Emergency Medical Response
Contents
1. SUPERIOR FIRE DEPARTMENT SOP 3 3 Emergency Medical Response 1 01 04 EMERGENCY MEDICAL RESPONSE PURPOSE To establish operating procedures and rules governing the operation of Basic Life Support BLS or Advanced Life Support ALS ambulances within Superior Fire Department BLS ambulances act as the first tier of a two tiered pre hospital phase of the Fire and EMS Department s emergency medical system It is the foundation on which ALS the second tier care is predicated of the pre hospital phase of the Department s emergency medical services system SCOPE This policy will be in effect in all EMS ambulance responses POLICY Basic Life Support Service To provide the best pre hospital care possible to any person in need of emergency medical services 1 There shall be no hesitancy in providing prompt response to every request for emergency service The stated goal is to have ambulances respond within five minutes of dispatch 2 The care provided is to be in the best interest of the patient and in accordance with the standard of care applicable to the level of certification of the persons providing care Response Upon dispatch to an emergency call the ambulance is to respond to the scene in accordance with the following 1 Use emergency warning devices following the procedures outlined in SOP 3 1 1 Operating Emergency Vehicles 2 Minimum staffing for an ambulance on an emergency incident shall be two persons2. the patient is unconscious or not responsible for their own care a responsible party or family member will be allowed to sign for them A copy of the admitting organization s face sheet listing all of patient s billing information will be obtained if available and or a copy of the patient s insurance information should be made e Communications i Radio Communications 1 Transmission of patients Protected Health Information over the radio shall be avoided in accordance with the Department s HIPPA Compliance policies 2 Dispatch shall be notified by all responding personnel whenever SUPERIOR FIRE DEPARTMENT SOP 3 3 Emergency Medical Response 1 01 04 a Responding to a call b Leaving the station on a call c Arriving on scene d Requesting more resources e Leaving the scene for the hospital f Becoming available due to patient refusal or completed transport ii Telephone Communications 1 The ambulance crew should patch with the hospital in any situation where they do not have offline standing orders and require the direction of a higher medical authority a The ambulance crew will patch with the hospital in order to document a patient refusal if there are indications that a patient needs immediate medical treatment but is exercising their right of informed consent b The crew will patch with the hospital in order to obtain medical direction in order to prioritize the patient s tr
3. 3 Any person staffing an ambulance on an emergency incident must be a An Arizona Department of Health Services ADHS certified emergency medical technician Basic or higher b The driver of the basic life support ambulance must meet the qualification standards of SOP 3 1 1 Operating Emergency Vehicles c A third or fourth person may ride with the patient as an observer trainee provided he she is certified in cardiopulmonary resuscitation Emergency Scene Operations 1 Scene Size Up SUPERIOR FIRE DEPARTMENT SOP 3 3 Emergency Medical Response 1 01 04 a Body Substance Isolation BSI Infection control procedures b Gloves c Eye protection d Gown and mask if necessary e Scene safety f Personal safety Is it safe to approach the patient g Crash rescue scenes h Toxic substance low oxygen areas i Crime scenes potential for violence are police on the scene j Unstable surfaces slope ice water k Protection of the patient environmental considerations l Protection of bystanders Help the bystander avoid becoming a patient m Ifthe scene is unsafe make it safe Otherwise do not approach or enter 2 Emergency Scene a Upon arrival on the scene the aid person Officer in Charge OIC is to ensure that a patient assessment is conducted in accordance with the ADHS Medical Protocols for EMT Bs or EMT Ps Patient s should be classified in accordance with the patient triage section of At
4. 4 Assess record patient information Vvital signs a General appearance i Age sex and weight ii General state of health iii Amount of distress mild moderate severe b Objective signs i Level of consciousness Mental Status A V P U ii Skin temperature and color iii Pupil status reactivity and equality c Vital signs i Pulse rate quality and time taken ii Respirations rate effort quality and time taken iii Blood pressure note time taken iv Perfusion capillary refill time peripheral pulses and time taken for pediatric patients d History of episode obtain from patient family observer i Chief complaint ii Time of incident or onset of symptoms and or prior treatment as related to present illness or injury iii Mechanism of injury if trauma patient M O L 1 Determine from patient family or bystander what the M O I was whether insignificant or significant SUPERIOR FIRE DEPARTMENT SOP 3 3 Emergency Medical Response 1 01 04 iv Self treatment and results e Physical Examination of Trauma and Medical Patients i Rapid Assessment High Priority Exam 1 Significant M O I Trauma 2 Unstable Medical Patient ii Focused History Examination Low Priority Exam 1 No significant M O I Trauma 2 Stable Medical Patient only pertinent with responsive patients iii Change patient status from low to high or high to low as it relates to the patient assessment at any point n
