EMS Patient Management and Stroke Protocols

EMS 700

• EMS 700 is a system that monitors EMS resources, ED conditions, and hospital statuses
• Assists with clinical decisions and matching each patient with the best need

Montgomery Hospice

• Patients enrolled in Montgomery Hospice have a sticker on their hospital bed
• When a patient is identified as Montgomery Hospice, call 6001 Muncaster Mill Rd, and collaborate with Hospice Staff
• Possible Outcomes: transport to Casey House, telehealth visit with Hospice Staff, scheduling of a Hospice visit, or transport to the ED (unlikely).

Stroke Patients

• Patients suspected of having a stroke must go to a Thrombectomy capable hospital: Shady Grove Medical Center, Suburban Hospital, Washington Hospital Center, or Georgetown University Hospital
• LAMS (LOS Angeles Motor Scale) helps determine the severity of a stroke
• If LAMS score is 4 or 5, it indicates Large Vessel Occlusion (LVO)
• If LAMS score is 4 or 5, patient can go to any Primary Stroke Center for treatment, any hospital in Montgomery County is a valid option
• A LAMS score of 0-3 means that the patient should go to a Thrombectomy capable hospital.

Patients in Police Custody

• Patients in Police Custody (who are not being Emergency Petitioned) have the right to refuse medical treatment and/or transport
• Medical decision capacity is determined by: Understanding, Appreciation, Reasoning and Expressing a choice
• Maryland Protocol lists 5 conditions under which people are incapable of making medical decisions.
• If a patient is being Emergency Petitioned, they cannot refuse and must remain in police custody.
• An Emergency Petitioned patient can be transported to a hospital-based emergency department via patrol car or by EMS when accompanied by Police

Repatriation

• Repatriation is when a patient is returned to a medical facility that provided previous treatment
• This is suggested in cases of: Treatment Expediency, Coordination of Care, Consistency of Care, and Improved Patient Outcomes

ROSC (Return of Spontaneous Circulation)

• MCFRS achieves a lot of ROSC in patients.
• The goal is to increase the number of patients who are discharged from the hospital neurologically intact.
• MCFRS now has a ROSC Checklist placed on each LUCAS device to help make this happen.

Trauma Care Bag

• The trauma care bag is used for Burns, Penetrating, and Blunt Trauma
• Examples of call types that would require use of the Trauma Care Bag: Shootings, Stabbings, Fires, Multi-Patient Dispatches, Building Explosions, Metro Events, Trail Rescues, ALL TRAUMA!!

Two Medics on One AFRA

• The decision of whether or not to place a second AFRA in service on an ALS2 call is up to the individual unit officer responding to the call.
• The decision should be consistent with the Operational Doctrine Statement
• Decisions should be based on the situation and priority is given to good medicine.

Verbal DNR

• When there is a cardiac arrest, the unit officer responding should use the SPASM mnemonic to guide the patient assessment.
• The unit officer should gather evidence of the patient's wishes. This includes talking to family, checking for a living will, or looking for an incomplete DNR.
• If the patient does not have an official DNR, the unit officer should attempt to obtain a verbal DNR from the patient's family.
• The decision to obtain a verbal DNR must be made with consideration of the patient's wishes and duty to act.

What is a Patient

• A patient is anyone encountered by EMS who has or may have an actual or potential injury or medical problem
• A patient exists if a 2nd party caller witnessed signs or symptoms which imply illness or injury, even in the face of denial by the patient
• A patient exists if a Power of Attorney has called 911
• A patient exists if a trained provider suspects a situation would lead to illness or injury.

Calling Party Differentiation

• A 1st party caller is the patient themselves.
• A 2nd party caller is someone who knows the patient and is familiar with their situation.
• A 3rd party caller is someone who is not on the scene, they may not know the patient well, such as a passerby.
• A 4th party caller is a professional entity who requests EMS services. For example, Police requesting EMS.

EMS700

• EMS700 is a program to help EMS professionals with resource management.
• EMS700 monitors EMS resources, ED conditions, and hospital statuses.
• EMS700 assists with clinical decisions matching each patient to the appropriate care.
• Examples of assistance: Alternative Destinations, Hospital Transports, DTT, Refusals.

