Metro West Ambulance Dispatch Operational Guidelines Washington County, Oregon

Transcription

1 Metro West Ambulance Dispatch Operational Guidelines Washington County, Oregon 2011 Progressive Document Version: 1 Issued: April 12, 2011

2 TO: FROM: Metro West Ambulance Dispatch Center Jonathan Chin, EMS Program Supervisor DATE: April 12, 2011 SUBJECT: Metro West Ambulance Dispatch Operational Guidelines 2011 Progressive Document The culture of the Washington County EMS Community and the operational approach to EMS within the County have dramatically changed over the past four years. The current Control Center Protocols from 2007 are dated, and reflect a rigid and authoritarian infrastructure for providing oversight to the system. This is not the current environment or the future of EMS in Washington County. Dispatch operational guidelines will be developed collaboratively by the WCEO. As guidelines, they allow for flexibility in their application as determined by situational and operational needs. Acknowledging the need to update and convert the current protocols to guidelines, along with ongoing system enhancements which require support and direction from Metro West Ambulance Dispatch (MWA- D), the 2007 protocols have been reformatted and deemed guidelines. Reformatting and utilizing this document as an operational guide will accommodate progressive updating of each section independently. As a progressive document, it is a dynamic document which continually changes as individual sections are updated and revised, approved, and then implemented. Version 1, dated April 12, 2011, is the original reformatted document and contains no content changes. The Table of Contents has been restructured to track revisions, i.e., which sections have been updated and those remaining to be done. This progressive format will be used until the entire document has been updated. Thank you in advance for your cooperation and participation in this process. 2

3 METRO WEST AMBULANCE DISPATCH OPERATIONAL GUIDELINES Washington County, Oregon Table of Contents Version 1 - March 24, 2011 Communications Protocols - Subject Revised Section Page Ambulance Diversion System Ambulance Diversion System (MPS or MCI) Ambulance Diversion System West Zone Management Ambulance Dispatch & Coordination Ambulance Coordination During Major Emergencies Ambulance Response to Stand-by & Staging Locations Ambulance Response to Fire Stand-by Ambulance Status Notification Ambulance Supervisor Emergency Calls Rec d Direct by Ambulance Companies Emergency Medical Dispatch Emergency Medical Dispatch Cards Version (MPDS 11.2) Emergency Medical Dispatch Certification Law Enforcement Center (Jail) Response Minimum Ambulance Coverage Mutual Aid Requests Non-Emergency Medical Requests for Service Out-of-County Ambulance Utilization Redirection of Ambulance Calls for Service Request for Ambulance Response from Hospice Agencies Request for Service MD/RN/Extended Care Facility Return of Fire Personnel by Ambulance Providers Slow Down/Cancellation Policy Suspected Deceased Person/Obvious Death Situation Traffic Accident Unknown (29-B5) (Third Party Caller) Tuality Forest Grove Hospital By-Pass Criteria Urgent Inter-Facility Transfers Veterans Administration Hospital Transports

4 Operational Protocols - Subject Revised Section Page Anti-Terrorism Threat Conditions & Recommended Protective Levels Fire Dept Paramedic Rescue Transport When Ambulance Available Firefighter Safety & Rescue Guidelines WC Standardized Life Flight Coordination Reportable Actions School Terrorism Incident Scoggins Dam Failure/Tualatin River Flooding

5 COMMUNICATIONS PROTOCOLS 5

6 AMBULANCE DIVERSION SYSTEM GUIDELINES Approved: Oregon ED Managers and EMS Providers Group 5/26/00 Revised: 7/11/02, 4/29/03, 11/11/05, and 06/09/06 I. OVERVIEW The Greater Portland Metropolitan Area has experienced steady growth patterns over the past several years. Ambulance providers, emergency departments, and hospitals struggle with increasing patient volumes and acuity at times reaching crisis proportions. As a result, the emergency health care system is being challenged to provide access and service to the community. The Ambulance Diversion Guidelines exist to provide guidance for emergency departments and ambulance providers during capacity times. The guidelines are a collaborative effort between affected hospital emergency departments, ambulance providers, County Emergency Medical Services (EMS) agencies, and the Oregon Association of Hospitals and Health Systems (OAHHS). II. III. IV. PURPOSE To effectively manage situations in the Greater Portland Metropolitan Area where the diversion of a EMS ambulance may be necessary due to temporary shortages of hospital emergency department (ED) resources and when such diversions may have an adverse effect on patient care or the EMS system as a whole. PHILOSOPHY To promote the underlying philosophy that the Greater Portland Metropolitan Area hospitals will make every effort to avoid the diversion of EMS ambulances because ambulance diversion may result in: - Transporting patients away from their hospital or physician of choice. - Prolonged pre-hospital care for unstable or critically ill patients. - Unacceptably prolonged transport times. - Attempts by field personnel to predict the specific diagnostic and therapeutic resources needed by individual patients. - Reduced ED availability to the community. - Reduced ambulance availability to the community. OBJECTIVES A. To promote efficient and effective provision of EMS ambulance services in accordance with County Codes, as well as State and Federal Regulations. B. To provide definitions and agreed upon procedures if ambulance diversion is determined to be necessary. C. To identify hospitals utilizing these guidelines and their respective geographical zones in the Greater Portland Metropolitan Area that may be impacted by ambulance diversion. D. To identify a zone management system when multiple hospitals attempt ambulance diversion simultaneously. E. To identify a system of accountability and quality improvement by providing ambulance diversion data to all participants on a monthly basis. V. DEFINITIONS A EMS Ambulance Diversion The diversion of a EMS ambulance from an intended receiving facility to an alternate receiving facility due to a temporary lack of emergency department resources such as staffing or space. B. Inter-Facility Transfers Hospital destination is pre-determined by physician-to-physician communication as a formal transfer. C. Regional Hospital A medical facility designated to coordinate MCI or disaster situations co-located with Trauma Center Communications (TCC) and Medical Resource Hospital (MRH) which provides online 6

