Philadelphia Fire Department: EMS Triage Protocols

• This document outlines the procedures and guidelines for activating an Emergency Medical Services Triage Physician and/or Surgical Response Team in Philadelphia Fire Department.
• This document is EMS Procedure #6, and was published in December 2017

Triage Physician

• A Triage Physician is an emergency medicine physician, State-certified as a medical command physician.
• They work at a Medical Command Hospital under contract with the City of Philadelphia.
• Triage Physicians provide medical command to the Philadelphia Fire Department.
• They may be assisted by additional physicians and nurses if required.
• All Triage Physician Team members should be capable of prehospital triage and patient stabilization.
• Physician triage is deployed when the number and/or severity of patients exceeds Fire Department personnel capability.
• It is also used when the Incident Commander deems a physician's expertise beneficial.

Triage Physician Hospital

• A Designated Triage Physician Hospital is contracted with the City of Philadelphia.
• They should to provide a Triage Physician Team when requested by the Philadelphia Fire Department.

Surgical Response Team

• A Surgical Response Team comprises an attending trauma surgeon and assistants, if needed.
• Team members can perform surgical procedures on confined victims.
• These teams are deployed when surgical intervention is required on scene, such as amputation.

Surgical Response Hospital

• A Designated Surgical Response Hospital is contracted with the City of Philadelphia.
• They should to provide a Surgical Response Team when requested by the Philadelphia Fire Department.

Duty Physician

• The Duty Physician serves as either the Triage Physician or Surgical Response Team Leader.

Responsibility

• The Incident Commander is responsible for requesting a Triage Physician and/or Surgical Response Team.
• This decision should be made with the EMS Branch Director.

Activating a Triage Physician Team

• If incident requires services, Incident Commander, with EMS Branch Director, notifies the Fire Communications Center (FCC).
• The FCC contacts the Designated Triage Physician Hospital to activate a Triage Physician Team.
• The FCC offers all pertinent information (casualty number, injury types, etc.).
• The Designated Triage Physician Hospital mobilizes the appropriate response personnel.
• The Triage Physician Team provides necessary medications and medical supplies beyond paramedics' scope.
• The FCC dispatches a Medic Unit (Police as last resort) for team member transport to the hospital's emergency department.
• The Incident Commander or EMS Branch can use an EMS command vehicle (ES01 or ES03) for transport.
• When the vehicle arrives, the FCC is contacted to confirm need.
• The FCC contacts the Incident Commander for confirmation.
• The Triage Physician Team then responds to the scene in the provided vehicle if still required.
• The transporting vehicle monitors the radio frequency to update the physician(s) on incident and patient condition.
• A record of physician(s) names is kept by the EMS Branch Director and/or Medical Group Supervisor.
• If unneeded upon arrival, the Duty Physician consults the Incident Commander and the team returns to its origin.
• The Team must respond when requested by the Incident Commander.
• The FCC notifies the appropriate EMS Field Deputy Chief and the Philadelphia Fire Department Emergency Medical Services Medical Director of all Triage Physician Team requests.
• At the end of the emergency, team members receive transportation to their point of origin.

Activating a Surgical Response Team

• If the incident and extrication needs warrant it, the Incident Commander, with the EMS Branch Director, notifies the Fire Communications Center (FCC).
• The FCC then contacts the Designated Surgical Response Hospital, informing the Physician of the team need.
• The FCC provides all relevant data (casualty number, entrapment type, equipment needed, etc.).
• The Surgical Response Physician initiates and coordinates mobilization of necessary personnel.
• The physician is responsible for surgical care medical supplies, guided by the incident.
• When a Surgical Response Team is activated, the FCC also contacts a Designated Triage Physician Hospital to activate a Triage Physician Team.
• The Triage Physician Team is available at the scene to assist the Surgical Response Team. The FCC provides pertinent information to the physician
• The Triage Physician Hospital coordinates the mobilization of appropriate response personnel.
• The physician team provides medications outside paramedics' scope and additional supplies.
• FCC provides transportation for the physician team member by dispatching Medic Units to the hospital's emergency departments.
• The IC or EMS Branch has option to use an EMS command vehicle (ES01 or ES03) for this transport.
• When teams are assembled ready to respond, FCC is contacted to confirm need.
• If confirmed, both teams respond to the scene in their vehicles.
• The transporting vehicles monitor radio frequency to update the physician(s) on incident and patient condition.
• A record of physician(s) names is made for the EMS Branch Director and/or Medical Group Supervisor.
• If a surgical procedure is for one patient, the physician accompanies the patient to the hospital.
• Multiple patients require the physician to stay for continued care.
• If the teams aren't needed, the Duty Physician consults the Incident Commander, and the team returns.
• The Teams must not be prevented from responding when requested by the Incident Commander.
• The FCC notifies the appropriate EMS Operations Deputy Chief and the Philadelphia Fire Department Emergency Medical Services Medical Director of all requests for a Surgical Response Team.
• Physicians or team members are transported back to their point of origin once the emergency concludes.

Designated Triage Physician Hospital (Appendix A)

• Einstein Medical Center
• Located at 5501 Old York Road, Philadelphia, PA 19141
• Emergency Department telephone: 215-685-9177
• Triage Physician Teams are comprised of between 1-2 physicians

Designated Surgical Response Hospital (Appendix B)

• Penn Presbyterian Medical Center
• Located at 51 N. 39thStreet Philadelphia, PA 19104
• PennSTAR Communications Center, 215-662-7736
• Surgical Response Teams are comprised of between 1-2 physicians