5. ENT Emergency Medical Response SOP 3 3 1 01 04 ATTACHMENT 2 PERMISSABLE HOSPITAL DESINATIONS Permissible hospital destination include but are not limited to Priority 1 Level 1 1 Scottsdale Memorial 2 Good Samaritan 3 Scottsdale Osborn 4 Maricopa County 5 Saint Joseph Priority 2 Level 2 1 Banner Baywood Medical Center Priority 3 Level 3 1 Cobra Valley Priority 4 Level 4 1 No transport SUPERIOR FIRE DEPARTMENT SOP 3 3 Emergency Medical Response 1 01 04 ATTACHMENT 3 PATCH GUIDE Patch Guide This is Name Unit with Superior Fire Department On scene In route with a Age 2 Sex LOC Vitals BP Pulse Resp EKG f C C Brief MOI Assessment Brief and Significant Past HX Pertinent to Event Treatment ETA to Receiving Facility Type of Patch Refusal Courtesy Notification Requesting Orders Patch should be brief 1 min or less
6. andle contaminated patients The receiving facility must be notified prior to transport d Obviously deceased persons are not to be transported e Non emergency and inter facility patients will not be transported 3 Hospitals on Reroute Status a Hospitals have the authority to go on reroute status whenever their facility staff does not have the capability to adequately care for any additional patients i Regardless of hospital status Priority 1 Patients are to be delivered to the nearest hospital for evaluation and stabilization ii After evaluation and stabilization the patient may need to be transported to a facility that can continue treatment b Priority 2 and 3 patients are to be taken to another permissible destination hospital unless the hospital on reroute has indicated their ability to care for this specific type of patient 4 Records a The hospital copy of the MAIS Runsheet is to be left with the patient in the emergency department for inclusion in the patient s records For patients who are to be transported all pertinent information shall be entered on the MAIS user s manual SUPERIOR FIRE DEPARTMENT SOP 3 3 Emergency Medical Response 1 01 04 ATTACHMENT 1 PATIENT ASSESSMENT Initial Assessment 1 Observe and take corrective action for any deficiencies in the patient s airway breathing circulation pulse shock 2 Stop any serious bleeding 3 Consider implementing C Spine
7. ansport c The crew will patch in order to inform the hospital of the incoming patient 2 The patch should include the information outlined in Attachment 4 3 The patch should generally take less than one minute 2 Trauma and Specialty Patients a All severely injured adult patients in the Town of Superior are to be transported to the Trauma Center at Scottsdale Medical Center and children under 13 are to be transported to Maricopa County Medical Center unless otherwise directed by Medical Control i Level 1 Trauma patients are to be transported via Helicopter If none is available they may be transported by an ALS Ambulance crew If no paramedic is available an intercept must be arranged with another agency as per SOP 1 3 5 Mutual Aid ii Patients enroute to the Trauma Center who are in cardiac respiratory arrest or impending arrest due to the airway obstruction are to be transported to the closest facility for resuscitation b Other facilities that are specially equipped and staffed for certain medical problems are included in Attachment 2 Transportation of patients directly from the scene to one of these facilities should only be done after consultation with Medical Control c Patients contaminated by hazardous material are to be treated and transported to the medical SUPERIOR FIRE DEPARTMENT SOP 3 3 Emergency Medical Response 1 01 04 facility that is identified in Attachment 2 as having the capability to h
8. ecessary iv Perform interventions as needed throughout assessment v Consult medical control for direction vi Request special additional personnel equipment as needed f Pertinent Medical History i Previous medical problems and conditions ii Routine medications iii Allergies iv Food or fluid intake and activity level for pediatric patients Detailed Physical Examination 1 Check for and take appropriate corrective action for fractures paralysis non profuse bleeding shock etc Patient Triage 1 Identify high priority patients a Poor general impression b Unresponsive patients no gag reflex c Responsive not following commands d Difficulty breathing e Shock hypoperfusion SUPERIOR FIRE DEPARTMENT SOP 3 3 Emergency Medical Response 1 01 04 f Complicated childbirth g Chest pain h Uncontrolled bleeding 2 Priority 1 a Critically ill or injured person who requires immediate attention Delay in treatment may be harmful to the patient potentially threatens life or function For example i Cardiac arrest ii Suspected acute myocardial infarction iii Allergic reaction with acute respiratory distress and hypertension systolic BP less than 80 mm Hg with shock like signs and symptoms iv Burns 1 A patient under 10 or over 50 years old with second and third degree over burns over more than 10 body surface area BSA 2 Patients of other ages with second or third degree burns ov
