Nassau Regional EMS Council Advanced Life Support Policy Procedure - Protocol Manual Section I Policies - Table of Contents

Transcription

1 Nassau Regional EMS Council Advanced Life Support Policy Procedure - Protocol Manual Section I Policies - Table of Contents Approved/ Revised Effective Introduction I.A 2/06/2008 3/01/2008 Medical Authority at the Scene I.B 8/03/2016 8/03/2016 Medical Control / Direction I.B-1 4/15/2015 5/01/2015 Medical Operations Center I.B-2 4/05/2017 4/05/2017 Ambulance Capacity I.C 4/02/97 4/02/1997 Trauma Notification I. D 6/01/2016 6/15/2016 Drug and Equipment Exchange List I.E 6/03/15 7/01/2015 Agency Medical Director I.F 6/03/2015 7/01/2015 Agency Medical Director Credentialing I.F-1 2/26/14 4/01/2014 On-Line Medical Control (OLMC) Physician Credentialing I.G 8/03/2016 8/03/2016 EMS Field Physician I.G-1 8/03/2016 8/03/2016 Patient Transfer Guidelines I.H 6/04/14 7/01/2014 Decision Not to Initiate C.P.R. I.J 2/06/08 3/01/2008 Paramedic Skills Use I.K 10/01/08 11/01/2008 BLS 12-Lead ECG Acquisition & Transmission I.M 4/05/2017 4/05/2017 Syringe Epinephrine for Basic EMTs I.N 8/02/2017 9/01/2017 Expired Agency Operating Certificate I.O 6/01/2016 6/15/2016 Pediatric Trauma Deferral I.P 4/04/2018 5/01/2108 Suspected Opiate Overdose Reporting I.Q 4/04/2018 5/01/2018 Medical Control 500MHZ Radio Frequency I.R 6/03/2015 6/03/2015 Protocol Utilization I.T 2/26/14 4/01/2014 Hazardous Materials Treatment Teams I.Z 4/07/04 12/01/2004 * = Recent Addition

2 Policies Introduction Policy I.A Reviewed: 8/08/2007 Approved: 2/6/2008 Effective: 3/01/2008 The Nassau Regional Emergency Medical Service s Advanced Life Support Protocols and Procedures have been approved by both the Nassau Regional Medical Advisory Committee and the Nassau Regional Emergency Medical Services Council Inc. They are to be used as a guide and a reference for all EMS personnel in their delivery of care. They represent both the standard New York State D.O.H. course curricula and current research and thinking in Emergency Medicine. BLS providers are to use the New York State BLS Protocols which have been adopted by the Nassau Regional Medical Advisory Committee (REMAC). The EMS provider is an extension of the physician and these policies are an integral part of the EMS system. Although much time and effort went into the development of these protocols, policies, and procedures, situations may arise which are not covered in this manual, when such a conflict or question arises, Medical Control is to be used as a resource. In the event of communication failure, standing orders should be combined with the providers training and judgment to deliver care which is both appropriate and within the scope of the providers training and certification. Medical Control physicians have the discretion to order medication or dosages other than those indicated in Medical Control Options. The protocols and policies apply to all EMS personnel providing care within the Nassau Regional EMS System.

3 Policies Medical Authority at the Scene I.B Reviewed: 6/27/2016 Approved: 8/03/2016 Effective: 8/03/2016 The EMS provider at the scene with the highest level of New York State EMS certification is responsible for patient care. This does not relieve the BLS provider from providing appropriate BLS care when an ALS provider is present. In accordance with New York State guidelines and Nassau Policy l.h, an ALS provider may turn patient care over to a BLS provider if he or she deems that no ALS care is needed. In the event that a New York State licensed physician (MD or DO) wishes to assume responsibility for patient care at the scene they must first establish their identity by presenting one of the following: Medical society card Professional organization membership card New York State Identification card Once the physician's identity is established, the ALS technician must contact medical control for approval of the physician. However, the ALS technician must limit his/her procedures those contained in the protocol and procedure manual. At this point the physician must agree to accompany the patient IN THE AMBULANCE to the hospital. Once the physician assumes control, the physician's requests concerning medical care and transport should be followed as long as they do not conflict with standard policies and procedures. If a conflict arises, the ALS technician must contact control and carry out the directions of the medical control physician. Nassau REMAC credentialed EMS Field physician can provide on-scene medical control and transfer patient care, as appropriate, to the on-line medical control physician and are then not required to accompany the patient to the hospital. If the on scene physician is the patient's attending and cannot accompany the patient to the hospital, subsequent care will be carried out by the ALS technician in conjunction with the medical control physician, following the applicable EMS protocol(s). If a procedure has been initiated that is not within the ALS technician s scope of practice, the medical control physician will assume the responsibility for continuing or discontinuing this therapy. If the ALS technician is unable to contact medical control, he/she may follow the direction from the onscene physician provided he/she has properly identified the physician and the physician is willing to accompany the patient in the ambulance to the hospital. The ALS technician must confine his/her procedures to those allowed by the current Nassau Regional EMS protocols. In all cases of on-scene physician intervention, the ALS technician must document the physician's name and address (and license number, if available or in the case of an EMS Field Physician their ID number) in the comment section of the PCR.

4 Policies Medical Control / Direction I.B-1 Reviewed: 3/30/2015 Revised: 4/15/2015 Effective: 5/1/2015 Medical Control is defined by New York State law as advice and direction provided by a physician or under the direction of a physician to certified first responders, emergency medical technicians, or advanced emergency medical technicians who are providing medical care at the scene of an emergency or en route to a health care facility. Medical control may be contacted at any time, however when following ALS standing orders, they must be contacted within twenty (20) minutes of patient contact, except as indicated below. Medical Control/Operations must be notified for all: Serious Trauma Cardiac Arrest MCI Potential Hazmat BLS Poisoning Burns Multiple patient incident Medical control may be contacted as a resource when questions arise as to proper patient care or transport. Hospital notifications, via MedCon, on BLS transports shall be made in the above circumstances and any BLS administration of medications. ALS When the EMT-CC or EMT-P initiates any ALS protocol or procedure, other than routine IV access and/or ECG monitoring, contact with medical control must be made. This contact should be made as soon as possible but should not delay appropriate patient care under standing orders. In the event of communication failure, the EMT-CC or EMT-P will be limited to the standing orders in the applicable protocol being followed. Once medical control is contacted, standing orders are no longer applicable and the Medical Control physician is responsible for treatment options. After contact with medical control, if the patient s condition changes, the appropriate standing orders for the new presenting condition may be used until medical control is re-contacted. Discretionary Decision Where there is no existing protocol and a clear need for Advanced Life Support exists, the EMT-CC or EMT-P must contact the Medical Control physician who may order the most appropriate treatment within the AEMT's scope of practice; in this case ALL orders must be read back and confirmed with the physician.