7 medical control for Multnomah and Clackamas counties. This is currently located at OHSU. D. Zone Manager - a medical agency or facility authorized to provide coordination to pre-hospital care providers and hospitals during times of zone wide diversion. E. Advanced Diversion System (ADS) computerized system that the hospitals and ambulance providers use to designate emergency department status. F. Hoscap ( - Region-wide web-site for distribution of hospital status information and incident management. G. Diversion Status Categories 1. GREEN - The ED is able to accept patients transported from EMS calls and unscheduled EMS transports, except those patients they do not normally treat. 2. YELLOW - The ED is unable to accept patients transported from EMS calls which require the following resources: a. CT SCAN The ED is unable to take patients who may need a CT scan, examples include, but are not limited to: Any brain CT (i.e. stroke, acute neurological deficit,) Suspected aortic aneurysm (Including abdominal and/or thoracic) Isolated abdominal injury which would not otherwise meet criteria for Trauma System entry. b. ED CRITICAL CARE The ED is unable to take unstable patient(s). Examples of chief complaints include, but are not limited to: Acute abdomen, non-traumatic Chest pain Coma/Sustained Altered Mental Status Respiratory distress Shock Status seizures Acute Neurologic Deficit A patient with a 12 Lead ECG that indicates a STEMI. (Contact Hospital to determine ability to accept patient.) 3. RED The ED is unable to accept patient(s) transported from a EMS call, except: Uncontrolled airway Non-trauma patient too unstable to transport to another facility Patient refuses alternate facility Prearranged inter-facility transfer Pregnant patients >20 weeks gestation or illness or injury which could have a potential life threatening effect on the mother and/or the fetus. A patient with a 12 Lead ECG that indicates a STEMI. (Contact Hospital to determine ability to accept patient.) 4. Trauma Red A designated trauma hospital will divert to another trauma hospital when it has exceeded its capacity of personnel, equipment, or facilities to assess and care for trauma patients. H. Life Flight Network Status Green Available Yellow On stand-by for another patient Red Unavailable 7

8 I. Destination Hospital/Services Abbreviations 1. DC Doernbecher Children s Hospital (located within OHSU ED) Portland 2. EM Legacy Emanuel Hospital Portland 3. EC Legacy Emanuel Children s Hospital (located in Emanuel s ED) Portland 4. FG Tuality Forest Grove Hospital Forest Grove 5. GS Legacy Good Samaritan Hospital Portland 6. MH Legacy Mt. Hood Medical Center Gresham 7. MP Legacy Meridian Park Hospital Tualatin 8. SC Legacy Salmon Creek Hospital Vancouver 9. PA Adventist Medical Center Portland 10. PM Providence Milwaukie Hospital Milwaukie 11. PR Providence Portland Medical Center Portland 12. SK Kaiser Sunnyside Hospital Clackamas 13. SV Providence St. Vincent Medical Center Portland 14. SW Southwest Washington Medical Center Vancouver 15. TH Tuality Hospital Hillsboro 16. UH Oregon Health Sciences University Hosp. Portland 17. VA Veterans Administration Hospital Portland 18. WF Willamette Falls Hospital Oregon City 19. LF Life Flight Network Hillsboro and Aurora 20. MW Metro West Ambulance Hillsboro 21. EMS Washington County EMS Office Hillsboro VI. AMBULANCE DIVERSION POLICY A. Ambulance diversion is not initiated because of: Lack of in-patient staffing or beds Key resources being reserved for anticipated elective patient care, i.e. elective surgical cases or radiological studies. B. The ED staff and ED physician determines that the emergency department is reaching capacity and attempts to accommodate by following their internal plan. C. The ED staff and ED physician determines that ambulance diversion is necessary in order to safely take care of patients in the emergency department because: Critical/unstable patients occupy all suitable ED beds. There is not enough staff to safely care for additional unstable patients in the ED. There is a loss of CT scanner capability. There is an in-house disaster, i.e. fire, flooding, electrical power outage, etc. which compromises patient care/safety. Trauma resources are unavailable (for designated trauma centers). D. The objective of the Trauma System is that only one of the designated Level 1 Trauma Centers may divert at a time: OHSU or Legacy Emanuel. E. When one of the Level 1 Trauma Centers goes on ambulance diversion status, notification of divert status to the other designated trauma center must occur. Trauma patients will then be diverted to the other Trauma Center. F. When both Level 1 Trauma Centers are at capacity the Trauma Center Communications will be notified to begin rotating trauma patients between the two trauma hospitals until the situation has stabilized or either hospital is able to return to standard operations. The Regional Hospital may also need to do an All Call to other community hospitals activating the MCI or disaster system in order to coordinate distribution of trauma patients. 8

