EMS 5 Min. 24'.pdf

Calling Party Di erential - 4th Party Caller - 1st - patient - 2nd - someone immediately with the patient - 3rd - passerby, unknown to patient - 4th - Police transfer to Fire Rescue EMS 700 What does 700 Do: - L...

Calling Party Di erential - 4th Party Caller - 1st - patient - 2nd - someone immediately with the patient - 3rd - passerby, unknown to patient - 4th - Police transfer to Fire Rescue EMS 700 What does 700 Do: - Liaise - EMS duty o cer and ED sta - Monitor - hospital status, conditions and EMS resources - Assist - matching clinical decision with patient needs - Collaborate - to make best medical decision - Noti cation (7A13) to 700 includes: - Provide - unit # - Inform - age, nature of illness - Advise - medical needs/ preference - State - plan, what you doing/ intend to do - What may 700 do: - They may send you to another ED for shorter wait times EPCR - Document Well - EPCR’s are legal historical health documents read by healthcare professionals, lawyers, patients… (200 request/ subpoena a month) - EPCR’s posts and are upload to the patient electronic healthcare records Narrative - Accuracy matters - If it is not documented it didn’t happen Fire App Narrative - Scene ndings, Crew actions, unusual circumstances, PPE levels fi fi ffi ff ff  Good Intent - “Good Intent” Indefensible statement, requires details of a scene - Completely nonexistent suspected emergency - Bene ciary obviously not ill or injured - would not have called - unimpaired - unattended minor - support with facts Montgomery County Hospice Casey House, 6001 Muncaster Mill 240-640-9411 - DNR patients already enrolled in Montgomery County Hospice - Transport to Casey, provide Telehealth, set up site visit Not All Strokes Are The Same - Positive Cincinatti or Cerebral Must go to Thrombectomy or Compressive Stroke Center : - LAMS 4 or 5 is indicate of (LVO) Large vessel occlusion - GW, Georgetown, Washington Hospital Center, Shady Grove, Suburban Less then 4 - Primary stroke center - All MOCO hospitals LAMS 0 1 2 Facial Droop Absent Present Arm Drift Absent Drifts down Falls rapidly Grip Strength Normal Weak No grip Stroke Last Known Well Time (LKW) - Look for indications of activity within last 22hrs - Be detectives - Look for (ICE) - In case of emergency - phone contact Posterior Cerebral Assessment - Stroke alert within 22 hrs fi Assessment positive with - Loss of balance/ dizziness - Blurred vision or intermittently blurred Patients in Police Custody - Must: - Transport Pt with CC (including severe agitation without CC) - Transport to medical facility and treat and assess per normal/ document well - Law enforcement in unit - Must Not: - Allow police to dictate care - No hand cu s face down or any compromising position - Police cannot use our equipment to restrain - Police Refusal: - Emergency petition cannot refuse (transport with police or in cruiser) - Pt must show to refuse: - Understanding - Appreciation - Reasoning - Expressing choice - Pt Cannot Refuse (5 protocol reasons): - Altered mental status - Attempted suicide - Acting irrational - Judgement impaired by severe illness/ injury - Emergency Petition Repatriate (return to treating facility) - Coordination of care - Consistency of care - Treatment expediency - Improve PT outcome - Post surgery PT’s - Treated within the last 30 days ff  Stabilization Room (with recliner) - Alternative destination Criss Center Stabilization Room Picard Dr - Not a shelter, No medical, trauma or police custody - over 18, stable walking PT, requesting help/ safe place to stay to sober up - Reasons For transport: - Low Acuity behavioral health and suicidal ideation - Acute alcohol or drug intoxication without withdrawal/ detox - Process: - Checklist, all yes, Epcr Signatures - Call 240-777-1374 Trauma Care Bag - For All Trauma Calls - 2 bags on Engines, Trucks, Squads and Ambo’s, 1 on all others - Resupply from EMS Logistics - Whats in it: - Hypothermia Blanket - QuikLitter - Equipment for Burns, Penetrating and Blunt Trauma 2 Medics on 1 AFRA - Unit O cer decision made with “Operation Doctrine Statement” - “Ensure Pt gets resources in most appropriate manner” - 1 call at a time, subordinate to operational needs Verbal DNR - Consult for Verbal DNR and provide justi cation - Happen anytime during call - Honoring family wishes - Not determining Futility or Early TOR DNR can happen at anytime with consult based on: - family wishes - improper form - reasonable belief PT doesn’t want to be resuscitated Providers Do Not Determine futility and call for early TOR ffi fi What Is a Patient Anyone encountered with an injury or medical condition - 1st and 2nd party caller with injury or illness even with patient denial - Power of Attorney or Patient Advocate (4th party caller) - Healthcare provider calls 911 - Trained provider suspects situation leads to injury or illness ROSC Checklist - Goal is to discharged PT neurologically intact - Checklist will be placed on each LUCAS by EMS Logistics, “readily accessible” for use after ROSC but before you move the PT 1. Tactical Pause 2. Airway, O2, Pause - Use ventilator - O2 titrate to 96-98% - Ventilation rate ETCO2 40-45 mmhg 3. Circulation - BP systolic 110 Fluids/ Pressor - Transmit ECG - STEMI alert as needed - 2nd Access - IV preferred - BP timer every 2 minutes 4. Support - Anti-arrhythmia, rate control, hypoglycemia - Treat agitation/ bucking - Package and move in controlled manner