9. er more than 20 BSA 3 Second or third degree burns of the face hand feet or perineum 4 Electrical burns 5 Chemical burns 6 Respiratory burns v Respiratory distress 1 Pulmonary edema with moderate to severe distress 2 Carbon monoxide inhalation 3 Smoke inhalation vi Overdose poisoning unconscious patient o conscious patient with unstable vital signs pulse less than 60 bpm or more than 120 bpm or hemodynamically significant hypotension vii Multiple trauma patient viii Trauma patient with multiple system involvement and or any of the following 1 Clinical shock systolic blood pressure less than 80 mm Hg SUPERIOR FIRE DEPARTMENT Emergency Medical Response SOP 3 3 1 01 04 Xi xii xiii 3 Priority 2 2 MAST applied and inflated 3 Respiratory distress 4 Unconsciousness 5 Uncontrollable bleeding Penetrating wound to head chest or abdomen Severe single system trauma Unconscious non trauma patient Seizures 1 Status epilepticus two or more seizures without a period of complete consciousness or continuous seizure activity 2 Trauma related seizure Suspected cardiovascular accident CVA with unstable vital signs decreased level of consciousness LOC complicating factors or progressing signs and symptoms a Less serious condition emergency medical attention but does not immediately endanger the patient s life V s will be started when indicated for e
10. l assistance and or has received treatment ii Patient refusals are a form of informed consent and therefore the patient must be capable of making the decision to refuse care Patients are able to make decisions if they are alert and oriented to a person place time events able to answer to answer questions appropriately able to understand the consequences of refusing medical care and not under the influence of minding altering substances If the patient is incapable of making an informed refusal a police officer must be consulted to consider involuntary transport iii In the case of patient under eighteen years of age an attempt must be made to contact the guardian for consent to treatment and transport Children who are unconscious or with life threatening injuries or conditions may be treated transported under the premise of implied consent The local police department must be contacted if the parent or guardian cannot be located If the parent or guardian refuses treatment transport they should sign the appropriate section on the back of the MAIS SUPERIOR FIRE DEPARTMENT SOP 3 3 Emergency Medical Response 1 01 04 runsheet iv Refusals do not need to be obtained for calls where the ambulance has been placed in service prior to arrival or arrives on the scene and there are clearly no injuries However refusals must be obtained from all involved parties on the scene if anyone on the scene receives care If a partic
11. ncy Medical Helicopter Care must be assumed the Flight Nurse and a signature must be obtained by the responsible individual Care may not be terminated with out ensuring continuity of care 2 Transport using emergency warning devices to the nearest hospital medical facilities having the capabilities and the facilities to stabilize treat the patient unless otherwise directed by Medical Control or physician on the scene who has assumed medical control In this instance the physician MUST accompany the ambulance to the hospital ii Priority 2 1 Normally transport using emergency warning devices to one of the hospitals listed in Attachment 2 At the discretion of the ambulance crew considering the best interest of the patient the transport may be accomplished without the use of emergency warning devices iii Priority 3 SUPERIOR FIRE DEPARTMENT SOP 3 3 Emergency Medical Response 1 01 04 1 Transport without the use of emergency warning devices to one of the hospitals listed in Attachment 2 or if requested and the patient will not require admission to a freestanding emergency facility or clinic that is not a greater distance than one of the permissible destination hospitals iv Priority 4 1 Does not require medical attention b Safety Restraint i All patients who are transported will be properly restrained in the vehicle Patients transported on the stretcher will have all three straps securely fastened Pa
12. so ill or badly injured that his judgment is impaired the law of implied consent shall prevail If the person does not meet this criteria he she cannot be forced to accept treatment or transportation c Infectious Disease i Whenever a patient is patient is known or believed to be suffering from a contagious disease or there is a potential for exposure to blood or body fluids ambulance personnel will follow the procedures outlined in the Infection Control plan SOP d Priority 4 Patients i When a patient has been classified as not in need of Fire and EMS Department services Priority 4 a medical consultation must be performed to verify that the patient does not need emergency medical treatment Then the patient shall be advised that their condition does not warrant the use of an emergency ambulance and that they should secure another means of transportation ii The OIC shall fully document the assessment and the physical findings on the MAIS runsheet iii Reasons for refusing to transport the patient should be clearly indicated in the narrative section of the report iv See Section 10 For guidelines regarding handling of deceased victims e Refusal of Aid i A properly documented patient refusal should be obtained when you have offered care to a patient and he she refuses care or any aspect of care or transportation A patient is defined as an individual on an emergency scene who has a medical complaint requests medica
