San Joaquin County Emergency Medical Services Agency Policy and Procedure Manual

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Policy Memorandum 2006-02 Clearing of Patients in Custody 4/27/2006 2009-01 Billing for services to non-transported patients 1/5/2009 2009-02 Emergency and Non-Emergency Patient Definitions 1/5/2009 2010-02 Patient Privacy 3/19/2010 2010-03 Patient Care Records (PCR) 12/3/2010 2010-04 Bariatric Patient Transports 12/17/2010 2011-02 Patients with Left Ventricular Assist Device (LVAD) 6/8/2011 2012-01 DNR and POLST 3/12/2012 2012-02 Patient Report at time of transfer to Emergency Department staff 4/19/2012 Rescinded 2/12/2015 2012-03 Scene Safety and Care for Patients with Penetrating Trauma 4/19/2012 2012-04 National Shortage of Sodium Bicarbonate 11/28/2012 2013-02 ALS Medical Cardiac Arrest FAQs 6/20/2013 2013-03 Cervical Spine Immobilization FAQs 6/20/2013 2013-04 Trauma Triage and Patient Transportation Superseded by EMS Policy Memorandum 2014-06 10/20/2013 11/6/2014 2013-05 Use of Hospital Heliports/Helipads Superseded by EMS Policy 4447 10/28/2013 7/1/2014 2014-01 Paramedic Report of Traumatic Arrest 1/10/2014 2014-02 Ebola and Emerging Infectious Disease 10/3/2014 Prehospital Ebola Response Guidance -REVISED 10/20/14 10/16/2014 2014-03 2014-04 ALS Adult Medical Cardiac Arrest Patient Destination 11/6/2014 2014-05 Southern Catchment Area Trauma Destinations 11/6/2014 2014-06 Major Trauma - Isolated Head Injury 11/6/2014 2015-01 Transfer of Prehospital Patient Care to Receiving Hospital Emergency Departments 2/12/2015 2015-02 National Shortage of Magnesium Sulfate 3/4/2015 2015-03 Spinal Motion Restriction (Stabilization) for the Injured Athlete 8/5/2015 2015-04 Multi-casualty Incident (MCI) and Base Hospital Communication 9/24/2015 2016-01 Use of the Kendrick's Extrication Device (KED) 1/6/2016 2016-02 Use of Hemostatic Dressings and Tourniquets 7/8/2016 2016-03 Temporary Change in Trauma Patient Destinations Superseded by EMS Policy Memorandum 2016-04 9/13/2016 Rescinded 9/30/2016 2016-04 Temporary Change in Trauma Patient Destinations Superseded by EMS Policy Memorandum 2016-05 9/30/2016 Rescinded 10/27/2016 2016-05 Update to Change in Trauma Patient Destinations Superseded by EMS Policy Memorandum 2016-06 10/27/2016 Rescinded 11/03/2016 Temporary Change in Trauma Patient Destinations 2016-06 Superseded by EMS Policy Memorandum 2017-01 11/3/2016 Rescinded 1/24/2017 2017-01 Restoration of Trauma Center Service Areas 1/24/2017 2016-06 Major Trauma Triage Criteria and Major Trauma Patient 2017-02 Destination 12/14/2017 2018-01 Response to Flu and Influenza likeillness 1/9/2018 Expired 02/28/2018 2018-02 Continued Integration of BLS Ambulances into the EMS System 3/1/2018 Updated 12/14/2017 - Page 1 of 6

