Nassau Regional Medical Advisory Committee

Nassau Regional Medical Advisory Committee Advisories Advisory# Subject Issued Effective 07-02.1 BLS Assisted Medications 2/7/07 2/7/07 07-06.1 BLS Use of Pulse Oximeters 6/6/07 6/6/07 08-12.1 Incident Rehabilitation 12/3/08 12/3/08 08-12.2 Adult Sexual Assault Forensic Examiner (SAFE) Program 12/3/08 12/3/08 11-05.1 Ventricular Assist Device (VAD) 5/04/11 5/04/11 12-08.2 Glucometer 8/15/12 8/15/12 13-12.1 Intranasal Naloxone 12/18/13 12/18/13 14-08.1 ALS Identification Card 8/06/14 8/06/14 14-08.2 Zoll Lifevest 8/06/14 8/06/14 15-06.1 Long Beach 911 Receiving ER 6/15/15 7/01/15 16-06.1 Cyanokit 6/13/16 6/13/16 17-02.1 BLS 12 Lead ECG Acquisition & Transmission 2/06/2017 2/06/2017

REMAC Advisory BLS 12 Lead ECG Acquisition & Transmission 17-02.1 Issued: 2/06/2017 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 and must then complete 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 16-01 which addresses this issue and indicates additional requirements which must be met.

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-5. 3. 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)

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 #: ( ) E-mail address: Agency Administrator (Chief, Captain or President): Name: Daytime Phone #: ( ) Email address: Agency Medical Director: Name: Daytime Phone #: ( ) Email address: Designated Agency Trainer: Name: Level of Certification: Credentials (if applicable): Daytime Phone #: ( ) Email address: (Nassau REMAC Policy I.M form 2)

Nassau Regional Emergency Medical Services Advisory Pre-hospital Narcotics 16-07.1 Issued: 7/25/2016 Background Narcotics have been a component of Nassau Regional ALS protocols for over 20 years. In 2013, the State Emergency Medical Advisory Committee passed a motion to mandate all ALS agencies statewide to obtain a narcotics license. This motion was affirmed by the New York State Department of Health and a policy statement was issued with a deadline of all EMT-CC & EMT-P agencies to have a narcotics license by May 2015. Any agency not possessing a narcotics license would be downgraded to BLS. It was legally determined that the policy statement was not sufficient and regulatory changes would be required. The State posted draft regulatory changes and many comments were posted. One of the changes resulting from the comments included allowing agencies downgraded to BLS to apply to the REMAC to operate at a minimalistic ALS level (Advanced EMT AEMT ) with a small subsection of ALS treatments. On July 20, 2016, the state regulatory change was published and became effective immediately. Operational Details All Advanced Life Support (ALS) agencies are hereby informed that as of the regulatory change on July 20 th, they are now required to apply for and obtain a narcotics license if they do not already possess one. We have been in touch with the State DOH, Bureau of EMS and Trauma and have been advised by the director that enforcement will not begin until the end of 2016 and will not affect agencies that are making a Good Faith effort to obtain a narcotics license. Any agency that does not apply or make a Good Faith effort to obtain a controlled substance license will be downgraded to BLS. Those agencies can then apply to the REMAC to operate at the Advanced EMT level (one level below EMT-CC and EMT-Paramedic). This designation would allow advanced airway procedures and treatment modalities for Allergies and Diabetics. We are working with our REMAC on this process and we will be sending out a survey to ascertain those agencies that may be affected. Agencies that need assistance with the application process can contact the REMSCo office for assistance. Attached is a copy of the published regulatory rule change for reference. Scott Glazer Chairman

Nassau Regional Emergency Medical Services Advisory Trauma Center Bypass 16-6.1 Issued: 6/15/2016 This advisory is to clarify an issue of apparent misunderstanding as it relates to Trauma Receiving Hospitals. There appears to be a belief that trauma patients must be taken to the highest level trauma center as per protocol. The standards for the provision of clinical care to injured patients for Level I/Regional and Level II/Area trauma centers are identical. All EMS personnel are advise that they should not be bypassing a trauma center based upon its level designation since the trauma centers in Nassau are either Level I or Level II trauma centers. In the case of pediatric trauma, those patients should be diverted to a designated pediatric trauma center. Any patient suffering an amputation, where replantation may be possible, should be diverted to either North Shore Manhasset or Winthrop, since both of these facilities are capable of handling replantation. Scott Glazer Chairman

Advisory Trauma, Burn, and Re-implant Centers 16-02.1 Issued: 2/3/2016 In an effort to reduce the confusion over trauma patient transports, the following is the list of trauma and specialty related receiving hospitals in the Nassau region; Adult Trauma North Shore University Hospital Manhasset Nassau University Medical Center Winthrop University Hospital South Nassau Communities Hospital Pediatric Trauma Winthrop University Hospital Steven and Alexandra Cohen Children's Medical Center Burn Center Nassau University Medical Center Re-Implant Centers Winthrop University Hospital North Shore University Hospital Manhasset This list is subject to change as Trauma Receiving Hospitals transition from NYS DOH credentialing to the American College of Surgeons standards. The REMSCo is working with all of our regional hospitals to provide updates to our EMS agencies. Scott Glazer Chairman

