all advanced life support patient care records, the appropriate sections must be completed based on the initial training. This includes a thorough narrative based on the highest scope of practice in D-CHARTE format. A minimum of two complete vital signs are required. Vital signs include blood pressure, pulse rate, respiratory rate, pulse oximetry, and Glasgow Coma Scale. In addition, blood glucose and temperature must be obtained.

If an EMS Supervisor arrives on the call and assumes patient care, they must be added to the call as the lead. The narrative may be initiated by the BLS crew, but the EMS Supervisor must review the chart once synchronized (not locked) in ESO Solutions and add their findings and actions taken. The ALS provider is responsible for the patient care record.

Refusal of Care / Transportation

The BLS unit may accept patient care and transport refusals. However, if under any circumstances, the crew does not agree with the patient or each other or if they feel that the patient is considered a high-risk refusal as defined by their experience, they should contact the EMS Supervisor. The EMS Supervisor may choice to respond, dispatch an advanced life support unit, or converse with the patient and/or family to remedy the situation after consultation with the BLS crew.

Should the patient ultimately refuse care and/or transport, the following is an example of the appropriate language you could use in the narrative:

REFUSAL OF CARE AND TRANSPORT: The patient decided to refuse care which consisted of (Specify Care) and/or transport to the hospital of their choice. The patient was found alert and oriented to person, place, time and situation at time of refusal. Further, we discussed several items that are consistent with someone who may demonstrate decisional capacity, such as; 1) Communicated a choice = The patient actively declined treatment and/or transport in their own Page 3 of 5 Orange County Emergency Services Basic Life Support Ambulance and Response October 1, 2018 words, 2) Understood relevant information = The patient expressed in their own words the medical crisis at hand and risks/benefits of medical treatment after discussion with OCES , 3) Appreciated the situation = The patient described their view of their medical condition and, 4) Reasoning about treatment/transport options = The patient’s criterion for making their decision appeared reasonable. An OCES Emergency Services Referral form was provided to the patient/surrogate. The appropriate signature was obtained in the ESO Solutions mask for this patient.

QUALITY ASSURANCE

All quality assurance begins with each staff member as they complete their patient care records. The patient care records are required to be completed by the end of shift. They are to be reviewed by each member, locked and synchronized in ESO Solutions unless otherwise specified by the EMS Supervisor. The EMS Supervisor for that shift will be responsible for reviewing one hundred percent of the patient care records for the BLS units. The BLS records may not be delegated to the Field Training Officers for review unless directed by the EMS Operations Manager or their designee.

The Quality Assurance Officer will review all basic life support calls and share their findings with EMS Operations Manage, or their designee, and the at the Quarterly Quality Assurance Meeting unless a gross violation was determined at which time, both the EMS Operations Manager and Medical Director will be notified at once.

EQUIPMENT

All in-service Orange County ambulances are outfitted for advanced life support level. In the case a basic life support ambulance being placed in service, the crew shall use the equipment appropriate to their scope of practice and MUST not use any medication or equipment they are not qualified to use.

LifePak 15 – The LifePak 15 monitor / defibrillator can be used in Automatic External mode and shall be brought in on all patient care contacts. A BLS provider may transmit a 12-lead tracing For suspected STEMI.

Meret Pack – The Meret Pack contains appropriate airway and respiratory equipment suitable for use at the BLS level.

CPAP BVM Colorimetric Device King Airway Oral and Nasal Airways Page 4 of 5 Orange County Emergency Services Basic Life Support Ambulance and Response October 1, 2018

Manual Blood Pressure Cuff and Stethoscope Diabetic Kit (Oral Glucose only) Tourniquet Thermometer Isolation Kit Limb Restraints

In addition, the Meret Bag carries the drug module that contains the following medication that may be used by EMTs in specific protocols.

Oxymetazoline (Afrin®) Ibuprofen Acetaminophen Aspirin Nitroglycerin Spray (if prescribed) Diphenhydramine PO Epinephrine 1:1,000 IM Albuterol Naloxone

Pediatric Bag (Handtevy®)

Pediatric Blood Pressure Cuff and Stethoscope Childbirth Kit Oral and Nasal Airway King Airway

SAS Bag – With the exception of the chest decompression needles, the bag contains all BLS material.

Spare Medication Box – The spare medication box contains similar medication as listed above.

Controlled Substances – The department’s controlled substance policy ensures that any time controlled substances are secured in a lockable safe in the vehicle and the vehicle is “in-service”, one member of the crew (the staff in possession of the safe key) must sign and acknowledge their presence. Upon end of shift, the controlled substances must be signed over to another staff member or signed to the “off-duty” vehicle.

REFERENCES

1. NC Division of Medical Assistance Medicaid and Health Choice Ambulance Services Clinical Coverage Policy No: 15 Effective Date: February 1, 2016

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