Section 1000 System Organization and Management 1001 Ambulance Ordinance of San Joaquin County 10/19/2004 N/A Section 2000 Personnel and Training 2010 Maintenance of EMS Personnel Lists 1/1/2009 N/A 2010A Personnel Notification Form 1/1/2009 N/A 2010B Organization Personnel and Contact Update Form 1/1/2009 N/A EMS Policy 2311 04/01/08 2011 Skills Competency Verification Process 7/1/2010 Individuals Designated by Provider to Verify Skills 2011A Competency 7/1/2010 EMS Policy 2311A 2101 EMS Dispatcher Accreditation 7/1/2010 01/01/10 2210 Emergency Medical Responder Certification 8/20/2010 07/01/10 Emergency Medical Responder Skills Competency Verification Form 10/16/2013 7/1/2010 2210A 2310 Emergency Medical Technician Certification 10/24/2013 7/1/2010 2310A EMT Skills Competency Verification Form 7/1/2010 01/01/10 2341 Mark-I Auto Injector Skill Sheet 1/1/2009 N/A 2540 Paramedic Accreditation 7/1/2012 07/01/10 2540A Paramedic Accreditation Field Evaluation 7/1/2012 N/A 2540B Paramedic Competency Verification Form 10/16/2013 7/2/2012 2540C Preceptor Evaluation Form Rescinded 07/2012 1/1/2010 N/A 2541 Paramedic Infrequently Used Skills 10/16/2013 7/1/2010 2544 Intraosseous Cannulation Performance Criteria - EZ-IO 1/1/2012 N/A 2545 Endotracheal Intubation - Adult Performance Criteria 10/16/2013 10/1/2012 2546 Intraosseous Cannulation Performance Criteria - Manual 1/1/2012 02/15/10 2547 Transcutaneous Cardiac Pacing (TCP) Performance Criteria 2/15/2010 01/01/10 2548 Needle Thoracostomy Performance Criteria 1/1/2016 01/01/10 2549 Needle Cricothyrotomy - TLJVPerformance Criteria 1/1/2012 01/01/10 2550 Naso/Orogastric Intubation Performance Criteria 1/1/2010 01/01/09 2551 12 Lead ECG Performance Criteria 1/1/2012 1/1/2010 2552 King Airway Performance Criteria 10/16/2013 10/1/2012 2553 Endotracheal Intubation - Pediatric Performance Criteria 1/1/2010 N/A 2554 Continuous Positive Airway Pressure (CPAP) Performance 1/1/2010 N/A 2555 Nasotracheal Intubation - Adult Performance Criteria 1/1/2012 02/15/10 Needle Cricothyrotomy Performance Criteria - ENK Flow 2556 Oxygen Modulator 1/1/2012 N/A 2560 Paramedic Scope of Practice 1/1/2016 01/01/12 2570 Paramedic Preceptor Authorization 7/1/2012 01/01/11 2571 Paramedic Student Field Internship Authorization 7/1/2012 01/01/11 Paramedic Internship Registration Form Re-numbered to 4301A 1/1/2011 N/A 2571A 2571B Preceptor/Paramedic Program Evaluation Form 7/1/2012 01/01/11 2610 Mobile Intensive Care Nurse Authorization 7/1/2014 07/01/12 2610A MICN Orientation Verification Form 7/1/2014 6/15/2006 2610B MICN Continuing Education Form 6/15/2006 N/A Updated 12/14/2017 - Page 2 of 6

2700 Prehospital Personnel: License, Accreditation, Certification, and Authorization Review Process 8/20/2010 07/01/10 2702 Causes for the Denial or Revocation of a PreHospital Emergency Medical Care Certificate 8/20/2010 N/A 2710 EMT and Advanced EMT Disciplinary Action - EMS 8/20/2010 N/A 2715 Process for EMT and Advanced EMT Disciplinary Action - 8/20/2010 N/A 2720 Paramedic Employer Reporting Requirements 8/20/2010 N/A 2740 Investigative Review Panel 7/9/2010 07/01/10 2900 EMS Continuing Education Program Approval 12/15/2005 710.01 Section 3000 Communications 3001 Guidelines for EMS Call Screening By Primary Public Safety Answering Points 4/21/2006 N/A 3001A PSAP Call