San Benito County Emergency Medical Services Agency Policy : 1120 Effective : May 1, 2010 Reviewed : May 1, 2010 NON-CONTRACT AMBULANCE AND CONVALESCENT TRANSPORT I. Purpose To ensure appropriate patient care and transportation by personnel who are duly authorized by San Benito County to provide medical transportation services but are not authorized to respond to emergency (9-1-1) calls. II. Definition A. Ambulance means any vehicle which is specially designed, constructed, modified or equipped for transporting sick, injured, infirm or otherwise incapacitated persons capable of supporting BLS or a higher level of care. B. Convalescent Transport means transport by a San Benito County authorized vehicle which is specially designed, constructed, modified or equipped for transporting patients who require wheelchairs or who cannot travel in an upright, sitting position and who in addition do not require medical care, assistance or monitoring during transport. C. Critical Care Transport or CCT means any transport of a patient by ambulance when the ambulance staff on board includes a physician, a registered nurse or other medical personnel authorized to provide a level of care that exceeds the paramedic scope of practice. D. EMS System Ambulance means an ambulance operating under San Benito County contract and authorized by San Benito County to respond to 9-1-1 emergency calls. E. Medical Care, Assistance or Monitoring means care, assistance or monitoring that requires any medical knowledge or skill. F. Non-Contract Ambulance means a BLS ambulance, an ALS ambulance or a Critical Care Transport unit operating in San Benito County but not authorized by San Benito County to respond to 9-1-1 emergency calls. Page 1 of 5
III. Patient Triage A. Policy: No medical transport service shall accept for transport any patient who requires a higher level of care than the transport service is capable of providing. If there is any doubt that the patient s condition allows safe transport at the available level of care (convalescent transport, BLS, ALS or CCT), then the patient must be transported at the appropriate higher level of care. 1. Convalescent transport services shall not accept patients: a. who require medical care, assistance or monitoring during the transport; or b. who require restraints; or c. who have intravenous (IV) lines, nasogastric (NG) tubes, gastrostomy tubes, heparin locks, foley catheters, tracheostomy tues or indwelling vascular access lines. 2. BLS ambulance services shall not accept patients: a. who have or appear to have life-threatening conditions; or b. who require or may be reasonably expected to require ALS assessment, monitoring or intervention during transport; or c. who would, under San Benito County Field Treatment Protocols, receive cardiac monitoring, prophylactic IV lines or any other ALS intervention. B. Telephone Triage: Determination as to the appropriate level of transport should be made, if possible, at the time service is requested and before a medical transport unit responds. 1. All callers requesting medical transportation shall be asked to provide enough information to answer the following questions: a. Is this a perceived emergency? Does anyone involved (patient, caller or call taker) consider it an emergency? b. Is this a request for immediate ambulance service? c. Is the patient experiencing unusual difficulty in breathing? Page 2 of 5
d. Is there a change in the patient s usual level of consciousness? e. Is the patient bleeding significantly? f. Is the patient experiencing unusual pain, numbness or tingling? 2. If any of the above questions is answered in the affirmative, or the answer cannot be determined, then the request for medical transportation must immediately be referred to 9-1-1 for emergency response unless the caller is the patient s private physician. In that case the medical transport service need not refer the request if it can provide medically appropriate care and transport. C. On-Scene Triage: 1. Upon initial patient contact, the medical transport crew shall promptly assess the patient to determine whether it can provide medically appropriate care and transport. 2. The ultimate responsibility for assessing and accepting a patient rests with the most medically qualified member of the transport crew; telephone triage is merely the first step in the medical screening process. No one may require the medical transport crew to accept any patient in violation of this policy. 3. Responding non-contract ambulance or convalescent transport personnel should call for a 9-1-1 emergency response whenever it may be necessary before or during transport. IV. Vehicle Accidents The primary responsibility for emergency response to and patient transport from vehicle accidents rests with the EMS System emergency ambulance service provider. A. Reported Accidents: A non-contract ambulance or convalescent transport service receiving an emergency call from a private person requesting an ambulance at the scene of a motor vehicle accident shall immediately notify the San Benito County Communications Center to initiate the appropriate emergency response. The noncontract ambulance or convalescent transport service shall not respond to such calls. B. Witnessed Accidents: If an accident is witnessed by a non-contract ambulance or convalescent transport crew, the crew shall immediately report the accident to the San Benito County Communications Center. Page 3 of 5
V. Documentation 1. If no law enforcement, fire or EMS System ambulance personnel are on scene: a. Stop to assess the situation and ascertain if there are any injuries. b. Contact County Communications on the radio, via 9-1-1 or through the company dispatch to request appropriate emergency response. c. If there are injuries, render appropriate patient care in accordance with San Benito County EMS Policies and Procedures until patient care can be transferred to EMS System ambulance personnel. 2. If law enforcement or fire personnel are on scene without an EMS System ambulance, stop and ask the Incident Commander if your assistance is required. 3. Make clear that you have happened upon the accident and have not been dispatched. A. PCR Completion: Non-contract ambulance and convalescent transport personnel shall complete a San Benito County Prehospital Care Record (PCR) for every patient contact, whether or not a transport results. B. Distribution: Copies of each completed PCR will be distributed and transmitted to the San Benito County EMS Agency. 1. If the patient was transported to Hazel Hawkins Memorial Hospital, the EMS Agency copy remains at the hospital and is forwarded to the EMS Agency on a monthly basis. 2. If the patient was not transported to Hazel Hawkins Memorial Hospital, the EMS Agency copy is to remain with the transporting agency and then sent to the EMS Agency on a monthly basis. 3. Copies of any specific PCR will be provided to the San Benito County EMS Agency promptly upon request. VI. Record Keeping A. Tape Recordings: 1. Non-contract ambulance and convalescent transport service providers shall tape record all telephone and radio calls for service. 2. Such tape recordings shall be kept for at least ninety days. Page 4 of 5
B. Written Requests: Copies of any written requests for service shall be kept for at least one year. C. PCRs: Copies of all completed PCRs shall be kept for at least one year. D. Inspection: Any of the above records shall be subject to inspection by the San Benito County EMS Medical Director or his/her designee, upon request with at least one working days notice. VII. Quality Assurance / Quality Improvement A. Written Plan: 1. Each non-contract ambulance and convalescent transport service provider shall have a written Quality Improvement Plan approved by the San Benito County EMS Agency. 2. The provider shall keep a current copy of its Quality Improvement Plan on file with the EMS Agency at all times. 3. The EMS Agency will, upon request, assist providers in the development of such plans. B. Quality Improvement Coordinator: Each non-contract ambulance and convalescent transport service providers shall designate a qualified employee to serve as its Quality Improvement Coordinator. 1. The provider shall keep this individual s name and telephone number on file with the EMS Agency. 2. The designated Quality Improvement Coordinator shall act as liaison with the EMS Agency and other EMS System participants. C. Policy Manual: Each non-contract ambulance and convalescent transport service provider shall keep a current copy of its policy manual on file with the EMS Agency at all times. Page 5 of 5