5 Policy Medical Operations Center I. B-2 Reviewed: 3/27/2017 Approved: 4/5/2017 Effective: 4/5/2017 Definition: The Medical Operations Center (MOC) of Nassau County Medical Control is the location that receives radio & telephonic communications from pre-hospital ambulances providing service to the public in Nassau County and transporting patients to a hospital or operating at the scene of a critical patient, MCI, trauma or Hazmat. The Medical Operations shall encompass Nassau County Regional EMS Agencies receiving or responding to emergency requests from a PSAP (Public Safety Answering Point). The center will receive and or initiate communications from/to Nassau hospitals regarding their operational status as it affects EMS operations and inform them of ambulances proceeding to their facilities. The MOC, in turn, will notify ambulances of any condition at their intended destination that would affect the ambulance (e.g. ambulance deferral/redirection, long delays, etc.). Presently, Nassau Regional MOC shall be located at the Nassau University Medical Center, East Meadow, NY, and staffed and operated by members of the Nassau County Police Department Emergency Ambulance Bureau s Nassau County Medical Control. Ambulances that are actively receiving Medical Control/Direction (Policy I.B) from Nassau Medical Control will be considered to be in contact with the Medical Operations Center. Destination Notification: All EMS agencies operating in Nassau (BLS or ALS), when transporting patients indicated below, to an appropriate hospital shall provide a notification to the receiving facility, through the Nassau Medical Operations Center: Critical Trauma patient Utilize REMSCo Trauma Worksheet (T-1) Critical Medical patient Hazmat MCI Stroke with known Last Known Well Time Utilize Stroke Worksheet (S-1) Only change was the addition of Stroke notification.

6 NASSAU REGIONAL E.M.S. STROKE WORKSHEET NASSAU REGIONAL E.M.S. STROKE WORKSHEET Date: Time: Date: Time: Stroke Notification Made: YES NO Hospital: ETA: Age: Sex: Male Female C-BOLT Cincinnati Stroke Scale findings: Blood Glucose results: Other pertinent clinical findings: Last Known Well (LKW): Time of Symptom Onset: VITAL SIGNS BP: / Pulse: Resp: Stroke Notification Made: YES NO Hospital: ETA: Age: Sex: Male Female C-BOLT Cincinnati Stroke Scale findings: Blood Glucose results: Other pertinent clinical findings: Last Known Well (LKW): Time of Symptom Onset: VITAL SIGNS BP: / Pulse: Resp: * Communicate this information to Nassau Medical Operations Center * REMSCo form S-1 * Communicate this information to Nassau Medical Operations Center * REMSCo form S-1 NASSAU REGIONAL E.M.S. STROKE WORKSHEET NASSAU REGIONAL E.M.S. STROKE WORKSHEET Date: Time: Date: Time: Stroke Notification Made: YES NO Hospital: ETA: Age: Sex: Male Female C-BOLT Cincinnati Stroke Scale findings: Blood Glucose results: Other pertinent clinical findings: Last Known Well (LKW): Time of Symptom Onset: VITAL SIGNS BP: / Pulse: Resp: Stroke Notification Made: YES NO Hospital: ETA: Age: Sex: Male Female C-BOLT Cincinnati Stroke Scale findings: Blood Glucose results: Other pertinent clinical findings: Last Known Well (LKW): Time of Symptom Onset: VITAL SIGNS BP: / Pulse: Resp: * Communicate this information to Nassau Medical Operations Center * REMSCo form S-1 * Communicate this information to Nassau Medical Operations Center * REMSCo form S-1

7 NASSAU REGIONAL E.M.S. TRAUMA WORKSHEET NASSAU REGIONAL E.M.S. TRAUMA WORKSHEET Date: Time: Date: Time: Trauma Team Requested: YES NO Hospital: ETA: Age: Sex: Male Female Mechanism of Injury: Trauma Team Requested: YES NO Hospital: ETA: Age: Sex: Male Female Mechanism of Injury: Extrication Required: Yes No Time: Extrication Required: Yes No Time: VITAL SIGNS VITAL SIGNS BP: / BP: / Pulse: Pulse: Resp: Resp: LOC: LOC: Pupils: Pupils: Intubated / BVM: Intubated / BVM: IV: IV: INJURIES INJURIES NASSAU REGIONAL E.M.S. TRAUMA WORKSHEET NASSAU REGIONAL E.M.S. TRAUMA WORKSHEET Date: Time: Date: Time: Trauma Team Requested: YES NO Hospital: ETA: Age: Sex: Male Female Mechanism of Injury: Trauma Team Requested: YES NO Hospital: ETA: Age: Sex: Male Female Mechanism of Injury: Extrication Required: Yes No Time: Extrication Required: Yes No Time: VITAL SIGNS VITAL SIGNS BP: / BP: / Pulse: Pulse: Resp: Resp: LOC: LOC: Pupils: Pupils: Intubated / BVM: Intubated / BVM: IV: IV: INJURIES INJURIES

8 Policies Ambulance Capacity I.C Reviewed: 8/08/2007 Approved: 4/02/97 Effective: 4/02/97 The following should be used as a guideline when confronted with a situation where there is multiple aided requiring transport. The guideline is intended to enhance the EMS technician s decision making process and does not replace the judgment of the technician responsible for transportation decisions. The number of aided to be transported in each ambulance is a decision that should be made by the highest medical authority at the scene. The decision is a judgment of risk and benefit to each patient s outcome. Considerations: The following issues are unique to each situation and should be taken into account when making the final transport decision: Type of patients: severity, need for specialty care (trauma, pediatric) relationships (supportive or hostile), medical considerations such as physical or emotional disabilities, need for privacy and infection disease risk. Type of Crew (ALS, BLS, gender) Response time for additional ambulances Transport times to receiving hospitals Unusual circumstances: weather, equipment failure at receiving hospitals etc. Medical Control Physician consultation In general, patients requiring ALS care should not be transported with another patient unless extenuating circumstances exist. An EMS technician may decide that there is a need to transport more than one patient in a single ambulance. When this is the case, every effort should be made to assign a technician to each patient in the ambulance. The level of care (ALS, BLS) should always match or be greater than the patient s needs.

9 Policy Trauma Notification I. D Reviewed: 5/02/2016 Approved: 6/01/2016 Effective: 6/15/2016 See State BLS Protocol T-6 & T-7 Background - These standards are more stringent and require enhanced coordination with EMS agencies upon transport of a trauma patient. Purpose - To provide a standardized policy for prehospital care providers to notify, communicate with trauma receiving facilities and properly hand off the patient to the receiving facility. Pre-notification is paramount for the system to work. Notification: 1. All hospital notifications for trauma patients MUST be sent through the medical operations center. 2. These can be made via the radio systems or by phone if unable to contact via radio. Use plain language, do not use jargon or codes. 3. The only trauma communication term in our region will be: Trauma Notification - advisory through Medical Control (MedCon) / Medical Operations (MedOps) to the receiving trauma center of the transportation of a trauma designated patient to their facility. Notifications will follow the regional trauma information format used by MedCon/ MedOps (REMSCo form T-1). 4. Each trauma receiving facility in our region has their own internal trauma team activation procedures. 5. This does NOT preclude prehospital personnel from requesting a trauma team activation if they believe the patient warrants it. The trauma receiving hospitals encourage the request. Hand Off 1. Upon moving the patient into the designated trauma room, the ED or trauma team leader shall request a report from the EMS crew (TTA time out). The crew shall utilize the "MIST" standardized trauma reporting tool. One EMS crew member shall provide the report, normally within 60 seconds. M Age/sex, Mechanism/Medical complaint I Injuries or Inspections S Signs and symptoms T - Treatment 2. Upon completion of the MIST report, the crew shall answer any questions from staff and depart from the room; this allows the trauma team to assume responsibility and initiate definitive care.

