EMS System for Metropolitan Oklahoma City and Tulsa 2019 Medical Control Board Treatment Protocols

Transcription

1 PROTOCOL 17A: Adult General Medical s Adult General Medical s Four (4) Levels of General Medical s Priority I and II Priority III No Will time and distance to the hospital of choice be detrimental to the patient s condition? Level I, Level II or III General Medical patient s choice Yes ü Hillcrest South Ø (Transported to SFH or HHS if S. of 41 st Street & SE of I-44, by hospital rotation) ü OSUMC Ø (Transported to SJMC, HMC or OSUMC if N. of 41 st Street & NW of I-44, by hospital rotation) ü closest appropriate Level I or Level II General Medical, (whichever is closer) Level I, Level II, III, or IV General Medical patient s choice ü Saint Francis South ü Hillcrest South Ø (Transported to SFH, SFS or HHS if S. of 41 st Street & SE of I-44, by hospital rotation) ü OSUMC Ø (Transported to SJMC, HMC or OSUMC if N. of 41 st Street & NW of I-44, by hospital rotation) ü closest appropriate Level I or Level II General Medical, (whichever is closer) At the discretion of the paramedic Level IV General Medical s may receive assigned Priority General Medical s closest appropriate Level 1 or Level II General Medical Pre Triage Criteria Priority I Adult General Medical ü s condition reuires immediate intervention by physician and nursing personnel upon arrival at the Emergency Department Ø Critical Medical Problems with unstable vitals signs Ø with unstable vital signs and / or reuiring critical procedures to save life Ø with time sensitive conditions Priority II Adult General Medical ü s condition reuires emergent medical intervention by physician and nursing personnel upon arrival at the Emergency Department. Priority II patients have potential time sensitive problems, are currently stable but at risk for sudden deterioration Ø Acute Medical Problems with stable vital signs Priority III Adult General Medical ü without acute medical problems i.e., no immediate life / organ threatening emergency General Medical s Level I and II General Medical s Emergency Medical Services and Operative Procedures Organized Emergency Department Physician/Nursing Staff with specialties in emergency care on-site 24 General Surgery/Anesthesiology Services on-site or on-call 24 Additional clinical services/specialties promptly available ü Nuclear diagnostic imaging ü Endocrinology ü Hematology ü Oncology Level III General Medical s Emergency Medical Services and Operative Procedures Organized Emergency Department Physician/Nursing Staff with specialties in emergency care on-site 24 General Surgery/Anesthesiology Services on-site or on-call Level IV General Medical s Emergency Medical Services twenty-four (24) with at least: 17A.1

2 PROTOCOL 17A: Adult s Adult s ST Elevation Myocardial Infarction s Three (3) Levels of s with STEMI Time and Distance to patient s hospital of choice detrimental to clinical condition? with STEMI Priority 2 Level I, II, III of choice Priority 2 closest Level I, II s Level I s (PCI-Capable ) Emergency Medical Services and Operative Procedures Physician/Nursing Staff trained in cardiac care 24 Capability of providing ü Immediate diagnostic angiography ü Reperfustion therapy by thrombolysis ü Percutaneous coronary intervention ü Coronary artery bypass graft ü Capabilities of receiving 12 lead prehospital ECG No Transport to Level I choice Yes Transport to closest Level 1 Level II s (Non- PCI ) Emergency Medical Services with an organized Emergency Department Physician/Nursing Staff trained in cardiac care 24 Capability of providing ü Reperfusion therapy by thrombolysis Level III (Non-PCI ) Emergency Medical Services twenty-four (24) hours a day with at least: Level III s may ONLY receive: ü Priority II cardiac patients Definition of Adult Priority I Adult Examples: ü Unstable Angina ü Acute myocardial infarction / STEMI ü Any complex of signs and symptoms consistent with acute coronary syndrome and cardiac decompensation, i.e., pulmonary edema, symptomatic cardiac dysrhythmia Priority II Adult Example: ü Cardiac patients with pre-existing condition reuiring evaluation only 17A.2

