Hudson Valley Regional EMS Protocols

1. Hudson ValleyRegional EMSProtocols A guide to understanding and applying the protocols

2. Credits & Reviewers HVREMAC Protocol Committee Daniel Olmoz, EMT-P Raphael Barishansky, MPH Nitin Natarajan, EMT-P

3. Overview Where did they come from The HVREMAC protocol committee Interpretation of Protocols EMT-I/CC Program The Treatment Protocols Helicopter Transport Protocol Physician Release Medication/Equipment List Drug Formulary

4. HVREMAC Operating under authority of Article 30 of NYS Public Health Law Regional EMS Council, Regional Medical Advisory Committee & EMS Program Agency All are administered through the Regional office Protocols are developed by RMAC Subcommittee and approved by its members, SEMAC, and DOH

5. Who Are You Guys Anyway? Raphael Barishansky, MPH Executive Director Pamela Murphy, MD Medical Director Daniel Olmoz, EMT-P Quality Improvement Coordinator William Jeffries, EMT-P Training Coordinator

6. Responsibilities Program Coordinator (development and implementation) Quality Improvement Programs BLS Albuterol administration Programs Public Access Defibrillation Programs BLS epi-pen administration program Coordinating Medical Control Plan

7. Responsibilities CLI CIC Training Courses Continuing Medical Education Programs Protocol exams and in-services Track all HVREMAC Providers Coordinate EMS programs through Course Sponsors

8. Medical Control All ALS activity is always under Medical Control, either on-line or off-line ONLY HVREMS Credentialized ALS providers may practice ALS in this Region. ALS providers must be credentialized prior to ANY unsupervised patient contact. Medical Control Physicians also must be credentialed by HVREMS Only HVREMAC may issue credentials

9. Interpretation of Protocols All protocols begin with NYS Basic Life Support Protocols All ALS protocols begin with Protocol #1, Routine Medical Care All standing orders must be completed in order Any standing order may be initiated prior to contacting medical control. Standing order may be withheld based on the Paramedic�s clinical judgment

10. Interpretation of Protocols Medical Control Options Must be ordered by MC Physician Sequence may be altered by Medical Control Treatment modalities should be agreeable to Paramedic and Physician

11. Medical Authority at Scene You are an extension of the Medical Control physician You may not relinquish medical authority/ control to anyone. Only a Medical Control Physician may relinquish Medical Control and only to an identified PHYSICIAN, who is on scene.

12. Medical Authority at Scene MC may allow ALS providers to follow orders from another Physician if those orders fall within the established HVREMS protocols Orders that do not fall under HVREMS Protocols: Must be performed by the physician Must be performed without the use of HVREMS ALS provider�s supplies. Require that the physician accompany the patient to the hospital

13. Medical Authority at Scene On scene physicians accepting Medical Control must sign �Physician Release Form� (appendix B). HVREMS Medical Control Physician may re-establish medical control at any time

14. Physician Release Form Updated Physician Release Form

15. Communications ALS providers may contact medical control at any time ALS providers must contact medical control: Upon completion of standing orders When a patient requires ALS care, but refuses either treatment or transport

16. Communications (con�t) If an ALS provider operations on the scene of a call for over 20 minutes without contacting medical control: The provider will file a report with their agency�s Chief Operations Officer (COO). The COO of the agency will compile and submit a monthly summary to their respective medical director for review.

17. Communications Failure In the event of communications failure Complete standing orders Continue to attempt to contact ANY HVREMS Medical Control Facility Document: Each attempt made to contact Medical Control Reasons for communications failure

18. Medication Administration Medications may be given Only on order of Medical Control (verbal or by specific protocol) Only by HVREMS Approved ALS provider The Paramedic is responsible for Verifying orders Maintaining Control of the Medication storage Documentation of medication administration on an ALS addendum.

19. Equipment/Medication List All agencies will be required to stock each ALS unit to the minimum levels as set forth in Appendix C Each ALS unit is responsible for a daily inventory of all medications and must keep records of such inventory All controlled substances must be stored in compliance with their respective controlled substances (Part 80) plan.

20. Equipment List

21. Destination Decision Patients shall be transported to the nearest appropriate hospital as defined by patient choice, medical condition, and state/regional protocols. Medical Control must approve any deviations. When patient is transported to a non Medical Control Hospital it is the Medical Control Physician�s responsibility to notify the receiving hospital.