Advisory SNCH Off Campus Emergency Dept. 15-08.1 Issued: 8/05/2015 We are currently anticipating the opening of the new South Nassau off campus hospital based free standing emergency department in Long Beach. It had been previously delayed and is now anticipated in early August. Located at: 325 East Bay Drive, Long Beach NY The REMAC previously issued an advisory (15-06.1 dated 6/15/15) indicating the patient subtypes that cannot be accepted at the new facility. This is a 911 receiving facility as designated by the NYS DOH and a PCR must be left with each patient as in other receiving facilities. All current transport decision policies and protocols remain in effect regarding trauma patients, strokes and other specialty diversions. All notifications and inquiries will be through Nassau Medical Control per current procedures. This facility will have limited restock capabilities, please limit to only those supplies utilized on transports to this facility. South Nassau offered and did conduct familiarization walkthrough s for local EMS agencies. If you need to schedule one for your agency, please contact SNCH or the REMSCo office ASAP. The PCR disposition code is: 708 Please feel free to contact the REMSCo office for any questions or additional information. Scott Glazer Chairman Nassau Regional EMS

Policies Regional Dispatch for Suspected Ebola Virus Disease (EVD) Policy 14-10.2 Page 1 of 2 Reviewed: Approved: 10/28/14 Effective: 10/28/14 Purpose: To establish procedures for response to, and mitigation of, suspected Ebola Virus Disease (EVD) assignments, while minimizing provider exposure. Scope: All Nassau EMS Providers (Career EMS Services, Volunteer Fire Departments, Volunteer Ambulance Corps and other First Response Agencies) who provide prehospital emergency medical treatment in this region. Procedure: Dispatch: Based on current guidelines, a telephone triage algorithm shall be utilized to assist in the identification of potential or suspected EVD patients. Response: When a Fever/Travel (F/T) call type has been identified, the dispatcher shall immediately notify the Nassau County Police Department (NCPD). Nassau County Police will dispatch the closest/appropriate NCPD Emergency Ambulance Bureau (EAB) unit to respond to Fever/Travel assignments, in lieu of a volunteer service provider(s). On-Scene: o If a volunteer Fire/EMS Service responds to a location and encounters a patient that meets the F/T call type criteria, and the assignment was not initially designated as such, the crew shall: Maintain a safe distance. Don appropriate PPE. Request the immediate response of the NCPD Emergency Ambulance Bureau (EAB). o The volunteer Fire/EMS Service personnel shall take the following actions: Stable Patient: Crews should await the arrival of NCPD EAB at a safe distance. Unstable Patient: After PPE has been donned, the crew should initiate patient care. All patients: Crews should limit the amount of personnel who make patient contact, or remain in or around the immediate patient environment. o Upon arrival, NCPD EAB resources shall assume patient care. The initial responding unit will assume a supportive role for NCPD EAB units. o Once the NCPD EAB unit has assumed patient care responsibilities: If no patient contact was established, the volunteer Fire/EMS Service personnel unit shall doff their PPE only after it has been determined that the NCPD EAB will not require their assistance, and patient transport to hospital has been initiated.

Policies Regional Response & Operation for Suspected Ebola Virus Disease (EVD) Policy 14-10.1 Page 1 of 2 Reviewed: Approved: 10/28/14 Effective: 10/29/14 Purpose: To establish procedures for response to, and mitigation of, suspected Ebola Virus Disease (EVD) assignments, while minimizing provider exposure. Scope: All Nassau EMS Providers (Career EMS Services, Volunteer Fire Departments, Volunteer Ambulance Corps and other First Response Agencies) who provide prehospital emergency medical treatment in this region. Procedure: Dispatch: Based on current guidelines, a telephone triage algorithm shall be utilized to assist in the identification of potential or suspected EVD patients. Response: When a Fever/Travel (F/T) call type has been identified, the dispatcher shall immediately notify the Nassau County Police Department (NCPD). Nassau County Police will dispatch the closest/appropriate NCPD Emergency Ambulance Bureau (EAB) unit to respond to Fever/Travel assignments, in lieu of a volunteer service provider(s). On-Scene: o If a volunteer Fire/EMS Service responds to a location and encounters a patient that meets the F/T call type criteria, and the assignment was not initially designated as such, the crew shall: Maintain a safe distance. Don appropriate PPE. Request the immediate response of the NCPD Emergency Ambulance Bureau (EAB). o The volunteer Fire/EMS Service personnel shall take the following actions: Stable Patient: Crews should await the arrival of NCPD EAB at a safe distance. Unstable Patient: After PPE has been donned, the crew should initiate patient care. All patients: Crews should limit the amount of personnel who make patient contact, or remain in or around the immediate patient environment. o Upon arrival, NCPD EAB resources shall assume patient care. The initial responding unit will assume a supportive role for NCPD EAB units. o Once the NCPD EAB unit has assumed patient care responsibilities: If no patient contact was established, the volunteer Fire/EMS Service personnel unit shall doff their PPE only after it has been determined that the NCPD EAB will not require their assistance, and patient transport to hospital has been initiated.

