MLFD Standard Operating Guidelines SOG# Subject: Patient Transfer of Care Initiated 1/30/2013

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Alicia Kelley
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1 MLFD Standard Operating Guidelines SOG# Subject: Patient Transfer of Care Initiated 1/30/2013 Approved: Revised PURPOSE It is the purpose of this SOG to provide and ensure the highest level of patient care service delivery to our customers, by expediting transport to definitive treatment through the use of Advanced Life Support (ALS) ambulance/helicopter service. It is the practice of the MLFD to establish a consistent process for the response and transfer of care from MLFD personnel to ALS/BLS ambulance/helicopter providers. The policy will define: Response guidelines and expectations of ambulance/helicopter personnel Parameters for the transfer and continuation of patient care Outline the process of conflict resolution and accountability with MLFD members and ambulance/helicopter personnel Guidelines This SOG integrates the procedures within the framework of the Incident Management System, MLFD Policies, and Treatment Protocols. It is the responsibility of the first arriving Company Officer to implement these procedures on all EMS incidents. Emergency response should be conducted as safely and expeditiously as possible. MLFD personnel are expected to: Communicate the standard functions by radio (i.e. responding, staging, on scene, transporting, available on radio) at all times Utilize the proper order model when conducting radio communications 1 SOG# 12-22

It is the practice of the MLFD to establish a consistent process for the response and transfer of care from MLFD personnel to ALS/BLS ambulance/helicopter providers.

2 If a transport unit (ambulance) arrives first on the scene of a non-routine incident (i.e. structure fire, multivehicle accident, etc.), the crew should: Park in a safe location that will not interfere with fire ground operations. Ambulances should park in a location at fire ground operations so the ambulance will not be blocked by fire apparatus and can still be utilized for transportation of patients from the scene. Provide a brief scene report that includes any obvious conditions (car on its top, victims trapped, etc.) Ambulance personnel should not enter the hazard zone, but should instead await further direction from the first due Company Officer or Incident Commander. On a fire incident, ambulance crews should avoid radio traffic, unless presented with extraordinary circumstances e.g. explosion, presentation of a victim etc. at which time they should give a brief explanation. If an ALS Ambulance arrives first on scene of a routine (EMS) incident, the crew is expected to don proper PPE/BSI and initiate appropriate treatment. Private Ambulance personnel are NOT to cancel responding MLFD units. Standard patient triage, treatment and transportation functions should take place at the direction of the Incident Commander, Company Officer or Paramedic on scene. Private ambulance companies and/ or outside fire district EMS Supervisors may be dispatched to respond to Multiple Alarm Medical incidents. Upon their arrival, they are expected to report to the Incident Commander. Unless otherwise instructed, place ambulances on the geographic side of the incident and direction of travel toward the most probable hospital destinations. The EMS Supervisor will assist the Transportation Sector Officer and may be assigned this responsibility at the discretion of the Incident Commander. The first arriving ALS unit on scene should initiate patient care. The first arriving MLFD Company Officer on scene will assume overall responsibility for the incident. The MLFD will retain its right as the incident authority for any patient encounter, regardless of the order of arrival on scene. This will allow for consistent command procedures and enhance overall patient care. 2 SOG# 12-22

Ambulances should park in a location at fire ground operations so the ambulance will not be blocked by fire apparatus and can still be utilized for transportation of patients from the scene.