Type Flow Sheet 4/21/2006 N/A 3101 Emergency Ambulance Service Provider Dispatch Requirements 5/1/2006 410.01 3109 City of Stockton Emergency Medical Dispatch Center Requirements 1/2/2008 N/A 3202 Medical Priority Dispatch System Assignments 7/1/2017 02/01/17 3410 ALS Field to Hospital Communication 7/1/2014 01/01/12 3411 ALS Radio Report Format 7/1/2014 01/01/12 Basic Life Support Unit Emergency Field to Hospital 3412 Communication 1/1/2009 530.09 3415 Trauma Center Notification 8/1/2013 2/1/2013 Section 4000 EMS Providers and Facilities 4101 EMS Response Vehicle Medication and Equipment 7/1/2016 4101 & 4102-10/16/2013 4102 ALS Medication and Equipment Inventory 10/16/2013 2/1/2012 4200 Management of Controlled Substances 10/16/2013 2/1/2009 FORM DEA 106 Report of Theft of Loss of Controlled Substances (11-00) 4301 Paramedic Field Internship ALS Provider Responsibilities 7/1/2012 N/A 4301A Paramedic Field Internship Registration Form 7/1/2012 N/A 4441 EMS Aircraft Classification and Authorization 1/1/2010 N/A 4442 EMS Aircraft Medical Control 1/1/2010 N/A 4447 EMS Aircraft Landing Sites 7/1/2014 5/1/2006 4448 EMS Aircraft Utilization 5/1/2006 N/A 4448A EMS Aircraft Utilization Form 5/1/2006 N/A 4701 Trauma System Management and General Provisions 1/1/2016 12/1/2012 4709 Trauma Center Service Areas 11/6/2014 N/A 4710 Trauma Center Designation 12/1/2012 N/A 4712 Level II Trauma Center Standards 12/1/2012 N/A 4713 Level III Trauma Center Standards 12/1/2012 N/A 4720 Trauma Center Team Activation 12/1/2012 N/A 4801 STEMI Receiving Center Designation 10/1/2011 N/A 4802 STEMI Receiving Center Data Requirements 10/1/2011 N/A 4811 Primary Stroke Center Designation 7/1/2017 N/A 4812 Primary Stroke Center Data Requirements 10/20/2017 N/A 4901 Base Hospital Standards 6/1/2008 310.01 4980 Receiving Hospital Diversion 1/1/2016 01/01/10 4981 Receiving Hospital Status 1/1/2016 N/A Updated 12/14/2017 - Page 3 of 6

Section 5000 Prehospital Care 5001 Authority for Medical Emergency Management 11/14/2006 530.03 5102 Patient Privacy 1/1/2010 N/A 5103 Determination of Death in the Field 10/16/2013 1/1/2012 5105 Do Not Resuscitate Orders 2/1/2007 540.05 Interaction with Physician or Other Health Care Provider on Scene 10/15/2010 08/31/10 5106 5106A Physician on Involvement with EMT-Ps 1/1/2009 540.06 5107 Use of Restraints 7/1/2010 11/01/06 5108 Care of Minors in the Field 1/1/2009 N/A Patient Refusal of Treatment or Transport Against Medical Advice (AMA) 7/1/2010 540.09 5109 5110 Anatomical Donor Cards 3/1/2008 530.09 5115 Cervical Spine Stabilization 7/1/2015 (rev) 7/1/2013 5121 Neurological Triage Criteria Rescinded 6/13 1/1/2012 09/01/07 5122 Pediatric Trauma Triage Criteria Rescinded 6/13 9/1/2007 550.04 5130 ALS Without Base Hospital Contact 1/1/2009 540.02 5130A ALS Without Base Hospital Contact Report 1/1/2012 01/01/09 5201 Medical Patient Destination 6/15/2016 1/1/2016 5210 Major Trauma Triage Criteria 8/1/2013 5121 and 5122 5215 Trauma Patient Destination 7/1/2017 1/1/2016 5500 BLS Treatment Protocols - Introduction 