9 G. Designated ED staff changes their status on the Ambulance Diversion System computer screen. H. In the event a hospital is unable to change their status on the Ambulance Diversion System screen, i.e. connection problems, the hospital may contact the zone manager to authorize the zone manager to change the hospital status on the Ambulance Diversion System screen. I. A hospital s Ambulance Diversion System status at the time ambulance transport begins with a loaded patient will determine the ability of the hospital to accept patients. To insure the up-to-theminute ability of a hospital to accept a patient, a transporting unit will contact dispatch requesting the status of the preferred destination hospital when the patient has been loaded and as they are preparing to depart the scene. Diversion of an ambulance shall not occur after the transport has begun. J. Every effort will be made to reopen to green status as soon as possible. VII. ZONE MANAGEMENT A. Occasionally, multiple hospitals will go on ambulance diversion at the same time. This poses a challenge to other hospitals trying to stay open to serve their community. B. Hospitals are grouped into the following geographical zones: West Zone Providence St. Vincent MC Legacy Meridian Park Hospital Tuality Community Hospital Tuality Forest Grove Hospital Zone Manager: Metro West Ambulance Central Zone Oregon Health Sciences University Providence Portland MC Legacy Good Samaritan Hospital Legacy Salmon Creek Hospital Veteran s Administration Hospital SW Washington Medical Center Legacy Emanuel Hospital Zone Manager: Regional Hospital East Zone Adventist Medical Center Kaiser Sunnyside Legacy Mt. Hood Medical Center Willamette Falls Hospital Providence Milwaukie Hospital Zone Manager: Regional Hospital C. Management of the hospital resources for any zone may begin if there is only one green hospital in the West or East Zones or two green hospitals in the Central Zone. Zone management may apply even when hospitals are closed to critical care. D. Zone Management Steps: 1. If hospital resources meet the criteria for zone management as specified in item C, the zone manager will initiate Active Zone Management for the zone(s) affected. 2. The zone manager will initiate an all call via the 800mHz radio to hospitals informing them of the Active Zone Management status. 3. Local transporting EMS agencies/ dispatch centers will notify their respective EMS units that zone management is in effect for the defined zone(s) and that their units are to contact the zone manager to obtain hospital destination(s). 4. Under zone management, the zone manager will determine the destination of all EMS transporting units within the affected zone(s). EMS may transport to any hospital outside of the affected zone if it is green status. 5. Ambulances may go outside their zone during Zone Management as long as their destination hospital is green and as long as the transport does not significantly impact an ambulance provider's ability to provide coverage in their area. This includes honoring previously agreed upon destinations. 9

10 6. Rotation will continue with one patient per hospital as determined by the zone manager. Each zone has identified small hospitals (West Tuality Forest Grove (FG); East Providence Milwaukie (PM). These hospitals will be skipped in the rotation every other time. The VA will be included (for Veterans only) at the discretion of the zone manager. Note: the rotation will not apply to the trauma hospitals for trauma entry patients. 7. Prior to discontinuing zone management, the zone manager will monitor key area hospitals and emergency transport agencies. When system resources are above the activation threshold the zone manager may discontinue zone management. When appropriate, the Multnomah County EMS Medical Director will participate in this discussion for the Central and East zones. F. Disaster Management (Epidemic, Pandemic, Multiple Patient Incident or Mass Casualty Incident Hospital destinations will be coordinated by Regional Hospital through HOSCAP and according to regionally and locally adopted emergency medical services protocols. VIII. ACCOUNTABILITY AND QUALITY IMPROVEMENT A. The hospitals shall develop: An internal system and resources to avoid ambulance diversion. An internal policy related to ambulance diversion. Internal mechanisms to monitor ambulance diversion including number of hours and reasons why. B. Hospitals are encouraged to track their own ambulance diversion hours via a report from the Ambulance Diversion System. C. Multnomah County EMS will report number of hours and category of divert to all East and Central Zone participants and Washington County EMS for the West Zone participants. D. A Greater Portland Metropolitan Area Ambulance Diversion Committee shall be established to address EMS ambulance diversion issues including monitoring diversion hours and categories. This committee will be a cooperative effort between involved EMS agencies, hospitals, and ambulance providers. E. Problems related to the implementation of these guidelines should be forwarded to the Ambulance Diversion Committee. IX. ORGANIZATIONS IN SUPPORT OF THESE GUIDELINES HOSPITALS Doernbecher Children s Hospital Legacy Emanuel Children s Hospital Legacy Emanuel Hospital Legacy Good Samaritan Hospital Legacy Meridian Park Hospital Legacy Mt. Hood Medical Center Legacy Salmon Creek Hospital Oregon Health Sciences University Portland Adventist Medical Center Providence Milwaukie Hospital Providence Portland Medical Center Providence St. Vincent Medical Center Southwest Washington Medical Center Sunnyside Kaiser Hospital Tuality Forest Grove Hospital Tuality Hospital Veterans Administration Hospital Willamette Falls Hospital Oregon Association of Hospitals and Health Systems County EMS Agencies Washington County Clackamas County Clark County Multnomah County Ambulance Providers American Medical Response Canby Fire Department Camas Fire Department Molalla Fire Department Metro West Ambulance North Country Ambulance Life Flight Network 10

11 HOSPITAL Adventist Medical Center SE Market, Portland OR (503) Doernbecher Children s 3181 SW Sam Jackson Park Rd Portland OR 97201(503) Kaiser Sunnyside SE Sunnyside Rd Clackamas OR (503) Legacy Emanuel Children s 2801 N Gantenbein, Portland OR (503) Legacy Emanuel 2801 N Gantenbein, Portland OR (503) Legacy Good Samaritan 1015 NW 22nd Ave., Portland OR (503) Legacy Meridian Park SW 65 th, Tualatin OR (503) Legacy Mt. Hood SE Stark, Gresham OR (503) Legacy Salmon Creek 2211 NE 139 th, Vancouver, WA (360) Oregon Health Sciences Univ SW Sam Jackson Park Rd Portland OR (503) Providence Milwaukie SE 32 nd, Milwaukie OR (503) Providence Portland Medical 4805 NE Glisan, Portland OR (503) Providence St. Vincent 9205 SW Barnes Rd. Portland, OR (503) SW Washington PO Box 1600, Vancouver WA (360) Tuality Forest Grove Hospital 1809 Maple St., Forest Grove OR (503) Tuality Hospital 335 SE 8 th, Hillsboro OR (503) Veteran s Administration 3710 SW US Veterans Hosp. Rd Portland OR (503) Willamette Falls Hospital 1500 Division St., Oregon City OR (503) Burn Unit Cardiac Surgery Decon X Heli pad X Hyper baric X OB NICU Peds Inpt. PICU Psych Inpt Trauma Center X X x X X X X X X X X X X X X X (2) X X X X X X X X X X X X X X x X X X X x X X X x X X X X X X X X X X X X (2) X X X X X X X x Desig nated area X X X X X X X X X X X X X X X X X X X X X X X X X > age 55 X X X X X x X X X Cath Lab Dx only Dx only 11