10 Policies & Procedures Drug and Equipment Exchange List I.E Page 1 of 2 Reviewed: 6/02/15 Approved: 6/03/2015 Effective: 7/01/2015 BVM Colorimetric C02 detector Advanced Airway End Tidal C02 monitors ET Tube Hand held nebulizer with tubing Padded board splints Airway/02: Trauma: Nasal Cannula Nasopharyngeal airways Non-rebreather mask Oropharyngeal airways Suction catheters (Yankauer and soft) Surgilube Rigid cervical collars Fluids and Administration Sets: 0.9% Sodium Chloride Saline Locks Minidrip administration sets Macrodrip administration sets Medications: Activated Charcoal Adenosine Albuterol 0.083% or Levalbuterol (Xopenex) Amiodarone HCL Aspirin Atropine Sulfate Calcium Chloride 10% 50% Dextrose & 10% Diazepam Diltiazem Diphenhydramine Dopamine Epinephrine 1:1000 Epinephrine 1:10,000 * Etomidate (Amidate) Furosemide Glucagon Glucose paste Haloperidol Hydrocortisone Sodium Succinate (Solu-Cortef) Ipratropium (Atrovent) Ketorolac (Toradol) 2% Lidocaine (Wylocaine) Magnesium sulfate Methylprednisolone (Solu-Medrol) Naloxone Nitroglycerin 0.4 mg tablet or metered spray Norepinephrine IV Drip (32 mcg/ml) Ondansetron (Zofran) Racemic Epinephrine 2.25% Sodium Bicarbonate Sodium Thiosulfate 25% sol. Tetracaine HCL ½ % Vasopressin

11 Policies & Procedures Drug and Equipment Exchange List I.E Page 2 of 2 Reviewed: 6/02/15 Approved: 6/03/2015 Effective: 7/01/2015 Syringes and Needles (Should be needleless type): 1cc TB syringe with 26g 3/8 inch needle l 0 cc syringe 3cc with 25g 5/8 inch needle 30 cc syringe 5cc with l8 g or 2 l g l ½ inch needle 20g 24g 1¼ inch assorted l8g 1¼ inch or 2 inch l6g 1¼ inch or 2 inch 25g 5/8 inch 21g 1½ inch Towels Sheets Pillows Pillowcases Blankets Emesis basins ECG electrodes Sterile Water Sterile Saline Angiocaths Needles Miscellaneous l4g 1¼ inch or 2 inch l5g or 17g spinal or I/0 needle 18g 1½ inch

12 REMAC Policies Agency Medical Director I.F Reviewed: 5/4/2015 Approved: 6/03/2015 Effective: 7/01/2015 It is the policy of the Nassau Regional Medical Advisory Committee (REMAC) that ALL agencies must, at all times, have an EMS Agency Medical Director. This includes Advanced Life Support (ALS) and Basic Life Support *(BLS). All Agency Medical Directors must be credentialed by the Nassau REMAC (see Policy I.F-1). It is the responsibility of all Nassau agencies to ensure that a completed Medical Director Information Sheet is filed annually with the Nassau REMSCo office. The completed Information Sheet MUST be submitted by January 31. If an agency changes Medical Director s then it must immediately complete and submit the Medical Director Information Sheet and Agency Medical Director Letter of Agreement within 30-days of the change. Agencies that fail to comply with the above policy shall have their authority to operate at ANY level suspended. The above forms are available on the Nassau REMSCo website. * Basic Life Support agencies that currently operate using Automatic External Defibrillation, Epi Pen, Albuterol, Blood Glucometry, and/or Naloxone are required by NYS DOH Bureau of EMS to have a NYS licensed physician approving the agency to use these treatments. New/changed material is underlined.

13 NASSAU REGIONAL EMERGENCY MEDICAL ADVISORY COMMITTEE 131 Mineola Boulevard, Suite 105 Mineola, NY Phone: FAX: Website: AGENCY MEDICAL DIRECTOR LETTER OF AGREEMENT I Dr. am serving as medical director in accordance with NYS PHL Article 30 for (agency name), as of. (date) Physician s Signature License # Authorized Agency representative Signature (Chief, President, Chair of Board, etc.) (Type/Print Name and Title)

14 Agency Medical Director Information Date Agency Name AGENCY LEVEL EMT-P OF CARE: EMT-CC BLS PROVIDER MEDICAL DIRECTOR NAME: MEDICAL DIRECTOR'S ADDRESS: (This must be an address that confidential medical information can be sent to NOT the Agency address.) MEDICAL DIRECTOR'S CREDENTIALS: PHONE NUMBER: ADDRESS: DEPARTMENT CONTACT NAME AND TITLE: DEPARTMENT CONTACT PHONE NUMBER: DEPARTMENT CONTACT Please mail this document to: Nassau Regional Emergency Medical Advisory Committee, 131 Mineola Boulevard, Suite 105, Mineola, NY or fax to (516) (1412)

15 REMAC Policies Agency Medical Director Credentialing I.F-1 Reviewed: 2/19/2014 Approved: 2/26/2014 Effective: 4/01/2014 It is the policy of the Nassau Regional Medical Advisory Committee that in order to be eligible to become a credentialed EMS Agency Medical Director, a physician must meet the following criteria: 1. Must hold a current NYS License to practice Medicine and Surgery 2. Have ACLS training or equivalent medical specialty training with a preference to ABEM and ABOEM. 3. Must have completed a specialty training program in Emergency Medicine, or other appropriate medical specialty with adequate documentation for verification. 4. Must complete the Credentialing/information packet and return the necessary items including: a. Must complete a REMAC Protocol take home exam b. Must submit a copy of the physicians CV to REMAC c. Return Letter of Agreement between physician and agency with both signatures d. Submit copy of diploma indicating successful completion of medical specialty training program e. Submit a copy of current ACLS card 5. Final Medical Director Credentialing is subject to REMAC approval * 6. Physician s are required to self report to the REMSCo office any license restrictions. Note: Attendance at REMAC meetings is strongly encouraged. * = ADDED MATERIAL

16 Policies On-Line Medical Control (OLMC) Physician Credentialing I. G Reviewed: 6/27/2016 Approved: 8/03/2016 Effective: 8/03/2016 It is the policy of the Nassau Regional Medical Advisory Committee that, in order to become a credentialed OLMC (On Line Medical Control) Physician, the qualified physician must meet the following criteria: 1. Must hold a current NYS License to practice Medicine and Surgery 2. Have BCLS/ACLS/PALS training or equivalent medical specialty training with a preference to ABEM and ABOEM. 3. (For designation as ON-SCENE EMS FIELD PHYSICIAN) you must be affiliated with a Nassau Regional certified EMS agency, or voting member of Nassau REMAC. 4. Must complete the Credentialing program: a. Must complete an approved OLMC exam as prepared by a regionally approved medical control facility (e.g. NUMC, CEMS) and approved by REMAC. d. Submit copy of diploma indicating successful completion of medical specialty training program, or verification of such by your Hospital Department representative. c. Must participate in CME pertaining to the protocols of your system, including QA/QI, protocol updates, and any other information as required by the Region *. Final On-line Medical Control Credentialing is subject to REMAC approval (Refer to NREMAC Policy I.F, NYS BEMS POLICY 11-03) * This documentation may be requested by the Credentials Committee for verification, and must be provided in a timely fashion, or the physician in question will lose ability to provide OLMC in this region.