3 PROTOCOL 17A: Adult Stroke s Adult Stroke s Three (3) Levels of Stroke s Stroke (Onset of Symptoms of Stroke within 3 Hours) Time and Distance to patient s hospital of choice detrimental to clinical condition? No Level I, II,III Stroke of patient s choice. Yes closest Level I, II Stroke Stroke (Onset of Symptoms of Stroke within 3 hours) Priority 2 / Stroke s (Onset of Symptoms of Stroke > 3 / 6 hours) Closest Level I Stroke Priority 3 / Stroke s (Onset of Symptoms of Stroke > 6 hours or time indeterminate) Level I, II,III Stroke of patient s choice if assigned or closest Level I, II, III, Stroke if patient unassigned Stroke s Level I Stroke s Physician / Nursing Staff trained in neurologic care on-site 24 Organized Emergency Department with written pathway for rapid identification and management of acute stroke patient CT of the head with technician on site 24 hours a day Clinical Laboratory Services 24 / 7 Stroke Call ü Capabilities for IV / tpa therapy for eligible patients 24 / 7 Endovascular Call ü Capabilities for endovascular therapy for eligible patients 24 / 7 Neurosurgery Call or availability within 2 hours Neuro-Intensive Care Unit Stroke Registry and Quality Improvement Process Level II Stroke s Physician / Nursing Staff trained in neurologic care on-site 24 Organized Emergency Department with written pathway for rapid identification and management of acute stroke patient CT of the head with technician on site 24 hours a day Clinical Laboratory Services 24 / 7 Stroke Call ü Capabilities for IV / tpa therapy for eligible patients Stroke Registry and Quality Improvement Process Definition of Adult Stroke Priority I Adult Stroke ü Examples: with acute stroke symptoms (within two hours of onset) with abnormal Los Angeles Prehospital Stroke Screen Priority II Adult Stroke ü Examples: with acute stroke symptoms > three (3) hours of onset but 6 hours with abnormal Los Angeles Prehospital Stroke Screen Priority III Adult Stroke ü Examples: with acute stroke symptoms > 6 hours of onset or time indeterminate with abnormal Los Angeles Prehospital Stroke Screen Level III Stroke s Emergency Department 24 ü Physician or physician extender and nursing staff trained in neurological care on site 24 CT of the head with technician on site 24 hours a day Clinical Laboratory Services Telestroke Video Conferencing Capabilities ü Video-Conferencing: evaluation over the internet/high-speed telephone line by stroke neurologist 24 / 7 Stroke Call ü Capabilities for IV / tpa therapy for eligible patients Transfer agreement established in advance to ensure orderly transition from Level III Stroke to specialized stroke care facility Level IV Non Stroke s No organized treatment for acute stroke 17A.3

4 PROTOCOL 17A: Adult Trauma s Adult Trauma s Four (4) Levels of Trauma s Priority I Trauma / Adult Priority II Trauma / Adult P - I Trauma / Adult Saint Francis ü located south of 41 st Street and southeast of I-44 St. John Medical ü located north of 41 st Street and northwest of I-44 OU Medical OU Medical Isolated P-1 neurologically-injured patients(unstable) P- II Trauma / Adult IF patient located SOUTH of 41 st Street and SE of I 44 then transport assigned patient* to either: ü *Saint Francis ü Hillcrest South P II Trauma / Adult ü Rotation within zone * P-II Hand injuries: transport to Saint Francis. P- II Trauma / Adult * patients go to Level III Trauma of choice patients go to closest Level III Trauma or Designated On-Call if Isolated Hand, Face, Neurosurgery and currently stable Priority III Trauma / Adult s Choice Pre Triage Criteria ü Rotation within zone ü Closest Trauma / Adult ü s with high energy blunt or penetrating trauma with physiologic or anatomic abnormalities Priority 2 Trauma / Adult ü s who are involved in a high energy event with risk for severe injury despite stable or normal vital signs with no altered mentation or respiratory distress or patients with a single system injury ü Select & Isolated hand injuries (Refer to I.1 Section 1) Priority 3 Trauma / Adult ü s without physiologic instability, altered mentation, neurological deficit, or significant anatomical or single system injuries and generally have been involved in low energy mechanism of injury incident. P- II Trauma / Adult IF patient located NORTH of 41 st Street and NW of I 44 then transport assigned patient* to either: ü *St. John Medical ü *OSUMC P II Trauma / Adult ü Rotation within zone * P-II Hand injuries: transport to St. John or OSUMC *At the discretion of the paramedic ASSIGNED P II Adult Trauma patients may be transported to their hospital of choice, regardless of their location, as long as the time and distance is NOT detrimental to the patient s clinical condition AND the patient has been fully educated to the trauma system design yet still makes an informed decision to be taken to their hospital of choice Trauma and Emergency Operative s Level I / Level II Trauma s Emergency Medical Services with organized trauma services Physician/Nursing Staff with specialties in trauma care available 24 All Priority I Trauma s should be transported to these facilities Level III Trauma s Emergency Medical Services with organized trauma services Physician/Nursing Staff with some specialties in trauma care available 24 Level III Trauma s are intended to receive patients at risk for severe injury with normal, stable vital signs or patients with single system injuries Level III Trauma s may receive Priority I Trauma s if the Level I or Level II Trauma s are on trauma services divert Level IV Trauma s Emergency Medical Services twenty-four (24) with at least: ü Level IV Trauma s may receive adult/pediatric patients without physiologic instability, altered mentation, neurologic deficit or significant anatomical injuries and have also not been involved in a significant mechanism of injury incident 17A.4