12 AMBULANCE DIVERSION SYSTEM (ADS) GUIDELINES FOR USE DURING A MULTIPLE PATIENT SCENE (MPS) OR MASS CAUSALITY INCIDENT (MCI) When an MPS or MCI is declared in Washington County, the hospital destination, both medical and trauma, of patients shall be coordinated through ADS. The Ambulance Diversion System Coordinator, designated as the Metro West Ambulance Dispatch Center, shall be responsible for the notification of hospitals and the coordination of hospital destinations with the Medical Branch Director or Communication Supervisor at the scene. PROCEDURE Upon notification of an MPS or MCI, the ADS Coordinator shall notify all Washington County Hospitals and other receiving hospitals through the ADS program. As soon as possible after the initiation of the MPS or MCI the Triage/Treatment/Communications Supervisor shall notify the ADS Coordinator as to the number of immediate (red), delayed (yellow) and walking wounded (green) patients at the scene. This information will be updated to the receiving hospital(s) if not provided during the initial hospital notification. Working with the Triage/Treatment/Communications Supervisor, the ADS Coordinator shall determine which hospitals should expect to receive patients. The ADS Coordinator shall determine, based on the beds available from Washington County hospitals, if hospitals in Multnomah and Clackamas County s will be receiving patients. If hospitals designated to receive patients are in Multnomah or Clackamas County s or patients are to be entered into the trauma system, the Regional Hospital Coordinator, currently MRH shall be notified by the ADS Coordinator. The ADS Coordinator shall be responsible for coordinating hospital beds in Multnomah and Clackamas County s with MRH. The Triage/Treatment/Communications Supervisor shall notify the ADS Coordinator when an ambulance is loaded and ready for transport. The ADS Coordinator will determine the destination of the ambulance and notify the Triage/Treatment/Communications Supervisor. The Triage/Treatment/Communications Supervisor will notify the ADS Coordinator upon departure of the ambulance and will provide the ADS Coordinator with the number and types of injuries and the ETA of the ambulance to the hospital. The ADS Coordinator will be responsible for notifying the destination hospital of the ambulances ETA and the numbers and types of patients. 12

13 AMBULANCE DIVERSION SYSTEM WEST ZONE MANAGEMENT Zone Management is a process consisting of a series of steps. Rotation of patients to closed (red) hospitals is one step in the Zone Management process. West Zone Hospitals Providence St. Vincent Medical Center Legacy Meridian Park Hospital Tuality Community Hospital Tuality Forest Grove Hospital Zone Management will begin if there is one green hospital remaining in the West Zone. Step 1 (One Remaining Green Hospital in the West Zone) Metro West Ambulance Dispatch will call the Emergency Department Charge Nurse at each West Zone hospital and notify them that rotation of patients is pending and try to determine how much longer the hospital will be on divert. Step 2 (All Hospitals in the West Zone are Red) Metro West Ambulance Dispatch will call the Emergency Department Charge Nurse at each West Zone hospital and notify them that the West Zone is in Zone Management and rotation of patients has begun. Step 3 (All Hospitals in the West Zone are Red) Metro West Ambulance Dispatch will initiate a general broadcast on the Fire Dispatch channel that the West Zone is in Zone Management. The broadcast shall say, All units, Medic Control, Washington County is now in hospital zone management until further notice. American Medical Response Portland Dispatch and Regional Hospital will be notified by phone that the West Zone is in Active Zone Management. On the ADS screen the West Zone will be changed to blinking to indicate Zone Management. Step 4 (All Hospitals in the West Zone are Red) In Zone Management Metro West Ambulance will be responsible for rotating patients to West Zone Hospital in the following rotation: St. Vincent, Tuality-Hillsboro, Meridian Park, Forest Grove. Rotation to Forest Grove will be skipped every other cycle. This rotation will be for all patients transported by ambulance from any regional ambulance provider. A hospital s status will not be changed by Metro West Ambulance. All hospital will remain red until changed by a hospital. Step 5 (One or more hospitals returns to Green Status) Metro West Ambulance Dispatch will initiate a general broadcast on the Fire Dispatch channel that the West Zone is in no longer in Zone Management. The broadcast shall say, All units, Medic Control, Washington County is no longer in hospital zone management. American Medical Response Portland Dispatch and Regional Hospital will be notified by phone that the West Zone is no longer in Zone Management. On the ADS screen the West Zone will be changed from blinking to steady to indicate Zone Management has stopped. 13

14 AMBULANCE DISPATCH AND COORDINATION An emergency ambulance shall be dispatched according to the emergency medical dispatch cards approved by the EMS Office. Emergency means those medical or trauma conditions that manifests itself by symptoms of sufficient severity that a prudent lay person possessing an average knowledge of health and medicine would reasonably expect that failure to receive immediate medical attention would place the health of a person, or the fetus in the case of a pregnant woman, in serious jeopardy. An emergency condition also includes any condition specifically dealt with in the emergency medical dispatch system adopted by the Washington County or those conditions covered in (G) of EMS Ordinance. Washington County Code states: Transport any individual requiring or with a high probability of requiring before or during transport the services of an emergency ambulance. Among examples of this are: 1. Persons with devices which prevent the rider from being able to protect their airway in the event of vomiting, 2. Persons requiring on-going treatment during transport which includes riders with IV infusions or oxygen except those riders on chronic supplemental oxygen, or other condition delineated by rule. 3. Persons not previously using a wheelchair whom are otherwise unable to move to the vehicle unassisted, unless the transport is at the express direction of a physician, 4. Persons with decompensation cardiovascular, respiratory or central nervous systems, 5. Persons with major bleeding from trauma, 6. Persons having a suspected major abdominal injury, 7. Persons with severe pain, 8. Persons with evidence of spinal cord injury unless previously examined by a physician, 9. Any person with full thickness burns. PROCEDURE A. The Metro West Ambulance Communications Center shall coordinate emergency ambulance response to calls that fall within the EMD card system. This coordination shall include ambulances on a mutual-aid basis both into and out of Washington County. B. Metro West Ambulance shall retain the ability to reassess the triaging of EMS requests by WCCCA and when they feel appropriate modify the dispatch of an ambulance to include increasing or reducing the number of ambulance unit(s) responding and/or increasing or reducing the code response of the ambulance unit(s). C. Calls for ambulance service that fall within the emergency medical dispatch card system and not defined by rule as Inter-Facility shall be immediately transferred to Metro West Ambulance for service. 14