17 Policies EMS Field Physician I. G-1 Reviewed: 6/27/2016 Approved: 8/03/2016 Effective: 8/03/2016 It is the policy of the Nassau Regional Medical Advisory Committee that, in order to become a credentialed EMS Field Physician, a qualified physician must meet the following criteria: 1) Must conform to REMAC Policy I.G. 2) There will be a Review of the EMS Field Physician application every 2 years, reflecting practices of credentialing requirements; to verify continued Medical Malpractice policy, current unrestricted License, adherence to Policy I.G and if substantive changes in protocols, satisfactorily complete a new protocol exam. a. Upon granting the title of Nassau Regional EMS Field Physician, an ID card will be loaned to the physician. The ID card will contain the words this ID is property of the Nassau REMAC and MUST be surrendered upon request. b. Every physician response is subject to a REMAC quality review. 3) It is not the function of this policy to dictate what equipment, and medications are carried in the physician response vehicle, nor to specifically describe requirements for a physician response vehicle. We will leave this to the agency sponsoring the physician and the individual credentialed physicians, with the understanding that they will be expected to be able to perform to the level of their training. 4) Goal: to enhance the EMS system, not to replace the EMS providers!! NOTE: this is not intended to supersede the NYS BEMS Policy on non-solicited physician response to an EMS scene.

18 Policies Patient Transfer Guidelines I. H Reviewed: 5/12/2014 Approved: 6/4/2014 Effective: 7/1/2014 These guidelines are intended to assist EMS providers in determining when patients who are evaluated by an EMT/AEMT may safely be transferred to a EMT for continued care and transportation. They can be utilized when an EMT/AEMT responds to and assesses a patient as requiring a basic life support level of care. The highest certified EMT-P, EMT-CC, EMT-Basic at the scene who has established patient contact is responsible for the patient care. These guidelines are not intended to limit the on-scene judgment of any EMS provider in the Prehospital setting. I. ALS personnel should transport patients with the following problems: Major Trauma Chest pain or pertinent history of a cardiac condition Altered mental status Cardiopulmonary Arrest Physiologic Shock Respiratory distress as evidenced by dyspnea with: a. Respiratory rate less than 10 or greater than 29 or b. Altered mental status or c. Cyanosis or d. Pulmonary edema Anaphylaxis Pertinent history of a diabetic condition Drug overdose/poisoning Moderate to severe burns Complications of childbirth or pregnancy II. A. Complete the Initial Assessment and make a determination if the patient is stable for BLS transport B. Verify that no ALS procedure has been initiated or indicated III. A. An EMT-P may transfer ALS level care to an EMT-CC provided that the patient does not require an ALS level intervention that the EMT-CC is not authorized to carry out, and the patient will not likely decompensate to the point where specific paramedic level ALS interventions may become necessary during transport to the hospital. B. An EMT-P may transfer ALS level care to an EMT-CC provided that the patient is not deemed to be unstable, either by assessment, or by protocol, and that the patient will not likely decompensate to the point of becoming unstable or critical during transport to the hospital. Documentation must include the medications & procedures initiated by the EMT-P prior to transfer of care to the EMT-CC, and that the conditions of transfer have been met. IV. If the level of care is questioned, the Medical Control Physician will make the final determination as to level of care and transfer, the Medical Control Physician has the authority to order ALS transport.

19 Policies Decision Not To Initiate C.P.R. Policy I.J Reviewed: 10/3/2007 Approved: 2/6/2008 Effective: 3/1/2008 Pronouncement of death is the determination that life does not exist. New York State law does not require that death be pronounced by a physician. There is no official standard to pronounce death and pronouncement is implied by the decision not to initiate Cardiopulmonary Resuscitation (New York State Department of Health Vital Records Registration Handbook, 2nd Ed.). A. Making Determination NOT to Initiate CPR In review of the State Health Department Policy, the EMT may decide not to initiate CPR in the following situations: 1. The arrest occurs during an inter-facility transfer and the sending facility has provided the EMT's with a written order not to resuscitate the patient. 2. The patient is enrolled in a Hospice program and a written order not to resuscitate the patient is presented by the family, or patient has a DNR bracelet, or the prehospital personnel have prior notification of the order in writing from the Hospice program. 3. In cases of obvious death such as, decapitation or other similarly mortal injuries or where rigor mortis, tissue decomposition, or extreme dependent lividity is present. The following Policy shall be in effect for the Nassau Regional Emergency Medical Services System: B. Actions to be Taken After Determination is Made In accordance with the New York State Emergency Medical Services Policy of Cardiopulmonary Resuscitation, when an EMT responds to the scene of a call as a member of the Nassau County EMS system and decides not to initiate CPR: 1. The Prehospital Care Report (PCR) should be completed and include all appropriate clinical and identifying information including description of patients clinical condition, time of decision and crew names/id numbers. 2. The hospital copy of the PCR must be given to a Police Officer and either the Police Officer or the EMT must contact the Medical Examiner's Office (24 hr. # ) prior to leaving the scene. 3. The Nassau County Medical Examiner's Office will consider this PCR as documentation of a pronouncement of death and render any further pronouncement unnecessary.

20 Policies Paramedic Skills Use Policy I.K Reviewed: 8/28/2008 Approved: 10/8/2008 Effective: 11/1/2008 The EMT-P skills identified in the Nassau Regional EMS Protocols may be used by the following: 1. Currently NYS Certified EMT-P with current Nassau REMAC credentials. 2. Physician Assistants (PA) or Registered Nurses (RN), with a current NYS EMT-CC certification, ACLS and PALS certification, and current Nassau REMAC credentials. PA s and RN s who meet the criteria in 2 may apply for authority to practice at the EMT-P level by submitting a request, in writing, with a copy of their license, registration and each of the above certifications. Requests must be submitted to: Nassau Regional Emergency Medical Advisory Committee 131 Mineola Blvd., Suite 105 Mineola, NY PA s and RN s must provide copies of Registration, ACLS and PALS certifications each time that they are renewed. PA s & RN s who are credentialed to perform EMT-P protocol skills are responsible to comply with all the duties and responsibilities that pertain to an EMT-P. The authority for all patient management will permanently reside with the physician at Medical Control, unless Medical Authority at the Scene (I.B-1) criteria is met.