MONTGOMERY HOSPICE

• DNR-B (Do Not Resuscitate) patients are already enrolled in Montgomery Hospice.
• Look for a sticker on their hospital bed to identify DNR-B Montgomery Hospice patients.
• Call the Montgomery Hospice number (6001 Muncaster Mill Rd) for assistance with DNR-B patients.
• Hospice staff will assist with transport options, telehealth visits, and scheduling in-home hospice visits.

Stroke Patients & Thrombectomy Capable Hospitals

• Stroke patients with a LAMS score of 4 or 5 are indicative of Large Vessel Occlusion (LVO) and must go to a Thrombectomy capable hospital.
• Thrombectomy capable hospitals in Montgomery County are:
  • Shady Grove Medical Center
  • Suburban Hospital
  • Washington Hospital Center
  • Georgetown University Hospital

Patients in Police Custody

• Patients in police custody who are not emergency petitioned may be considered for the Crisis Center Stabilization Room.
• The Crisis Center is located at 1301 Piccard Drive.
• The Crisis Center is not an alternative shelter and cannot stabilize unconscious patients.

Crisis Center Stabilization Room

• Criteria for Transport to the Crisis Center Stabilization Room:

  • Age 18 or over
  • Medically stable
  • Able to communicate
  • Cooperative
  • Consents to transport
  • Can walk on their own or with minimal assistance and sit in a recliner.
  • One or more of the following:
    • Requesting mental health support
    • Experiencing acute alcohol intoxication
    • Under the influence of other substances and needs a safe place to sober up.

• Exclusions from Transport to the Crisis Center Stabilization Room:

  • Evidence of trauma or needs stitches.
  • Chest pain, shortness of breath, unexplained abdominal or back pain.
  • Any plan to harm self or others (suicidal ideation is okay).
  • Combative or violent.
  • History of DTs or seizures upon withdrawal (for intoxication).
  • In police custody.

Trauma Care Bag

• The Trauma Care Bag is not your average trauma kit.
• It contains:
  • Blanket to prevent hypothermia.
  • QuikLitter for extrication.
  • Supplies for burns, penetrating, and blunt trauma.
• Examples of calls to use the Trauma Care Bag:
  • Shootings/Stabbings
  • Fires
  • Multi-patient Dispatches
  • Building Explosions
  • Metro Events
  • Trail Rescues
  • ALL Trauma!!

Two Medics on One AFRA

• Decision to add a second AFRA:
  • The individual unit officer responding to the call has the authority to make this decision based on the situation.
  • Decisions must be consistent with the Operational Doctrine Statement.
  • The extra manpower could be beneficial for carrying a patient up or down stairs or pit crew CPR.

Verbal DNR

• When a verbal DNR is considered:
  • Cardiac Arrest
  • Reasonable belief that the patient does not want resuscitation.
  • Paperwork is not an “official DNR” or is missing.
• Process for obtaining a verbal DNR:
  • Gather evidence of the patient's wishes (talk to family, review living will, incomplete DNR).
  • Obtain a verbal DNR via the normal medical consult process by articulating why you believe the patient did not want resuscitation.
• Keep in mind: Obtaining a verbal DNR can happen at any point, including after resuscitation has begun.

What is a Patient?

• A patient is anyone encountered by EMS with an actual or potential injury or medical problem.
• Anyone who requests EMS (1st party caller) or anyone who has had EMS requested for them (2nd party caller) is considered a patient.
• This also includes:
  • Someone a health care professional calls 911 for (2nd party caller).
  • Someone a Power of Attorney calls 911 for (4th party caller).
  • Patients where a 2nd party caller witnessed signs or symptoms of illness or injury, even in the face of denial by the patient.
  • Anyone involved in a situation that a trained provider suspects would lead to illness or injury.

This quiz covers essential protocols related to EMS 700, Montgomery Hospice, and the management of stroke patients. It focuses on the identification, appropriate facility visits, and coordination with hospice staff for optimal patient care. Test your understanding of these critical health logistics and emergency procedures.