EMS 5-Minute Drills.pdf

"EMS Five Minute Drills" *Calling Party Differentiation *EMS700 *EPCR *Good Intent *Montgomery Hospice *Stroke Patients Not Same *Patients in Police Custody *Police Custody Refusals *Repatriation *Stabilization Room *Trauma Care Bag *Two Medics On One AFRA *Verbal DNR *What Is a Patient *ROSC Ch...

"EMS Five Minute Drills" *Calling Party Differentiation *EMS700 *EPCR *Good Intent *Montgomery Hospice *Stroke Patients Not Same *Patients in Police Custody *Police Custody Refusals *Repatriation *Stabilization Room *Trauma Care Bag *Two Medics On One AFRA *Verbal DNR *What Is a Patient *ROSC Checklist  What is a 4th party caller? (and 1st, 2nd, 3rd) Someone whois Someonewho isactually actuallywith withthe the Someone who both does not The patient patient or is intimately familiar with withpatient the the patient and their and their  condi- know the patient is the caller. condition/situation tion/situation and is is not on scene; “single caller passerby” is the prime example of this scenario Interconnected professional prefessional entities who transfer requests for EMS/Fire needs. Prime examples are the police side of ECC requesting EMS, Security/Fire alarm/medical monitoring companies  The healthcare system currently faces many challenges: 1) Higher acuity patients 2) Staffing shortages 3) Longer inpatient hospital stays EMS700 is in place to HELP you! They:  Liaise with the EMS DOs and ED staff 7A13  Monitor EMS resources, ED conditions and hospital statuses  Assist with the clinical based decisions, matching each patient with the best need  Alternative Destinations, Hospital Transports, DTT, Refusals, etc.  Collaborate with you to make the best medically based decision destination When notifying EMS 700:  Provide the transporting unit (e.g., “A708B”, not “ALS708”)  Inform of age, nature of illness/injury, and pertinent assessment findings  Advise of medical needs, repatriation, patient preference, if warranted  State your plan – what you intend to do / where you intend to transport EMS 700 may send a unit:  farther to avoid a long wait at a closer ED, or to match inpatient capabilities (ICU, BH)  to Children’s if local pediatric beds are limited or if PICU admission is a possibility Understand, there will still be times when the demand for EMS services surge the healthcare system and inundates the facilities in the area’s ability to promptly register, triage, and/or treat. IL·- ·_ - -. - I Say something like this... Avoid communications like this... _, "Medic 723 to EMS700, we have a 17-year- :....  ePCR’s are a legal, historical healthcare document and read by healthcare professionals, lawyers, police, family members, patients, and others. The ePCR narrative: The FireApp narrative: Reflects only things relating to Scene findings the patient and care provided Crew actions Accuracy matters…times, Unusual circumstances procedures, medications PPE levels Proofread! Grammar! Punctuation! Imagine in two or three years, sitting on the stand, and all you have is your FireApp Report & ePCR… Can you defend what you did or did not do? Did you know… …as soon as an ePCR is posted it uploads to the patient’s electronic health record …MCFRS receives approximately 200 PCR requests & 50 subpoenas a month  Writing “Good Intent” is indefensible & provides no information. Document what you did "GOOD INTENT" & found on scene. Document well!  WHO: DNR-B patients WHAT: A new WHY: Patents and already enrolled in option for assisting families sometimes Montgomery Hospice patients with call 911 out of (look for sticker on their palliative care desperation or anxiety hospital bed like the background image) 6001 Muncaster Mill Rd When you identify a DNR-B Montgomery Hospice patient, call the number above and collaborate with Hospice Staff Possible outcomes include: Transport directly to the Casey House from anywhere in the county Telehealth visit with Hospice Staff – they will facilitate Scheduling of a Hospice Visit in the home Transport to the ED (unlikely)  Must go to a Thrombectomy Capable Primary Stroke Center or Comprehensive Stroke Center: Shady Grove Medical Center Suburban Hospital Washington Hospital Center LAMS (LOS ANGELES MOTOR SCALE) Georgetown University Facial Droop Arm Drift Grip Strength Hospital Absent – 0 Absent – 0 Normal – 0 George Washington University Hospital Present – 1 Drifts Down – 1 Weak Grip – 1 Falls Rapidly – 2 No Grip – 2 Can go to any Primary Stroke Center: LAMS of 4 or 5 is Indicative of Large Vessel Occlusion (LVO) All Hospitals in Montgomery County  Be a patient with a chief × Allow police to dictate any treatment or transport complaint (including decisions undifferentiated agitation) × Allow any patient to be handcuffed behind their  Be transporting to a back, restrained face down, medical facility or positioned in any other  Receive all appropriate way that compromises medical assessments and patient assessment or care treatments  Be accompanied by a law × Provide medical equipment (reeves) solely for law enforcement officer in enforcement purposes or the transport unit restraint EMIHS 5-minute Lineup Drill People in police custody (who are not being What determines an individual’s Emergency Petitioned) medical decision capacity? ✓ Understanding who have the medical ✓ Appreciation capacity to make ✓ Reasoning decisions have the right to ✓ Expressing a choice refuse medical treatment and/or transport (e.g., Maryland protocol lists five conditions arrested for a crime – not under which people are incapable of suicidal) making medical decisions. Do you know all five? Click here! Consult as necessary for High-Risk Refusals Remember… An individual being Emergency Petitioned