15 AMBULANCE COORDINATION DURING MAJOR EMERGENCIES When a major emergency is declared in Washington County, these guidelines will help guide the coordination of ambulances. Metro West Ambulance's Control Center shall be designated as the ambulance control center for Washington County. Metro West Ambulance's Control Center shall be responsible for the coordination of ambulance resources to medical requests. This shall include ambulance response into and out of the county as well as requests originating from within the county. Dispatch of ambulance resources shall be done according to the major emergency version of the Emergency Medical Dispatch (EMD) cards. Note: WCCCA may or may not continue triaging all requests for medical assistance using the EMD cards. If WCCCA discontinues triaging calls, Metro West Ambulance may be asked to take over that responsibility. COORDINATION OF AMBULANCE RESOURCES TO MEDICAL CALLS Patients shall be transported to the nearest emergency department. Exceptions to this are those patients requiring specialized medical care (burns, hyperbaric chamber, obstetrical emergencies.) The Washington County EMS Office shall suspend inter-facility transports until the lifting of the major emergency and/or authorization. TRAUMA ENTRIES Patients requiring trauma system entry shall be transported to the OHSU/Emanuel Hospital only if transportation routes allow. If highways are congested or blocked, trauma patients shall be transported to St. Vincent Hospital. Under the most extreme conditions, trauma patients may have to be taken to the nearest hospital. Patients must still be entered into the trauma system as normal by contacting the Trauma Communications Center (TCC) and providing them with the necessary patient information, including trauma band number. If the patient is diverted to a non-trauma facility TCC must be notified of the diversion as soon as possible. If a patient meets trauma system entry criteria but must be diverted to a non-trauma hospital, the State EMS Office s Trauma Division must be contacted immediately. Provided them with the patient s name, trauma band # and destination hospital. Ambulance units will not be sent "stand-bys" unless there is the highest possibility that injuries may occur. Stand-by for non-medical events (i.e. fires, downed power lines) shall occur only if the county ambulance level is above three. MAJOR EMERGENCY CHECKLIST 1. Confirm major emergency guideline activation at WCCCA on Fire dispatch channel or telephone. If activation of guidelines for ambulance coordination during major emergencies came from the Washington County EMS Office, notify WCCCA on fire dispatch channel. 2. Notify field units that they are now operating under Major Emergency Guidelines. If roadways into and out of Portland are congested or blocked, trauma entry patients shall be transported to St. Vincent Hospital. If transport to St. Vincent Hospital is not possible, patients shall be transported to the nearest hospital. 4. Notify Washington County hospitals, including Meridian Park Hospital that patients will be transported to the nearest hospital. 5. Contact St. Vincent Hospital Emergency Department and request they be prepared to receive trauma patients. 6. Notify Washington County EMS Office by telephone/pager of Major Emergency Guideline activation. 7. Notify Metro West Ambulance management personnel of major emergency guideline activation so they can: a. Provide additional dispatch personnel as needed. b. Staff additional ambulance units as needed or directed by EMS Office or company management or per Multiple Casualty Incident Plans. 8. Use Modified EMD Cards to establish priorities for ambulance response. Low Priority - Send ambulance only when County ambulance level is three (3) or above. Medium Priority - Send ambulance only when County ambulance level is two (2) or above. Priority - Send nearest ambulance immediately. 9. When operations under these Guidelines are terminated, notify: a. Field units that they can return to everyday activities. b. Washington County hospitals, including Meridian Park Hospital. c. Notify St. Vincent Hospital that they will no longer receive trauma patients. d. Washington County EMS Office, if activation came from WCCCA. e. WCCCA if activation came from Washington County EMS Office. f. Metro West Management. 15

16 MAJOR EMERGENCY CHECKLIST 1. Confirm major emergency guideline activation at WCCCA on Fire dispatch channel or telephone. If activation of guidelines for ambulance coordination during major emergencies came from the Washington County EMS Office, notify WCCCA on fire dispatch channel. 2. Notify field units that they are now operating under Major Emergency Guidelines. Tell them if roadways into and out of Portland are congested or blocked, trauma entry patients shall be transported to St. Vincent Hospital. If transport to St. Vincent Hospital is not possible, patients shall be transported to the nearest hospital. 4. Notify Washington County hospitals, including Meridian Park Hospital that patients will be transported to the nearest hospital. 5. Contact St. Vincent Hospital Emergency Department Duty Physician and ask them to prepare to accept trauma entry patients. 6. Notify Washington County Emergency Medical Services Office by telephone or pager of Major Emergency Guideline activation at WCCCA. 7. Notify Metro West Ambulance management personnel of major emergency guideline activation so they can: a. Provide additional dispatch personnel as needed. c. Staff additional ambulance units as needed or directed by EMS Office or company management or per Multiple Casualty Incident Plans. 9. Use Modified EMD Cards to establish priorities for ambulance response. Low Priority - Send ambulance only when County ambulance level is three (3) or above. Medium Priority - Send ambulance only when County ambulance level is two (2) or above. Priority - Send nearest ambulance immediately. 10. When operations under these Guidelines are terminated, notify: a. Field units that they can return to everyday activities. b. Washington County hospitals, including Meridian Park Hospital. c. Notify St. Vincent Hospital to deactivate as a back-up trauma center. d. Washington County EMS Office, if activation came from WCCCA. e. WCCCA if activation came from Washington County EMS Office. f. Metro West Management as appropriate. 16