Policies Regional Response & Operation for Suspected Ebola Virus Disease (EVD) Policy 14-10.1 Page 2 of 2 If patient contact has been established, the potentially exposed Fire/EMS Service personnel shall ride in the NCPD EAB ambulance to the hospital, and await decontamination/doffing direction from hospital personnel. Note: In this instance, it is important to not potentially infect a second ambulance or other emergency vehicle. Operations: o Personnel shall maintain body substance isolation (BSI) and don their appropriate personal protective equipment (PPE) prior to making any patient contact. o Patient Assessment and treatment shall be initiated in accordance with all local and State policies, protocols and procedures. o All Providers should remain vigilant of the potential for exposure to bodily fluids, and protect themselves accordingly. Transportation: o Patients should be transported to the closest, appropriate ambulance receiving hospital. o Immediate notification to Medical Control MUST be made in ALL suspected EVD cases. o Once at the hospital, the patient should NOT be delivered into the hospital until directed to do so by hospital personnel. o EMS Crews shall remain outside the hospital while awaiting instruction from hospital staff. o Hospital personnel will be responsible for patient transfer, as well as the supervision of decontamination and PPE doffing. o Note: Do not enter hospital with donned PPE or other potentially infected equipment. EMS Providers must understand that this Advisory is subject to change as additional information becomes available. Volunteer Fire or EMS Personnel are not exempt from training or preparing for care or transportation of EVD patients, in accordance with the NYS Commissioners Public Health Order, and must remain vigilant at all times to the possibility of encountering infected patients. This Advisory does not replace or supersede any policies or protocols administered by The New York State Department of Health.

Advisory Required Equipment 12-08 Issued: 8/15/2012 The REMAC and REMSCo require that all in-service ambulances carry the following: Epinephrine Auto-injectors Glucometer (ALS only) Agencies are reminded that they must obtain a limited lab license from the NYS DOH before you can operate the glucometer. The REMAC has NOT established a training program or protocol for BLS personnel to utilize glucometers and Agency Medical Directors are not authorize to allow BLS personnel to use them. Pulse Oximeter 1 Automated External Defibrillator (AED) 2 1 = The use of a manual defibrillator with pulse oximetry capability meets this requirement. 2 = The use of a manual defibrillator which has the ability to be and is set in an AED mode for BLS use meets this requirement. Agencies shall insure that BLS personnel are trained on how to use this equipment and to verify, before use, that a manual defibrillator is set in the Automated mode. In addition, the NYS Bureau of EMS, in Policy 10-01 mandated that the following equipment must be carried on ALL in-service ambulances: Epinephrine Auto-injectors (see BEMS Policy 11-08 for requirements) Automated External Defibrillator (AED) For the record there is NO mandate or deadline for agencies to have 12-lead monitors at either the State or Regional level. However, the REMSCo has previously recommended that any agency contemplating upgrading or replacing their current equipment to seriously consider a move to a 12-lead model. The State has declared that 12-lead equipment is the Gold Standard for pre-hospital emergency care and is currently developing standards for facility designation as S-T Elevation in Myocardial Infarction (STEMI) receiving facilities (similar to stroke receiving designation), this may result in a deadline by which all ALS agencies will be required to have 12-lead equipment. If you have any questions, please feel free to contact the REMSCo office. Scott Glazer Chairman

Advisory Fire Service Academy and Mutual Aid EMS Coverage 11-02 Issued: 6/06/2011 The Nassau Regional EMS has approved the Plainview Fire Department s letter of agreement in regards to EMS Coverage during training evolutions at the Nassau County Fire Service Academy. Agencies participating in training at the Fire Service Academy are encouraged to bring and utilize their agency EMS assets during these evolutions. The participation of agency EMS assets will allow for training and coordination of NFPA required incident rehabilitation (refer to Nassau REMAC Advisory 08-12.1 for further information), integration of EMS and Fire resources in an actual incident setting under ICS and provide prehospital care and transport in the event of an injury or illness. This letter of agreement allows agencies participating at the Fire Service Academy to operate under a mutual aid request to the Plainview Fire Department and complies with the requirements for mutual aid and operations outside of an agency s designated operating area as stated in the New York State Public Health Law, Article 30. Please contact the REMSCo office for any questions or additional information. Scott Glazer Chairman Nassau Regional EMS