21 Policies BLS 12-Lead ECG Acquisition & Transmission I. M Reviewed: 3/27/2017 Approved: 4/05/2017 Effective: 4/05/2017 The NYS SEMSCo & SEMAC have authorized the acquisition and transmission of 12 Lead ECG by EMT and AEMT personnel in accordance with State Protocol M-5 Adult Cardiac Related Problems. Any Nassau agency wishing to implement this skill MUST receive approval from the Nassau REMAC. In order for an agency to be approved they must have personnel trained in the skill, possess the necessary equipment to perform the skill, be capable of transmitting the ECG to Nassau MedCon and insure that the transmission is completed prior to arrival at the destination hospital. The Nassau REMSCo Education and Training Committee has developed a course of instruction which will be provided to agency trainers that are either EMT-CC or EMT-P. The agency trainers must utilize the provided training to teach and qualify those personnel in the agency that will be performing this skill. The agency is responsible to maintain accurate records that indicates who is trained, when they were trained and a record of successful completion of the skill. An agency applying for approval must submit the Agency Request to Participate form signed by the Agency Chief and Agency Medical Director that attests to the completion of training, the certification that the agency is capable of transmitting the ECG to MedCon, has a quality assurance and appropriateness review plan, and a continuing education program. In addition, a completed BLS 12-Lead Agency Information form must be submitted with the request. The agency will receive a letter from the REMAC once it is approved, the agency must then complete the Medical Director Verification Form DOH-4362 (which will be provided with the approval letter) and submit a copy to the NYS Bureau of EMS and Trauma Systems and to the Nassau REMSCo office. The NYS Bureau of EMS and Trauma Systems has issued Policy which addresses this issue and indicates additional requirements which must be met. Advisory is rescinded.

22 Agency Request to Participate BLS 12 Lead Acquisition & Transmission The, hereby requests to be authorized to use BLS 12 Lead ECG Acquisition & Transmission by EMT & AEMT personnel. In accordance with the following: 1. We possess and will maintain the equipment necessary to acquire 12 Lead ECG and transmission capability. 2. Only EMT-Basic and AEMT personnel that have successfully completed the BLS 12 Lead ECG Acquisition & Transmission Training Program will be authorized to utilize this skill in accordance with State Protocol M All personnel authorized to utilize this skill will be trained in accordance with the training plan provided by the Nassau REMSCo Education & Training Committee. We will provide continuing education to insure maintenance of competencies. We will maintain documentation of training to include lists of attendees, dates attend, and a record of successful completion of the skill by each attendee. 4. Our agency and personnel agree to follow all program policies, procedures, and protocols set forth by the Nassau REMAC. 5. We have a quality assurance and appropriateness review plan. Our agency agrees to participate in the Regional Quality Improvement Program. All calls in which BLS 12 Lead skill has been used must be reviewed by the Agency Medical Director. We will provide information and documentation, when requested, to the Nassau Regional QI Coordinator. 6. Any changes to the Required Agency Information will be reported to the Nassau REMAC within 30 days. 7. We will be using the following 12 Lead equipment: (Make & Model) 8. We will be transmitting the 12 Lead ECG by: (radio, cellphone, Wi-Fi - describe) The signatures below certify that the above request is being made and that we will be responsible for all aspects of participation in this Regional program. Agency Chief Signature & date (Print Name & Title of individual) Agency Medical Director Signature & date (Print Medical Director s Name) (Nassau REMAC Policy I.M form 1)

23 Nassau BLS 12 Lead Agency Information (please print) Agency Name: Agency Code: Address: State: Zip Code: Designated representative responsible for the BLS 12 Lead Program: Name: Daytime Phone #: ( ) address: Agency Administrator (Chief, Captain or President): Name: Daytime Phone #: ( ) address: Agency Medical Director: Name: Daytime Phone #: ( ) address: Designated Agency Trainer: Name: Level of Certification: Credentials (if applicable): Daytime Phone #: ( ) address: (Nassau REMAC Policy I.M form 2)

24 Policies Syringe Epinephrine for Basic EMTs I. N Reviewed: 7/17/2017 Approved: 8/02/2017 Effective: 9/01/2017 The NYS SEMSCo & SEMAC have approved the use of Syringe Epinephrine by properly trained basic EMT personnel operating with an EMS agency. The NYS Commissioner of Health has approved this skill to be brought to the basic EMT skill level. Any Nassau agency wishing to implement this skill MUST receive approval from the Nassau REMAC. Agencies that were previously approved, by the Nassau REMAC, to participate in the Check & Inject program, and have trained their personnel, are not required to apply again to the Nassau REMAC Agencies must review NYS Bureau of EMS Policy # for training and requirements that must be met before an agency can place syringe epinephrine in service. This does not preclude the use of epinephrine auto-injectors which remain as an acceptable means of administration. In order for an agency to be approved they must have personnel trained in the skill and possess the necessary equipment to perform the skill The NYS DOH BEMS has developed a course of instruction which is available to CLI s & CIC s. The trainers must utilize the provided training to teach and qualify those personnel in the agency that will be performing this skill. The agency is responsible to maintain accurate records that indicates who is trained, when they were trained and a record of successful completion of the skill. An agency applying for approval must submit the Agency Request to Participate in Syringe Epinephrine for Basic EMT form (I.N-1) signed by the Agency Chief and Agency Medical Director that attests to the completion of training, has a quality assurance and appropriateness review plan, and a continuing education program. In addition, a completed Syringe Epinephrine for Basic EMT Agency Information form (I.N-2) must be submitted with the request. The agency will receive a letter from the REMAC once it is approved, the agency must then complete the Medical Director Verification Form DOH-4362 (which will be provided with the approval letter) and submit a copy to the NYS Bureau of EMS and Trauma Systems and to the Nassau REMSCo office.

25 Agency Request to Participate Syringe Epinephrine for Basic EMTs The, hereby requests to be authorized to use Syringe Epinephrine for Basic EMT personnel. In accordance with the following: 1. We possess and will maintain the equipment necessary: a manufacturer marked syringe(s) indicating a dosage for P (Pediatric at 0.15mg) and for A (Adult at 0.3mg) and Epinephrine (1:1000) 1mg in 1ml vial(s). 2. Only EMT personnel that have successfully completed the training program will be authorized to utilize this skill in accordance with REMAC Protocol M All personnel authorized to utilize this skill will be trained in accordance with the training plan provided by the NYS DOH BEMS&TS. We will provide continuing education to insure maintenance of competencies. We will maintain documentation of training to include lists of attendees, dates attend, and a record of successful completion of the skill by each attendee. 4. Our agency and personnel agree to follow all program policies, procedures, and protocols set forth by the Nassau REMAC. 5. We have a quality assurance and appropriateness review plan. Our agency agrees to participate in the Regional Quality Improvement Program. We will provide information and documentation, when requested, to the Nassau Regional QI Coordinator. 6. Any changes to the Required Agency Information will be reported to the Nassau REMAC within 30 days. The signatures below certify that the above request is being made and that we will be responsible for all aspects of participation in this Regionally approved program. Agency Chief Signature & date (Print Name & Title of individual) Agency Medical Director Signature & date (Print Medical Director s Name) (Nassau REMAC Form - I.N-1 (1708)