17 EMERGENCY MEDICAL DISPATCH CARDS Complaint Determinant Major Emergency Response Abdominal Pain/Problem (Card 1) Allergies/Hives/Medication Reactions/Stings (Card 2) Animal Bites/Attacks (Card 3) Assault/Rape (Card 4) Back Pain (Card 5) Breathing Problems (Card 6) Alpha (A) Bravo (C) Charlie (D) Alpha (A) Bravo (B) Charlie (C) Delta (D) Echo (E) Alpha (A) Bravo (B) Delta (D) Alpha (A) Bravo (B) Delta (D) Alpha (A) Charlie (C) Delta (D) Charlie (C) Delta (D) Echo (E) Low Low Medium Low H igh Low Low Medium Alpha (A) Burns/Explosions (Card 7) Bravo (B) Charlie (C) Delta (D) Medium Alpha (A) Carbon Monoxide/ Inhalation/Hazardous Materials (Card 8) Bravo (B) Charlie (C) Delta (D) Low Omega Cardiac/Respiratory Arrest (Card 9) Bravo (B) Delta (D) Echo (E) 17

18 Chest Pain (Card 10) Alpha (A) Charlie (C) Delta (D) Low Choking (Card 11) Alpha (A) Delta (D) Echo (E) Convulsions/Seizures (Card 12) Alpha (A) Bravo (B) Charlie (C) Delta (D) Alpha (A) Diabetic Problems (Card 13) Charlie (C) Delta (D) Charlie (C) Delta (D) Drowning (Near)/Diving Problems Alpha (A) Low (Card 14) Bravo (B) Medium Electrocution (Card 15) Charlie (C) Delta (D) Echo (E) Low Eye Problems/Injuries (Card16) Alpha (A) Bravo (B) Delta (D) Falls/Back Injuries (Traumatic) (Card 17) Omega Alpha (A) Bravo (B) Delta (D) Low Headache (Card 18)) Alpha (A) Low Bravo (B) Charlie (C) Heart Problems (Card 19) Alpha (A) Bravo (B) Charlie (C) Delta (D) 18

19 Heat/Cold Exposure (Card 20) Hemorrhage/Lacerations (Card 21) Inaccessible Incident / Other Entrapments (Card 22) Alpha (A) Bravo (B) Charlie (C) Delta (D) Alpha (A) Bravo (B) Charlie (C) Delta (D) Alpha (A) Bravo (B) Delta (D) Low Medium Low Low Omega Overdose/Ingestion/Poisoning (Card 23) Pregnancy/Childbirth/Miscarriage (Card 24) Psychiatric/Suicide Attempts (Card 25) Sick Person (Specific Diagnosis) (Card 26) Stab/Gunshot Wound (Card 27) Stroke (Card 28) Bravo (B) Charlie (C) Delta (D) Omega (O) Alpha (A) Bravo (B) Charlie (C) Delta (D) Alpha (A) Bravo (B) Delta (D) Alpha (A) Bravo (B) Charlie (C) Delta (D) Alpha (A) Bravo (B) Delta (D) Alpha (A) Bravo (B) Charlie (C) Low Low Low Medium Low Medium Medium Medium 19

20 Traffic Accidents (Card 29) Traumatic Injuries (Specific) (Card 30) Unconscious/Fainting (Near) (Card 31) Unknown Problems (Card 32) Omega (O) Alpha (A) Bravo (B) Delta (D) Alpha (A) Bravo (B) Delta (D) Alpha (A) Charlie (C) Delta (D) Echo (E) Bravo (B) 32-B-1 32-B-2 Delta (D) Low Low Medium Low Low Medium Low Transfer / Interfacility / Palliative Care (Card 33) *Only applicable in WA CO. This card is only effective when a Registered Nurse or Doctor, is/has been in attendance with the patient in the last hour. And they take full responsibility for the care of the patient. Alpha (A) Charlie (C) Delta (D) Plus: Breathing not Verified Active Seizures Unconscious which is not normal for the patient Uncontrolled Bleeding Obstructed Airway Systolic Blood Pressure is less than 90 which is not normal for the patient Out of position requiring a Code 3 response greater than 15 minutes. Low 20

21 AMBULANCE RESPONSE TO STANDBY AND STAGING LOCATIONS Stage - Committed until released. Used when ambulance is asked to delay approach to patient until police arrive. Used in situations where a patient is suspected to be present. Standby - Not committed to the incident and available for emergency call. PROCEDURE A. All responses to stage/stand-by requests shall be code-1. B. Response to stage shall be code-1 if ambulance is to wait for the arrival of law enforcement, regardless of the code response dictated by the EMD cards. C. During the response to a stage/standby or while at the scene the ambulance unit shall be available for any code-3 call. If an ambulance is removed from a stand-by WCCCA shall be notified as soon as possible. Ambulance responses to high acuity incidents (stabbing/shooting/hanging) shall not be diverted. D. A replacement ambulance shall be sent to the stand-by as soon as possible. 21