7/1/2007 510.02, 510.04, SJ- B100-SJ-B999 510.01, 510.07-.08, 510.10 5502 BLS Scope of Practice Summary 7/1/2007 5503 BLS Routine Medical Care 7/1/2007 N/A 5504 BLS Patient Assessment - Primary Survey 7/1/2007 510.03 5505 BLS Patient Assessment - Secondary Survey 1/1/2016 07/07/07 5506 BLS Spinal Immobilization Rescinded 6/13 7/1/2007 510.09 5507 BLS Inter-facility Patient Transports 1/1/2012 07/01/07 5510 BLS Chest Pain of Suspected Cardiac Origin 1/1/2012 07/01/07 5511 BLS Cardiac Arrest 10/16/2013 01/01/12 5520 BLS Respiratory Distress 7/1/2007 N/A 5530 BLS Altered Mental Status 7/1/2007 N/A 5531 BLS Seizures 7/1/2007 N/A 5540 BLS Shock Non-Traumatic 7/1/2007 N/A 5541 BLS Abdominal Emergencies 7/1/2007 N/A 5542 BLS Poisoning and Overdose 1/1/2016 07/01/07 5551 BLS Allergic Reaction - Anaphylaxis 1/1/2016 01/01/12 5552 BLS Bites and Stings 7/1/2007 N/A 5553 BLS Snake Bite 7/1/2007 N/A 5554 BLS Hypothermia - Frostbite 7/1/2007 N/A 5555 BLS Hyperthermia 7/1/2007 N/A 5560 BLS Gynecological Emergencies 1/1/2012 07/01/07 5561 BLS Childbirth 1/1/2012 07/01/07 5581 BLS Burns 7/1/2007 N/A 5582 BLS Traumatic Cardiac Arrest Rescinded 10/2013 7/1/2007 N/A 5583 BLS Head-Neck--Facial Trauma 1/1/2012 07/01/07 5584 BLS Chest-Abdominal Trauma 1/1/2012 07/01/07 5585 BLS Extremity Trauma 1/1/2012 07/01/07 5700 ALS Treatment Protocols - Introduction 2/15/2010 01/01/10 Updated 12/14/2017 - Page 4 of 6

5701 Routine ALS Care 1/1/2012 02/01/07 5702 ALS Advanced Airway Management 10/1/2012 01/01/12 5704 ALS Patient Assessment - Primary Survey 10/16/2013 01/01/12 5705 ALS Patient Assessment - Secondary Survey 9/1/2007 510.05 5707 ALS Adult Pain Management 7/1/2016 2/1/2007 5708 ALS Adult Nausea Management 7/1/2015 N/A 5710 ALS Medical Cardiac Arrest 10/16/2013 6/1/2013 5710A Medical Cardiac Arrest - Pit Crew Appendix A 7/1/2013 N/A 5711 ALS Ventricular Fibrillation/Pulseless VTach 10/16/2013 1/1/2012 5712 ALS Wide Complex Tachycardia with a Pulse 1/1/2012 02/01/07 5713 ALS Narrow Complex Tachycardia; Atrial Fibrillation/Flutter 1/1/2012 02/01/07 5714 ALS Narrow Complex Tachycardia; SVT 1/1/2012 02/01/07 5715 ALS Asystole 10/16/2013 1/1/2012 5716 ALS Pulseless Electrical Activity 10/16/2013 1/1/2012 5717 ALS Bradycardia 1/1/2012 02/15/10 5719 ALS Chest Pain 7/1/2016 10/01/11 5720 ALS Cardiogenic Shock 1/1/2012 02/15/10 5721 ALS Hypertension - Rescinded 12/11 2/1/2007 N/A 5724 ALS Ventricular Ectopy 1/1/2012 02/01/07 5726 ALS Return of Spontaneous Circulation 1/1/2012 02/15/10 5727 ALS Therapeutic Hypothermia 1/1/2012 N/A 5731 ALS Allergic Reaction/Anaphylaxis 2/1/2007 SJ-A43 5733 ALS Poisoning/Overdose 1/1/2012 02/01/07 5735 ALS Heat Illness 2/1/2007 SJ-A63 5736 ALS Hypothermia 1/1/2012 02/01/07 5738 ALS Envenomation 2/1/2007 SJ-A61 5751 ALS Altered Level of Consciousness 10/16/2013 1/1/2012 5753 ALS Seizures 10/16/2013 1/1/2012 5754 ALS Acute Stroke 10/25/2017 7/1/2017 5761 ALS Gynecological Emergencies 1/1/2012 1/1/2007 5762 ALS Vaginal Hemorrhage with Shock - Rescinded 12/11 2/1/2007 SJ-A75 5763 ALS Severe Pre-Eclampsia/Eclampsia - Rescinded 12/11 1/1/2010 02/01/07 5764 ALS Childbirth 1/1/2012 01/01/10 5771 ALS Bronchospasm 1/1/2010 06/01/08 5772 ALS Acute Pulmonary Edema 10/16/2013 02/02/10 5774 ALS Airway Obstruction 1/1/2010 02/01/07 5781 ALS Amputation - Rescinded 12/11 2/1/2007 N/A 5782 ALS Burn Care 2/24/2012 02/01/07 5783 ALS Adult Trauma Treatment 1/1/2016 10/16/13 5784 ALS Traumatic Arrest - Rescinded 12/11 2/1/2007 SJ-A83 5790 ALS Nerve Agent Exposure 7/1/2010 N/A 5800 Pediatric Routine Medical Care 1/1/2012 06/01/07 5808 ALS Pediatric Nausea Management 7/1/2015 N/A 5810 Pediatric Pulseless Arrest Asystole/PEA 7/24/2014 01/01/12 5811 Pediatric Pulseless Arrest - VFIB/VTACH 1/1/2012 06/01/07 5812 Pediatric Bradycardia 1/1/2012 02/15/10 5813 Pediatric Tachycardia with Pulses 1/1/2012 06/15/07 5815 Pediatric Apparent Life Threatening Event 6/1/2007 N/A 5817 Pediatric Airway Obstruction 1/1/2012 01/01/10 Updated 12/14/2017 - Page 5 of 6

5819 Pediatric Respiratory Distress: Stridor 1/1/2012 06/01/07 5820 Pediatric Respiratory Distress: Bronchospasm 3/10/2010 06/01/08 5824 Pediatric Shock 1/1/2012 06/01/07 5826 Pediatric Allergic Reaction 1/1/2012 06/01/07 5828 Pediatric Seizure 10/1/2012 01/01/12 5829 Pediatric Altered Level of Consciousness 10/16/2013 10/1/2012 5830 Pediatric Poisoning/Overdose 10/1/2012 01/01/12 5833 Pediatric Trauma Rescinded 10/2013 6/1/2007 06/01/07 5837 Pediatric Burns 10/16/2013 6/1/2007 5839 Pediatric Pain Management 7/1/2016 6/1/2007 5850 Neonatal Resuscitation 6/1/2007 SJ-N01-2 5952 Monitoring Potassium Chloride Infusions 7/1/2016 1/1/2007 5954 Monitoring Heparin Infusions 7/1/2016 1/1/2007 5955 Monitoring Nitroglycerin Infusions 7/1/2016 1/1/2007 Section 6000 Data Collection and System Evaluation 6008 Interim Patient Care Report 7/9/2009 4/1/2006 6020 Notification of new Public Access Defibrillation Program 6/14/2007 N/A 6101 Sentinel Event Reporting Requirements 7/1/2010 03/17/09 6101A Sentinel Event Report Form 3/17/2009 01/07/08 6101A 6102 EMS Unusual Occurrence Process 7/1/2010 540.01 6102A Unusual Occurrence Form 7/1/2010 6002 6286 Prohibited Abbreviation List 10/1/2006 N/A 6301 Ambulance Provider Data Requirements 12/15/2005 N/A 6620 Continuous Quality Improvement Process 5/1/2006 N/A 6630 Continuous Quality Improvement Council 10/1/2006 N/A 6680 Research Studies 5/1/2006 N/A 6710 Trauma Center Quality Improvement 12/1/2012 N/A 6715 Trauma Audit Committee 9/1/2014 N/A 6720 Trauma Data Management 12/1/2012 N/A Section 7000 Multi-Casualty Incident and Disaster Medical 7010 Multi-Casualty Incident Field Operations 06/1998 N/A 7020 Multi-Casualty Incident Control Facility Operations 02/1998 12/1997 7030 Medical/Health Mutual Aid System 03/2005 N/A 7040 Hospital Inpatient Bed Polling 2/1/2009 N/A 7101 EMS CHEMPACK Request - Prehospital 8/20/2010 07/01/10 07/01/10 7101A & 7101B 7101A EMS CHEMPACK Release and Receipt Form 8/20/2010 EMS Active Threat Plan; An Integrated Response for Law Enforcement and Multi-Casualty Incident Branch 7210 Operations 6/14/2016 N/A Updated 12/14/2017 - Page 6 of 6