22. Ambulance Diversion A hospital based decision Not binding on ALS services Compliance is voluntary Decided between Medical Control and Senior ALS Provider Ancillary staff does not have the right to divert ALS units

23. Transfer of Care Paramedics may transfer care: To an appropriate receiving facility To Air Medical Crew or Critical Care Team When ALS capabilities are exceeded and patient is triaged to BLS or other ASL providers When Coroner or medical examiner assumes custody When there is no indication fore ALS care, as determined by Senior ALS provider

24. Transfer of care Joint decision between Senior ALS Provider and Medical Control Must be included in documentation Communications Failure: Paramedic will make final decision

25. Inter- Facility Transfers The Hudson Valley Regional EMS Council will not be responsible for providing Medical Control for inter-Facility Transports

26. Inter facility Transfers In cases of significant patient deterioration during an inter-facility transport� The ALS provider may revert to HVREMAC protocols and transport to the nearest facility.

27. Protocol Exceptions Some situations / Scenarios will not conform to protocol Paramedics are not obligated to perform treatments which he/she feels may be contrary to the patient�s well being The Paramedic and MC may Jointly decide on an alternative course of action

28. Protocol Exceptions While acting in a setting which falls beyond the scope of the Regional ALS protocols no provider shall be faulted or suffer punitive action for: Following the orders of the Medical Control physician Refusing to follow an order that would increase patient�s risk Refusing to perform a procedure beyond your training or expertise

29. Protocol Exceptions Whenever an action occurs outside of HVREMS protocols the MC Physician and ALS provider shall each generate and forward a report to the REMAC within 3 days of the deviation.

30. Record Keeping All ALS providers must generate a PCR immediately following a call Medical Control must sign the PCR, or ALS addendum

31. Patients Who Refuse Care Patients have the right to refuse care Patients have the right to refuse transport You may only infringe upon this right if the patient or guardian (proxy, parent, or other responsible party) lacks the capacity to make an informed decision.

32. When a patient wishes to refuse Attempt to gain a rationale (include family) Evaluate mental status and decision making capacity Communicate with Medical Control if ALS is indicated Document Obtain release signatures

33. Complaint Procedures Who can file a compliant: Patients The general public Participating organizations Nurses & Doctors Participating ALS and BLS providers HVREMS Staff

34. Complaint Procedures Complaints should be directed to: Raphael Barishansky, MPH Executive Director HVREMSCO (845) 567-6740 Execdir@HVREMSCO.org

35. Complaint Procedures Acceptable grounds for complaint: Practicing without NYS certification Practicing without HVREMAC credentials Protocol deviations Unprofessional Conduct Fraud or falsification of records Misappropriation or unauthorized possession Insubordination

36. Disciplinary Procedures Evaluation Committee Chairman Regional Medical Director: Regional Executive Director: 2 HVREMAC physicians 2 HVREMAC EMS providers

37. Adult Protocols

38. Protocol 1: Routine Medical Care BLS Oxygen Therapy Airway Control Vital Signs EKG IV Access Blood Samples Medical Control Contact Transport

39. Protocol 32: RSI Credentialized agencies and paramedics only

40. RSI Program There is currently a moratorium on RSI programs QI data has been inconclusive and difficult to obtain Efficacy is unclear HVREMAC is currently determining the future of the program

41. Pediatric Protocols

42. Pediatric Definitions A pediatric patient is any patient who is Less than 15 years of age For the purposes of CPR and AED a child will be considered to be 8 years of age or less Transport should be considered prior to ALS interventions IO for patients under 6 years old May be used up to 12 years old (better be right)

43. Protocol 33: Routine Medical Care BLS Oxygen Therapy Airway Control Vital Signs EKG IV / IO Access Blood Samples Medical Control Contact Transport

44. Helicopter Transport GuidelinesTrauma Transport Guidelines

45. Helicopter Transport GuidelinesTrauma Transport Guidelines

46. Regional Trauma Centers Contact Information for Regional Trauma Centers

47. Medication List Required Medication List Updated Medication Minimums

48. References Pediatric Weight Reference Chart Burn Chart

49. Drug Formulary Drug Formulary