26 Nassau Syringe Epinephrine for Basic EMT Agency Information (please print) Agency Name: Agency Code: Address: State: Zip Code: Designated representative responsible for the Epi Syringe Program: Name: Daytime Phone #: ( ) address: Agency Administrator (Chief, Captain or President): Name: Daytime Phone #: ( ) address: Agency Medical Director: Name: Daytime Phone #: ( ) address: Designated Agency Trainer: Name: Level of Certification: Credentials (if applicable): Daytime Phone #: ( ) address: (Nassau REMAC Form - I.N-2) (1708)

27 Policies Expired Agency Operating Certificate I. O Reviewed: 5/02/2016 Approved: 6/01/2016 Effective: 6/15/2016 The New York State Department of Health Bureau of Emergency Medical Services has determined that when an ambulance agency fails to renew their NYS Operating Certificate at or before its expiration date they are no longer authorized to provide ambulance service. In fact they have deemed that any ambulance agency that continues operating after their certificate has expired is in violation of NYS Public Health Law 3005 and multiple section of Part 800, NYS EMS Code. Further, it should be noted that, during the uncertified period, the agency is no longer afforded any of the protections under the law and places their certified personnel at risk. The State has advised the REMAC that any agency that allows their certification to expire is no longer authorized to provide care, to include ALS level of care. They have also indicated that any agency that subsequently renews an expired certification must make new application to the REMAC to be authorized to operate at any level of care. Agencies applying for authorization to operate at an ALS level of care must complete and submit the following to the REMAC: A letter on agency letterhead requesting that the agency be authorized to operate at the EMT-CC or EMT-P level of care, the letter must be signed by the agency Chief/President. Agency Personnel Roster form (DOH-2828b) Medical Director s Verification form (DOH-4362) Certified EMS Agency Information Update form (DOH-2936) Applications for any BLS special REMAC approvals Agencies applying for authorization to operate at the BLS level of care with special REMAC approvals must submit the application for each of the special approvals (as specified in the Bureau of EMS Policies) to the REMAC, these include, but are not limited to: Automated External Defibrillation (AED) Epinephrine administration (excluding assisted medication) Albuterol Blood Glucometry Naloxone CPAP BLS 12 Lead ECG Transmission Agencies are reminded that the REMAC must vote to approve these requests and they currently meet on the 1 st Wednesday of even numbered months. An agency may NOT operate at the ALS level or utilize BLS special skills/medications until approved by the REMAC.

28 REMAC Policies Pediatric Major Trauma Deferral I. P Reviewed: 3/26/2018 Issued: 4/04/2018 Effective: 5/01/2018 Purpose - To provide a standardized policy for prehospital care providers to defer Pediatric Major Trauma patients to an appropriate facility capable of providing definitive care. Pediatric Major Trauma patients, whose condition permits, should have their destination DEFERRED to a State designated Pediatric Trauma Center: Cohen Children's Medical Center th Ave, New Hyde Park, NY Good Samaritan Hospital Medical Center Montauk Highway, West Islip, NY Stony Brook University Hospital Nicolls Road, Stony Brook, NY Pediatric Major Trauma patients are those identified in NYS DOH Bureau of EMS Basic Life Support Protocol T-7 (copy attached). Pediatric patients who have an Unmanageable Airway (i.e. patient whose upper airway is compromised by an obstruction, e.g. mandibular fractures, tongue, hematoma, blood, or vomitus preventing ventilation, or a patient being ventilated through a needle cricothyrotomy) should be transported to the closest receiving hospital. Trauma Notification shall be made through Medical Control (MedCon) / Medical Operations (MedOps) to the receiving trauma center utilizing the format indicated in REMSCo form T-1 (attached).

29 or Stony Brook

30 NASSAU REGIONAL E.M.S. TRAUMA WORKSHEET NASSAU REGIONAL E.M.S. TRAUMA WORKSHEET Date: Time: Date: Time: Trauma Team Requested: YES NO Hospital: ETA: Age: Sex: Male Female Mechanism of Injury: Trauma Team Requested: YES NO Hospital: ETA: Age: Sex: Male Female Mechanism of Injury: Extrication Required: Yes No Time: Extrication Required: Yes No Time: VITAL SIGNS VITAL SIGNS BP: / BP: / Pulse: Pulse: Resp: Resp: LOC: LOC: Pupils: Pupils: Intubated / BVM: Intubated / BVM: IV: IV: INJURIES INJURIES NASSAU REGIONAL E.M.S. TRAUMA WORKSHEET NASSAU REGIONAL E.M.S. TRAUMA WORKSHEET Date: Time: Date: Time: Trauma Team Requested: YES NO Hospital: ETA: Age: Sex: Male Female Mechanism of Injury: Trauma Team Requested: YES NO Hospital: ETA: Age: Sex: Male Female Mechanism of Injury: Extrication Required: Yes No Time: Extrication Required: Yes No Time: VITAL SIGNS VITAL SIGNS BP: / BP: / Pulse: Pulse: Resp: Resp: LOC: LOC: Pupils: Pupils: Intubated / BVM: Intubated / BVM: IV: IV: INJURIES INJURIES

31 REMAC Policies Suspected Opiate Overdose Reporting I. Q Reviewed: 3/26/2018 Issued: 4/04/2018 Effective: 5/01/2018 Fire, EMS and Police resources are now able to contribute to a single reporting system that allows for the near real-time tracking of overdoses. This initiative is to allow the dedication of resources into areas when a spike or cluster of such cases manifests itself. Signs and symptoms such as: constricted / pinpoint pupils, slow or absent breathing with altered mental status, etc. Scene indicators such as: bystander s claim of overdose, paraphernalia present or medical history suggestive of opiate/narcotic use. After all calls involving a suspected opiate overdose (Transport, RMA, DOA, etc.) The medical provider who is in charge of patient assessment and care will call Nassau County Medical Control ( ), upon completion of the call. The following information will be needed by MedCom for entry into the system: o Actual or closest numerical address of the location where patient was found o For fatal OR non-fatal overdoses Was Naloxone administered? If so, single or multiple doses? Did the patient respond to the treatment? This reporting is anonymous as the system does not record the identity of the provider, nor the agency or unit reporting the information. Advisory is rescinded.

32 REMAC Policies Medical Control 500MHZ Radio Frequency I. R Reviewed: 5/4/2015 Approved: 6/03/2015 Effective: 7/01/2015 For EMS Agencies utilizing Nassau County Medical Control & 500MHZ radios are directed to utilize the radio channels as outlined below. Talk Group #1 used for all notifications and/or to request a med channel. If requesting a run you will be directed by the Medical Control Operator to Talk Group #2 which is the medical channel for your patient presentation, documentation of ALS standing orders, or request for additional ALS orders. Talk Group #3 will used for MCI s and will be used as an additional medical channel when needed. Radio Channels Labeled Med 5 & Med 9 are for use in transmitting 12 lead EKG using Rosetta LT. All other 12 lead EKG can be transmitted via Rosetta DS through the Internet to Medical Control, this includes Physio s monitors and Life Net System. Agencies that have Internet air card capability may also send 12 lead via those systems as well after making notifications via radio. The old medical control radio system will stay operational until installations of all 500MHZ radios are complete. Any agency needing assistance in setting up 12 lead EKG transmissions should contact their cardiac monitor manufacturer s sales representative.