22 AMBULANCE RESPONSE TO FIRE STAND-BYS Metro West Ambulance will assign an ambulance to all fire assignments in Washington County as long as the ambulance level is above two (2). Ambulances will not be sent to Task Force assignments. If the County ambulance level is two (2) or below an ambulance will be assigned to the box as soon as the level rises above two (2). Fire-Com will be immediately notified of any delay in the assignment or response of a stand-by ambulance and the estimated time for the delay. The ambulance will respond code-1 to the box assignment and will be available for redirection to code-3 calls. If the assigned ambulance is redirected to a code-3 call, the next nearest ambulance will be immediately assigned to the box as long as the County ambulance level is above level two (2). Fire-Com shall be immediately notified of the switching of any unit. Upon arrival at the fire, the ambulance shall position themselves to be available to respond to code-3 calls and shall notify Fire-Com and Command of their arrival. If the ambulance needs to leave for a code-3 call, Command and Fire-Com must be notified. Metro West Dispatch will assign a replacement ambulance as soon as possible and notify Fire-Com of any delay in the assignment or response. If the County ambulance level drops to one (1), any ambulances on stand-by at box assignments shall immediately be put back in to the ambulance status plan and assigned to the appropriate ambulance post. If an ambulance assigned to a box causes a depletion in ambulance resources and causes longs ambulance responses to other calls during the assignment, Metro West Ambulance may petition the County for response time exemptions for those long responses. 22

23 AMBULANCE STATUS NOTIFICATION To develop a procedure for the notification of WCCCA when Metro West Ambulance unit availability reaches two (2) or less. Ambulance units at hospitals shall be considered available for emergency response. This protocol shall not take the place of existing requirements that Metro West Ambulance Units notify WCCCA and fire users of their response to incidents and the location from where they are responding on the appropriate TAC channel. PROCEDURE When Metro West Ambulance s number of units available for emergency response reaches two (2), and in the estimation of Metro West dispatchers will remain at, or below two (2) for more than five (5) minutes, Metro West shall announce on the fire dispatch channel, Information to all units, Washington County ambulance level is at X. Upon rising above Level 3 announce that on the fire dispatch channel, Information to all units, Washington County ambulance level is at X. This notification shall take place only after the appropriate dispatching and coordination of ambulance units has been done. No delay in dispatching, coordination of response, movement of ambulance units to posting location(s) is expected. These take precedent over the requirements of this protocol. 23

24 AMBULANCE OPERATIONS SUPERVISOR The MWA Operations Supervisor has the option to respond to all ambulance calls. In general, they may respond to unusual incidents, critical calls, air ambulance activation, multiple patient scenes and mass casualty incidents. When a supervisor responds, WCCCA will be notified on the on the designated TAC channel. The Supervisor shall advise WCCCA if they are transport capable or not. The Supervisor's presence is to directly oversee ambulance operations within the scope of the incident command system and MPS/MCI Protocol. If responding as a non-transport unit, the Supervisor shall position their unit out of the flow of traffic as to not block other emergency vehicles. The Supervisor will report to Incident Command for assignment. If command does not have an assignment for the Supervisor, the Supervisor shall oversee ambulance operations to include the Transport and/or Communications Position. If responding as a transport capable unit, but transport of patient(s) is not anticipated the Supervisor shall position their unit out of the flow of traffic as to not block other emergency vehicles. The Supervisor will report to Incident Command for assignment. If command does not have an assignment for the Supervisor, the Supervisor shall oversee ambulance operations to include the Transport and/or Communications function. If responding as a transport capable unit and transport of patient(s) is anticipated the Supervisor will report to Incident Command/Medical Group for assignment. 24

25 EMERGENCY CALLS RECEIVED DIRECTLY BY AMBULANCE COMPANIES THIS PROTOCOL APPLIES TO ALL AMBULANCE PROVIDERS THAT ARE NOT DESIGNATED AS AN EMERGENCY AMBULANCE PROVIDER BY WASHINGTON COUNTY. Ambulance company dispatchers will be responsible for handling incoming calls for medical assistance made directly to them according to the EMD cards with immediate notification of WCCCA. When an ambulance company receives a request for medical assistance, the company shall use the EMD Card System to determine whether an emergency response is required. If the ambulance provider dispatcher is not emergency medical dispatch certified as required by these protocols, they shall immediately transfer the call to Metro West Ambulance. An emergency means a medical or trauma condition that manifests itself by symptoms of sufficient severity that a prudent lay person possessing an average knowledge of health and medicine would reasonably expect that failure to receive immediate medical attention would place the health of a person, or the fetus in the case of a pregnant woman, in serious jeopardy. An emergency condition also includes any condition specifically dealt with in the emergency medical dispatch system adopted by the Washington County or those conditions covered in (G) of EMS Ordinance. Washington County Code states: Transport of any individual requiring or with a high probability of requiring before or during transport the services of an emergency ambulance. Among examples of this are: 1. Persons with devices which prevent the rider from being able to protect their airway in the event of vomiting, 2. Persons requiring on-going treatment during transport which include riders with IV infusions or oxygen except those riders on chronic supplemental oxygen, or other condition delineated by rule. 3. Persons not previously using a wheelchair who are otherwise unable to move to the vehicle unassisted, unless the transport is at the express direction of a physician, 4. Persons with decompensation of cardiovascular, respiratory or central nervous systems, 5. Persons with major bleeding from trauma, 6. Persons having a suspected major abdominal injury, 7. Persons with severe pain, 8. Persons with evidence of spinal cord injury unless previously examined by a physician, 9. Any person with full thickness burns. NON-EMERGENCY RESPONSE Non-emergency means those medical or trauma conditions that are not specifically dealt with in the emergency medical dispatch system adopted by the County. The County by rule shall further delineate categories contained in the emergency medical dispatch system that may be handled by a nonemergency ambulance provider. Unless specified by rule, those conditions that fall within the emergency medical dispatch system shall immediately be transferred to the emergency ambulance providers designated by Washington County. Administrative Rule defines non-emergency to mean those medical conditions, that in the judgment of an individual certified or licensed at the emergency medical technician, registered nurse, physician assistant or physician level, are not expected to cause death, permanent disability or permanent harm within the next 24 hours and do not require a code-3 response as determined by the EMD card system. 25