cannot refuse and they must remain in police custody. They can be transported to a hospital-based emergency department via a patrol car or by us when accompanied by police. REPATRIATE To return a patient to a medical facility that provided previous treatment ✓ Treatment Expediency ✓ Coordination of Care ✓ Consistency of Care ✓ Improved Patient Outcomes Any hospitalization… especially surgeries! “(General Patient Care 2.1) If for Priority 2 or 3 patients, the patient has had a hospital admission within the last 30 days the EMS clinician should transport (repatriate) the patient to that hospital...” Coordinate with EMS700 – Honor reasonable requests EMIHS 5-minute Lineup Drill ROSC Checklist Coming to a LUCAS near You! Why: MCFRS achieves a lot of ROSC in patients. Now the goal is to increase the number of patients who are discharged from the hospital neurologically intact. What: A list of things for you to VERIFY and DO after you get ROSC but before you move the patient. Where: The ROSC Checklist will be placed on each LUCAS devices by EMS Logistics. The goal is to ensure it’s readily accessible when you need it. Review the MIEMSS ROSC Protocol! EMIHS 5-minute Lineup Drill New Alternative Destination Option Crisis Center Stabilization Room – 1301 Piccard Drive Indications: Low acuity behavioral health patients Alcohol or drug intoxication EMIHS 5-minute Lineup Drill New Alternative Destination Option Criteria 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 CALL 240-777-1374 to arrange for patient transport The Crisis Center is not an alternative shelter and cannot stabilize unconscious patients EMIHS 5-minute Lineup Drill New Alternative Destination Option Exclusions Evidence of trauma or needs stitches Chest pain, short 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 The Crisis Center is not an alternative shelter and cannot stabilize unconscious patients EMIHS 5-minute Lineup Drill New Alternative Destination Option Process Assess the patient using the criteria in the worksheet Obtain consent and signature on the worksheet Call the "Crisis Center Stabilization Room" in Sonim phone (240-777-1374) Enter through the Crisis Center entrance and take the patient to the Stabilization Room The Crisis Center is not an alternative shelter and cannot stabilize unconscious patients EMIHS 5-minute Lineup Drill New Alternative Destination Option Process Complete checklist with Stabilization Room staff Obtain ePCR signatures The Crisis Center is not an alternative shelter and cannot stabilize unconscious patients EMIHS 5-minute Lineup Drill New Alternative Destination Option What’s in it for patients No waiting – recliner is available right away Sober up safely with medical monitoring and meals Get connected to resources like detox, rehab, group support, etc. Get specialized care Get connected directly with mental health professionals No ER process or costs What’s in it for us? Get the right people to the right place Save the hospital beds for medically ill patients Faster turnover times The Crisis Center is not an alternative shelter and cannot stabilize unconscious patients EMIHS 5-minute Lineup Drill EMIHS 5-minute Lineup Drill EMIHS 5-minute Lineup Drill EMIHS 5-minute Lineup Drill  What is in it? Not Your Average Trauma Kit. Uses include: 1. Blanket to Prevent Hypothermia 2. QuikLitter for Extrication 3. Burns, Penetrating & Blunt Trauma Call Type Examples: 1. Shootings / Stabbings 2. Fires (RID, Aid Station) 3. Multi-Patient Dispatches 4. Building Explosions 5. Metro Events 6. Trail Rescues 7. ALL TRAUMA!! Go get it! Get your hands on it!  Question: “If I have 2 paramedics, should I place the 2nd AFRA in service on an ALS2 call?” The individual unit officer responding to the call has the authority to make this decision and it will vary upon the situation. Decisions must be consistent with the Operational Doctrine Statement On cardiac arrests the unit officer has a designated role that cannot be filled if they are acting as an ALS provider The extra manpower could be beneficial for carrying a patient up or down stairs or pit crew CPR You must ensure that the patient gets the Placing a responding unit in service to resources they need in the most appropriate improve county coverage is subordinate to manner good medicine. Take one call at a time.  Situation: Actions: 1. Establish floor of care (SPASM mnemonic) 1. Cardiac Arrest 2. Gather evidence of patient’s wishes 2. Reasonable belief that the patient does not Talk to family want resuscitation Living will 3. Paperwork is not an “official DNR” or is Incomplete DNR missing 3. Obtain a verbal DNR via normal medical consult process by articulating the reason you believe the patient did not want resuscitation Keep in mind... Obtaining a verbal DNR can happen at any point, including after the resuscitation has begun This decision balances our duty to act with respect for patient and family wishes You are identifying and complying with the patient’s wishes for their care – you are not determining futility or calling for early TOR  What is a PATIENT? Any person encountered by EMS with an actual or potential injury or medical problem Any person who has requested Any person for whom a EMS (1st party caller) or who health care professional has EMS requested for them calls 911. (2nd party caller). Any person for whom a Power of Attorney has called 911. This can include a state appointed "Patient A patient exists if a 2nd party Advocate" (4th party caller). caller witnessed signs or symptoms which imply illness Any person involved in a or injury, even in the face of situation that a trained denial by the patient. provider suspects would lead to illness or injury.