33 Policies Protocol Utilization I. T Reviewed: Approved: 2/26/2014 Effective: 3/01/2014 Any agency that receives calls for service made to a Public Service Answering Point (PSAP) is required to use Nassau REMAC protocols and have Nassau REMAC trained and credentialed personnel providing care. An agency that does NOT accept PSAP calls may use the current version of the protocols of their home based region. Agencies using home based (non-nassau) protocols must submit a copy of the protocols to the Nassau REMAC for approval. Whenever the home based region amends their protocols it is the responsibility of the provider agency to submit copies of the amendments, within 60 days of change, to the Nassau REMAC for approval.

34 REMAC Policies Hazardous Materials Treatment Teams I. Z Page 1 of 4 Approved: 4/7/2004 Effective: 12/1/2004 Introduction Protocols to facilitate rapid medical intervention at the scene of Hazardous Materials incidents have been developed by the Protocol Subcommittee to the Regional Emergency Medical Advisory Committee (ReMAC). To ensure that these aggressive protocols are under more direct medical oversight, and are only used by skilled and trained technicians, ReMAC has created the following policy. This policy establishes the following: 1. Scope of Application 2. Organization 3. Medical Supervision 4. Treatment review and reporting (Quality Improvement) 5. Training 6. Dispatch Recommendations 7. Requirements for internal procedures Scope This policy applies to the utilization of Nassau ALS Protocol III.X Hazardous Material Treatment, herein referred to as "Advanced HazMat Treatments" or "AHT". Organization Only qualified and authorized members of a team organized by a volunteer fire department, volunteer ambulance corps, Police Department or hospital based EMS agency and approved by Nassau ReMAC are authorized to provide Advanced HazMat Treatments.

35 REMAC Policies Hazardous Materials Treatment Teams I. Z Page 2 of 4 Approved: 4/7/2004 Effective: 12/1/2004 Medical Oversight The recognized team, or other organization, shall have a written agreement with a physician Board Certified in Emergency Medicine or who is ReMAC qualified. The written agreement, a current copy of which must be submitted to the ReMAC, shall include the following at a minimum: 1. Name and contact information for the designated physician 2. Qualifications of the physician and a copy of their New York State Medical License. 3. Physician participation in Team Quality Improvement (QI) Activities 4. Physician review each use of AHT 5. Submission of a written summary of each physician review of AHT to the regional Quality Improvement Coordinator with appropriate recommendations if applicable. 6. Physician approval of team training 7. Requirement for the physician to participate in the Regional QI program. 8. A copy of any procedures or polices developed by or for the team/organization. Quality Improvement Each team shall have a quality improvement plan that specifically ensures that training, use of AHT, and availability of AHT, is assessed and documented following each Hazardous Materials Incident to which the team is dispatched. At a minimum, an annual assessment shall be conducted and documented. A summary of each assessment with observations and recommendations as appropriate shall be sent to the regional Quality Improvement Coordinator. A specific person in each team or organization shall be designated to coordinate Quality improvement. The designated person shall respond to requests for information from the regional Quality Improvement Coordinator. To the extent practical, and at the discretion of the team or organization, the QI plan may be part of the existing QI program, so long as it includes the elements above.

36 REMAC Policies Hazardous Materials Treatment Teams I. Z Page 3 of 4 Approved: 4/7/2004 Effective: 12/1/2004 Training Specific written Training requirements for the team or organization shall be developed and approved by the designated physician. At a minimum, all personnel authorized to administer AHT shall be trained to the Hazardous Materials Operations Level as defined in 29CFR the OSHA Hazardous Waste Operations and Emergency Response (HAZWOPER) Standard. Teams and organizations providing AHT should be familiar with County Police and Fire Marshal Hazardous Materials Teams and their procedures. Dispatch Each team or organization should notify and be on file with the 911 and Fire Communications dispatch with availability information. It is desired that at least one or more Advanced Medical Technicians be assigned with their properly equipped unit to each Hazardous Materials Incident where personnel are thought to be contaminated or where public sector Hazardous Materials teams are operating in Level A, B, or C personnel protective levels. No AHT protocol procedures may be initiated unless Advanced Life Support (ALS) personnel authorized and approved under this policy are present at the scene to administer them. Procedures Each team or organization providing AHT shall have written procedures approved by the current Medical Director. The procedures shall include at the minimum the following elements: 1. Training Requirements 2. Quality Improvement Plan

37 REMAC Policies Hazardous Materials Treatment Teams I. Z Page 4 of 4 Approved: 4/7/2004 Effective: 12/1/ How to determine when approved protocols will be used (e.g. how the technician will determine what chemical the patient has been exposed) 4. Response procedure 5. Equipment List and Location 6. Access Control to Medications 7. A Current list of personnel with each persons NYS EMS certification number, level, and expiration date, authorized to provide AHT

38 Nassau Regional EMS Council Advanced Life Support Policy Procedure - Protocol Manual Section II Procedures - Table of Contents Approved Effective Alternative Hospital Destinations II.A 2/26/2014 4/01/2014 EMS Helicopter Guidelines II.B 2/06/2008 3/01/2008 Field Termination of Resuscitative Efforts II.C 2/04/2004 4/01/2004 Hospital Diversion II.D-1 10/07/ /01/2015 Ambulance Redirection II.D-2 12/08/2008 8/01/2009 * ALS Technician Credentialing II.E 10/04/ /01/2017 ALS Care Rendered Outside Affiliated Agency s Oper. Certificate II.G 6/04/2014 7/01/2014 * = Recent Change

39 Procedures Alternative Hospital Destinations II.A - Page 1 0f 2 Reviewed: 2/19/2014 Revised: 2/26/2014 Effective: 4/01/2014 This procedure supersedes the New York State Basic Life Support Protocol "General Approach to Prehospital Management" Transport section. This procedure applies to all BLS and ALS transports as appropriate. The purpose of this guideline is to assist EMS agencies with transportation decisions in situations where there is no major trauma and the technician or patient/family request transportation to a hospital which is not the nearest hospital. This guideline is intended to enhance the EMS technician's decision making process and does not replace or challenge the judgment of the scene technician responsible for transportation decisions. The decision to transport an emergency patient in an ambulance to an alternative destination is a risk/ benefit judgment and remains with the emergency medical technician responsible for patient care. Consultation with the on-line medical control physician is encouraged, especially when the technician and patient/family do not agree on the hospital disposition. A. Transport the patient as soon as possible to the nearest appropriate hospital. 1. If mechanism of illness/injury and/or historical/physical findings do not indicate major trauma: a. Transport the patient to the nearest regionally approved hospital emergency department (ED); or b. Transport the patient to a regionally approved alternative destination* if: (1) The patient remains stable throughout the transport, and the patient requests transport to an alternative destination, and the additional transport time to the alternative destination is less than 10 additional minutes; or (2) The patient requires specialty care at the alternative destination that is unavailable at the nearest hospital; or (3) An on-line medical control physician so directs. * Hospitals are the only Nassau ReMAC regionally approved alternative destinations to receive emergency patients by ambulance.