3 Transfer of Care The transfer of patient care from the MLFD to ALS transport personnel should take place only after the following criteria have been met: Report has been given to transport personnel Report shall include a brief description of the patient s complaint(s), condition, any treatment initiated, response to treatments and any other pertinent patient information When a transport arrives on scene prior to MLFD arrival, the first arriving Company Officer will seek out the transport personnel and ask for report on all patients encountered. The Company Officer will then assume responsibility for the scene. Patch/courtesy notifications will be completed by personnel accompanying the patient during transport to the hospital. If a patch is required for medical direction or to obtain orders prior to transport, the patch will be made by MLFD Paramedics prior to transportation. The transport can, at the discretion of the Company Officer and in agreement of the Paramedic, be allowed to proceed to the hospital preventing further delay on scene. This should occur after two complete sets of vital signs have been obtained. If two complete sets of vital signs are unable to be obtained, the reason should be documented clearly on the encounter form. Medications will be restocked to MLFD companies from the ALS transport crews. Examples of Stable Patients to be transferred to ALS transport personnel: Level of Consciousness, A&O x 4 (with consideration of pre-existing conditions); non-traumatic altered mental status; GCS maintained at greater than 13, with stable vital signs. Respirations in normal range for the age group; no abnormal sounds (with consideration of pre-existing conditions) Heart Rate is in normal range for the age group; no irregularities (with consideration of pre-existing conditions) 3 SOG# 12-22

on scene prior to MLFD arrival, the first arriving Company Officer will seek out the transport personnel and ask for report on all patients encountered.

4 Blood Pressure in normal range for the age group; >90 systolic and <180 systolic (with consideration for pre-existing conditions) No uncontrolled bleeding Relief or improvement of chest pain; less than or equal to 3 on a 10 scale; do not anticipate further medications being given en route Any stable patient when the ALS Transport Paramedics on scene, along with the Company Officer and MLFD Paramedic are comfortable with transporting the patient. The following incidents are representative of where transfer of patient care should not take place to a BLS Transport, Search and Rescue or other agency and at minimum; one MLFD Paramedic should remain as primary caregiver and in medical control until ALS Transport is available. Medical cardiac arrest Trauma code Drowning/near drowning Level I/Immediate patient Facial burns, and/or any second or third degree burn covering more than 10% of the body; all electrical burns; burns to hands, feet, or genitalia Respiratory failure, severe respiratory distress Acute Coronary Syndrome with indicative changes on the 12 Lead EKG Chest pain unresponsive to treatment (>3 on a 10 scale) or anticipate giving medications en route to treat the chest pain (i.e. NTG, Morphine) Non-traumatic decreased LOC less than or equal to 13 or decreased LOC due to trauma Any patient who has been administered a narcotic (i.e. Morphine, Versed, Valium) Imminent Childbirth/recent childbirth Any unstable patient Abnormal blood pressure, heart rate, or respirations causing hemodynamic compromise Overdose or accidental poisoning which require treatment with medications (i.e. 4 SOG# 12-22

Paramedic are comfortable with transporting the patient.

5 Narcan, Charcoal) Excessive body temperatures with convulsions or deliriums from extreme heat/cold Status epileptics or seizure patients that remain postictal Cerebral Vascular Accident (or possible stroke/tia) Severe orthopedic injuries, open fractures, multiple fractures Combative patients Sexual assault patients Treatment of any Fire Department or Police Department personnel Any patient where receiving Paramedic does not feel comfortable accepting patient Any patient whose presentation of signs and/or symptoms could lead to medication being administered while en route. Conflict Resolution and Accountability The MLFD Paramedic is in charge of the patient care until that patient care is transferred to an ALS transport unit or to a provider with a higher level of medical expertise. The accepting authority assumes ALL responsibility for the patient. Although the Captain is responsible to supervise the activities that take place under their command, the Paramedic is the primary authority for EMS related support or guidance. Any concerns, issues, or problems that may arise will be managed through the appropriate chain of command with assistance, as necessary, by the Fire Chief. 5 SOG# 12-22

receiving Paramedic does not feel comfortable accepting patient Any patient whose presentation of signs and/or symptoms could lead to medication being administered while en route.

COUNTY OF KERN EMERGENCY MEDCAL SERVICES DEPARTMENT. EMS Aircraft Dispatch-Response-Utilization Policies & Procedures

COUNTY OF KERN EMERGENCY MEDCAL SERVICES DEPARTMENT Final - May 2, 2002 Russ Blind Interim Director Robert Barnes, M.D. Medical Director TABLE OF CONTENTS Section: Topic: Page #: I. Definitions 3-4 II.