26 If the response required by the EMD cards is code-3 or code-1 and the ambulance company dispatcher is EMD certified and the Ambulance Company is licensed to provide emergency ambulance service, the dispatcher shall complete the EMD process and dispatch an ambulance. As soon as possible WCCCA shall be notified of the location and the nature of the request as well as the telephone number of the person requesting aid and any other pertinent information received from the EMD process. EXCEPTION: Calls received directly from nursing homes and care facilities where there is a Registered Nurse in attendance of the patient, WCCCA does not need to be notified unless: 1. The patient s breathing status can not be verified. 2. The patient is in active seizures. 3. The patient is unconscious which is not normal for the patient. 4. The patient has uncontrolled bleeding. 5. The patient has an obstructed airway. 6. The patient s systolic blood pressure is less than 90mmHg, which is not normal for the patient. 7. The ambulance is out of position requiring a code 3 response greater than fifteen (15) minutes. If the response required is not covered in the EMD cards and the ambulance company dispatcher is EMD certified and the Ambulance Company is licensed to provide emergency and/or non-emergency ambulance service, the dispatcher shall complete the EMD process and dispatch an ambulance. If the ambulance company dispatcher taking the call is not EMD certified they shall transfer the call immediately to Metro West Ambulance. Requests for ambulance service that do not fall within the EMD cards system can be handled by any licensed ambulance provider. 26

27 EMERGENCY MEDICAL DISPATCH Emergency Medical Dispatch System The Medical Priority Dispatch System (MPDS ) and Association of Public Safety Communicators Officials (APCO) have been approved as the standard for dispatch of emergency medical calls for Washington County. These card systems shall be utilized on every medical call unless otherwise directed by EMS protocols. The Washington County Emergency Medical Services Office shall be responsible for setting the ambulance response levels. Equipment Response Equipment response shall be according to EMD card and according to the capabilities of the jurisdiction. Quality Assurance/Quality Improvement The EMS Office shall develop and implement a Quality Assurance/Quality Improvement (QA/QI) program. This QA/QI Program will review and monitor the application of the MPDS or APCO EMD Card system and assist with the training of emergency medical dispatchers. 27

28 EMERGENCY MEDICAL DISPATCH CARDS Version 11.2 Adopted: 02/01/06 Complaint Determinant Routine Response Abdominal Pain/Problem (Card 1) Alpha (A) Ambulance C-3 Bravo (C) Ambulance C-3 Charlie (D) Ambulance C-3 Alpha (A) Ambulance C-1 Allergies/Hives/Medication Reactions/Stings (Card 2) Bravo (B) Ambulance C-3 Charlie (C) Ambulance C-3 Delta (D) Ambulance C-3 Echo (E) Ambulance C-3 Alpha (A) 1 Ambulance C-1 Animal Bites/Attacks (Card 3) Alpha (A) 2-3 No Ambulance Bravo (B) Ambulance C-3 Delta (D) Ambulance C-3 (stage for police if animals uncontrolled) Assault/Rape (Card 4) Alpha (A) Bravo (B) Delta (D) Ambulance C-1 (Consider Staging for Police) Ambulance C-3 (Code 1 Stage for Police) Ambulance C-3 (Code 1 Stage for Police) Back Pain (Card 5) Breathing Problems (Card 6) Alpha (A) Ambulance C-1 Charlie (C) Ambulance C-3 Delta (D) Ambulance C-3 Charlie (C) Ambulance C-3 Delta (D) Ambulance C-3 Echo (E) Ambulance C-3 Alpha (A) 1 Ambulance C-1 Burns/Explosions (Card 7) Alpha (A) 2-3 No ambulance Bravo (B) Ambulance C-3 Charlie (C) Ambulance C-3 Delta (D) Ambulance C-3 Carbon Monoxide/Inhalation/Hazardous Materials (Card 8) Alpha (A) No Ambulance Bravo (B) Ambulance C-3 Charlie (C) Ambulance C-3 Delta (D) Ambulance C-3 28

29 Cardiac/Respiratory Arrest (Card 9) Omega Not authorized in Washington County Bravo (B) No Ambulance Delta (D) Ambulance C-3 Echo (E) Ambulance C-3 Chest Pain (Card 10) Choking (Card 11) Alpha (A) Ambulance C-1 Charlie (C) Ambulance C-3 Delta (D) Ambulance C-3 Alpha (A) No Ambulance Delta (D) Ambulance C-3 Echo (E) Ambulance C-3 Alpha (A) Ambulance C-3 Convulsions/Seizures (Card 12) Bravo (B) Ambulance C-3 Charlie (C) Ambulance C-3 Delta (D) Ambulance C-3 Diabetic Problems (Card 13) Alpha (A) Ambulance C-1 Charlie (C) Ambulance C-3 (Consider staging) Delta (D) Ambulance C-3 Charlie (C) Ambulance C-3 Delta (D) Ambulance C-3 Drowning (Near)/Diving Problems Alpha (A) Ambulance C-3 (Card 14) Bravo (B) Ambulance C-3 Electrocution (Card 15) Eye Problems/Injuries (Card16) Falls/Back Injuries (Traumatic) (Card 17) Charlie (C) Ambulance C-1 Delta (D) Ambulance C-3 Echo (E) Ambulance C-3 Alpha (A) No Ambulance Bravo (B) Ambulance C-3 Delta (D) Ambulance C-3 Omega No Ambulance Alpha (A) Ambulance C-1 Bravo (B) Ambulance C-3 Delta (D) Ambulance C-3 Headache (Card 18)) Alpha (A) Ambulance C-1 Bravo (B) Ambulance C-3 Charlie (C) Ambulance C-3 29