40 Procedures Alternative Hospital Destinations II.A - Page 2 0f 2 Reviewed: 2/19/2014 Approved: 2/26/2014 Effective: 4/01/2014 NOTE: Patients who are critical or unstable must be transported to the nearest hospital emergency department! 2. If mechanism of injury and/or physical findings indicate trauma, in accordance with NYS BLS Protocol T-6: a. Transport the patient to the nearest regionally designated Regional or Area Trauma Center; or b. Transport the patient to the nearest hospital emergency department if: (1) The patient is in cardiac arrest; or (2) The patient has an unmanageable airway; or (3) An on-line medical control physician so directs. B. Intercept with an ALS unit (if available) en route to the nearest appropriate hospital as noted in specific treatment protocols. NOTE: Do not delay patient transport to await the arrival of an ALS unit! Agency Resources: Allocation of ambulances and technicians at the time of a request for an alternative hospital destination is unique to each situation and should be considered in transportation decisions. Nassau ReMAC requests that each EMS agency in the Region develop an agency policy that addresses alternative destinations.

41 Procedures EMS Helicopter Guidelines Procedure II. B Page 1 of 5 Reviewed: 2/19/2014 Approved: 2/06/2008 Effective: 3/01/2008 Utilization: Request System: The Nassau County EMS System utilizes the Nassau County Police Department Aviation Unit helicopters for aero medical emergency transportation. These helicopters are certified as ambulances in New York State and are staffed by a pilot and an EMT-CC or Paramedic (herein referred to as medic ). There are special circumstances and injuries that may require the use of the helicopter to enhance the care of the patient and the speed of transport to the hospital. Each helicopter has the capacity to transport two patients in a bunked position. There is a crew on site at the Aviation Unit for two tours from 7:30 a.m. to 11:20 p.m. daily. Between 11:20 p.m. and 7:30 a.m. crews are on call and there is a 45-minute response time The highest medically qualified individual at the scene will request the helicopter for EMS transport. The NCPD Aviation Unit can be requested via: Direct Phone Nassau Police Communications Center (by Radio or call 911) Fire Communications (FireCom) Medical Control Direct radio communications with the helicopter(s) can be established through Medical Control. Medical Control will assign a medical control channel to communicate directly with the flight crew. Aviation Unit medics will contact medical control for all notifications and ALS runs. Patient Selection: It is recognized that the decision to request air transport is one, which is made by EMS personnel, based on the patient s clinical condition and consequent safety vs. benefit analysis The following clinical situations serve as guidelines in determining when to request helicopter transport: A. Patients Appropriate for Helicopter Transport

42 Procedures EMS Helicopter Guidelines Procedure II. B Page 2 of 5 Reviewed: 2/19/2014 Approved: 2/06/2008 Effective: 3/01/ Patients that meet the New York State Trauma Deferral Guidelines when transportation time can be decreased by more than 15 minutes 2. Patients with Second and Third Degree Burns covering greater than of 30% of the body when ground transportation time to the referral site can be decreased by 15 minutes or more 3. When patient extrication and ground transport begins to infringe on the Golden Hour or trauma care, the helicopter should be considered if transport time can be decreased by 15 minutes or more 4. Patients with suspected spinal injury when ground transport on unpaved roads interferes with spinal stabilization or may further compromise the patient s condition B. Patients Inappropriate for Helicopter Transport 1. Patients who weight more than lbs. (flight crew will make the final determination) 2. Patients with a potential altered mental status (emotion disorders, drug/alcohol abuse, or general agitation) 3. Patients with acute CHF, acute MI, and any patient who must be positioned with the head and upper body elevated 4. Patients who express fear of specific aversion to air transport 5. Any patient who, in the judgment of the medic, is potentially inappropriate NOTE: If a patient is deemed inappropriate, if requested, the medic will assist the ground crew for ground transportation. C. Transfer of Medical Responsibility The NCPD Aviation Unit has the authority to refuse air transport The ground EMS crew is responsible for care and transport of all patients, who, in their judgment, are inappropriate for air transport or when the NCPD Aviation Unit is unable to transport

43 Procedures EMS Helicopter Guidelines Procedure II. B Page 3 of 5 Reviewed: 2/19/2014 Approved: 2/06/2008 Effective: 3/01/2008 NCPD Aviation Unit medics will assume the medical responsibility for the patient once the decision to use the helicopter for patient transport has been made In the event that the helicopter responds without an Aviation Unit medic aboard, the ground technician will continue medical responsibility for the patient by accompanying the patient in the helicopter D. Document all helicopter transport information on PCR and forward to receiving hospital Practical Considerations: Ground crew should place patient on narrow backboard (16 maximum) or scoop stretcher in preparation for helicopter transport. Large backboard is too wide to be place aboard the ship Because electrical equipment may not meet FAA specifications, the EMS ground crew defibrillator should be replaced with the Aviation Unit equipment in preparation for transport. The oxygen will be switched to the aviation unit oxygen equipment. Because of the helicopter s ability to illuminate areas in the dark (30 million candle watt), it is a useful tool for searching an accident scene for victims who may have wandered or have been ejected from a vehicle. Helicopters are also equipped with Forward Looking Infrared Equipment (FLIR). NCPD Aviation Unit does not provide helicopter EMS transport out of state Helicopter transportation is not affected by change in atmospheric and barometric pressure Safety Guidelines: All participants at the scene must obey the Police Officer who manages the landing site. It is the responsibility of all participants at the scene to maintain the strictest safety procedures To make the helicopter safe for all concerned, and to minimize potential hazards, observe the following practices:

44 Procedures EMS Helicopter Guidelines Procedure II. B Page 4 of 5 Reviewed: 2/19/2014 Approved: 2/06/2008 Effective: 3/01/2008 Identify a landing area with a minimum of 100 x 100 feet Inform communications of any obstacles at the landing site (trees, telephone lines, antennas, etc.) Secure the landing area to prevent unauthorized persons from approaching Keep the landing zone clear of loose articles and hazardous debris, and protect the patient from rotor wash Keep well clear of the landing area when the helicopter is approaching or taking off Turn off all strobe lights Do not approach the helicopter. Helicopter medic will approach ground crew Approach within the pilot s field of vision (see diagram) Carry equipment horizontally, below your waist level never upright or over your shoulder. Follow the suggestions of the flight crew when assisting near the helicopter No smoking Do not wear hats when approaching the helicopter

45 Procedures EMS Helicopter Guidelines Procedure II. B Page 5 of 5 Reviewed: 2/19/2014 Approved: 2/06/2008 Effective: 3/01/2008 Approaching or Leaving A Helicopter It is recommended that all Nassau County EMS providers, including hospital personnel receiving helicopter transports, participate in the course on Helicopter Safety developed by the Nassau County Police Department Aviation Unit. Contact Aviation Unit at to set up a training program.