5 PROTOCOL 17A: Pediatric General Medical s Pediatric General Medical s Four (4) Levels of Pediatric General Medical s Priority I Priority II Priority III ü Saint Francis ü The Children s or Integris Baptist Medical (whichever is closer) s that reuire immediate control of the airway where paramedic attempts have failed to maintain the airway with either ETT or BVM should be transported to closest Level I or II General Medical Pre Triage Criteria Priority I General Medical / Pediatric ü Children (age 16 years) ü s condition reuires immediate intervention by physician and nursing personnel upon arrival at the Emergency Department, i.e.: Ø Cardiac / Respiratory arrest Ø Signs / symptoms of shock Ø Status epilepticus Ø Poisoning / Overdose Priority II Pediatric General Medical ü Children (age 16 years) ü s condition reuires emergent medical intervention by physician and nursing personnel upon arrival at the Emergency Department. ü Priority II patients have potential time sensitive problems, are currently stable but at risk for sudden deterioration Priority III General Medical / Pediatric ü Children (age 16 years) ü without acute medical problems i.e., no immediate life / organ threatening emergency ü Saint Francis ü St. John Medical ü Hillcrest Medical ü The Children s ü Integris Baptist Medical Ø (Transported to SFH if South of 41 st Street & SE of I-44) ü St. John Medical ü Hillcrest Medical Ø (Transported to SJMC or HMC if North of 41 st Street & NW of I- 44, as designated by rotation) ü The Children s Hopsital ü Integris Baptist Medical Ø (Whichever is closer) or facility of patient s choice (may be non-categorized) ü If time and distance detrimental to patient s condition, transport to closest appropriate categorized pediatric or medical hospital Pediatric General Medical s Level I Pediatric General Medical s Emergency Pediatric Medicine Organized Emergency / Pediatric Department Additional Services ü Pediatric Critical Care Services with dedicated pediatric intensive care unit (PICU) ü General Surgery/Anesthesiology Services on-site or on-call 24 Level II Pediatric General Medical s Emergency Pediatric Medicine Organized Emergency / Pediatric Department Physician / Nursing Staff with special capability in pediatric emergency medicine shall be on-site or on call 24 Additional Services ü General Surgery/Anesthesiology Services on-site or on-call 24 ü Pediatric neurosurgery ü Pediatric orthopedics Level III Pediatric General Medical s Emergency Pediatric Medicine Organized Emergency Department Physician / Nursing Staff with special capability in pediatric emergency medicine shall be on-site or on call 24 Additional Services ü General Surgery/Anesthesiology Services on-site or on-call 24 ü Basic facilities for management of minor pediatric inpatient problems Level IV Pediatric General Medical s Emergency Pediatric Medicine twenty-four (24) with at least: ü designated by Rotation ü Closest categorized hospital 17A.5

6 P PROTOCOL 17A: Pediatric Trauma s Pediatric Trauma s ( 16 years of age) Priority I Trauma / Pediatric Priority II Trauma / Pediatric Saint Francis OU Medical If the patient reuires immediate airway management and paramedic attempts have failed to maintain the airway with ETT or BVM, the patient should be transported to closest Level II or III Trauma P- II Trauma / Pediatric Saint Francis ü Whenever possible, transport injured adult and pediatric members of the same family to the same hospital. P- II Trauma / Pediatric The Children s OU Medical ü Whenever possible, transport injured adult and pediatric members of the same family to the same hospital. Priority III Trauma / Pediatric s Choice ü Rotation within zone ü Closest 17A.6

7 P PROTOCOL 17A: Neonatal Medical s Neonatal s ( 30 days) Level I (Unstable) Level II (Stable) ü Integris Baptist Medical ü The Children s ü Mercy ü Saint Francis South ü St. John Owasso ü Integris Baptist Medical ü Integris Canadian Valley ü Mercy ü The Children s ü St. Anthony s Neonatal Priority Determination Priority I - Unstable Cardiac or respiratory arrest Less than 35 weeks gestation at time of birth(estimated) APGAR 5 at 5 minutes SpO2 less than 90% on oxygen Diagnosed genetic disorders Priority II - Stable 35 weeks or later gestation at time of birth (estimated) APGAR > 5 at 5 minutes No immediate life threat identified 17A.7