13. tachment 1 Patients may only be walked to the ambulance if they do not have a life threatening or serious illness or injury an illness or injury that could be exacerbated by walking and treatment can be maintained during the transfer Examples of this type of patient include a heart attack or heart disease respiratory distress pulmonary edema respiratory rate lt 10 or gt 20 heart rate lt 60 or gt 100 shock like states and musculo skeletal injuries 3 Multiple Casualties Mass Casualty Incident a Whenever the Fire and EMS Department responds to an incident in which multiple casualties eight or more occur such as a transportation accident or structural collapse the first unit on the scene shall notify Fire and EMS Communications as to the number of victims and the extent of the injuries i e minor severe fatal prior to contact with patients b Communications will notify the appropriate hospital s of the situation in order for the hospital s to arrange for the care of victims and put their disaster plan into effect if necessary 4 Patient a Treatment i The ambulance crew shall perform treatment of injuries and conditions SUPERIOR FIRE DEPARTMENT SOP 3 3 Emergency Medical Response 1 01 04 commensurate with the training level of the ambulance personnel ii The standard of care shall be the current state EMT B protocols where applicable b Consent i When a person is unconscious or is
14. tients transported in the Captains chair or on the bench seat will have a seatbelt securely fastened Children 40 pounds or less or under 4 years old will be secured in a car seat to the stretcher Patients who are being actively resuscitated may have one or more stretcher straps off to facilitate resuscitation Family members who accompany patients to the hospital must wear seatbelts while in Fire and EMS Department vehicles c Arrival i Upon arrival at the hospital all emergency warning devices and the vehicle engine are to be turned off and the ignition keys removed while the vehicle is unattended d Admission i Normally patients are to be delivered to the hospital emergency department however some patients for example obstetrical may be directly admitted to the appropriate unit of the medical facility if the patient and the ambulance crew are accompanied by the proper medical staff ii Patients are not normally to be allowed to walk from the ambulance into the hospital ED They may be transported via the stretcher or a wheelchair All treatments i e oxygen and i v s should be continued during transfer into the ED iii Once in the ED the ambulance crew should give a brief report to the receiving nurse The hospital copy of the run report is to be left with the patient for inclusion in the patient s records Where possible a signature should be obtained from the patient on the HIPPA policy form and on the billing sheet If
15. ular individual has no complaints document this fact on the runsheet and have the patient and the witness sign in the designated areas When in doubt err on the side of obtaining the proper refusals v When a patient refuses treatment and or transport you must advise them of the possible consequences of refusing care especially if you believe that they are seriously ill or injured and that they should seek prompt medical attention including calling us back if necessary if their condition changes vi Proper documentation of a patient refusal of treatment and or transport on the runsheet includes all of the following patient assessment treatment if applicable the patient s level of consciousness decision making capability what you have told him her about the refusal as outlined in the previous paragraph and the patient signature with a third party witness if possible i e police officer the person obtaining the refusal should sign and list their county ID number on the second witness line Transport 1 Mode of Transportation Hospital Destination a All patients should be transported to an appropriate hospital that has the capability of caring for the particular medical emergency of the patient Not all hospitals have the same responsibilities i e pediatrics obstetrics dialysis etc Attachment 3 outlines the capabilities of each hospital i Priority 1 1 Wherever possible the patient will be transported via Emerge
16. xample i ii iii Vi Vil viii Overdose poisoning conscious or with stable vital signs Altered mental status in a patient with stable vital signs Congestive heart failure with stable vital signs Burns 1 A patient under 10 or over 50 years old with second or third degree burns over less than 10 BSA 2 Patients if other ages with second or third degree burns over less than 20 BSA Asthmatics with mild to moderate respiratory distress Mild chest pain not suspected to be serious in nature Concussions with awakening or agitation Moderate blood loss with stable vital signs bleeding controlled and no shock like signs or symptoms SUPERIOR FIRE DEPARTMENT SOP 3 3 Emergency Medical Response 1 01 04 ix Fractures with neurovascular compromise x Seizures 1 Multiple separate seizures 2 Seizures associated with signs and symptoms of a CVA 4 Priority 3 a Non urgent condition requires medical attention but not on an emergency basis for example i Uncomplicated fractures ii Minor Burns iii Lacerations requiring suturing with bleeding controlled 5 Priority 4 a Does not require medical attention and may not require transport e g obviously dead Authorization This Standard Operating Procedure is approved by the Superior Fire Department Chief for implementation Operations Chief Fire Marshal Todd Pryor Date 6 1 2008 SUPERIOR FIRE DEPARTM
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