Calhoun County EMS ALS Protocols

1、Clinical Protocols yet declines transport. Check this box if the patient receives EMS treatment but then refuses transport. (i.e. hypoglycemic patient who receives glucose and wakes up, or patient with history of SVT who adamantly refuses transport post conversion of SVT with adenosine). Medic shoul

2、d document medication and dose administered on the line provided. Patient deemed competent, refuses; indicate which treatment the patient refused, buts agrees to transportation. (check this box only when a patient (or legal guardian) has agreed to ambulance transport but is refusing EMS recommended

3、care. Patient refuses Air-Medical Transport, but agrees to ground ambulance transportation. Check this box only when the patient agrees to ground transport but adamantly refuses helicopter transport. Section C: PATIENT/GUARDIAN/POWER OF ATTORNEY HAS BEEN ADVISED Of pre-hospital treatment and/or tran

4、sportation options. Check this box and list all transport and/or pre-hospital treatment options.(i.e. patient transported by family, continuous monitoring and transport recommended for patient declining transport after adenosine conversion etc) That transport by means, other than by ambulance, could

5、 be hazardous and is not recommended based upon current condition / complaint, specific injury or medical illness. Check if patient declines EMS offer of transport and the potential for deterioration could occur. (i.e. chest pain that decides to go by private vehicle) That significant risk(s) could

6、be involved with refusal of EMS treatment and/or transportation, related from, but not limited to; exacerbation of present complaint / condition / injuries, or the possibility of significant disability and/or death occurring from refusal of emergency medical care or transportation. Patient has been

7、informed of their right to refuse pre-hospital treatment and/or offer of transport to an appropriate medical facility (after being advised of potential complications) and appreciates consequences of his/her decision. That it is the preference of CCEMS to provide transport to the closest appropriate

8、medical facility for further evaluation and treatment. Section D: PATIENT SIGNATURE (this section to be completed by patient or patient representative) Have patient or patient representative 9not the medic) read and check all appropriate boxes in this section in which they are refusing. Recommended

9、treatment Ambulance / air transport Myself Minor less than 18 Other: _ check this box if they are declining care or transport for another person in their charge. List name of person on line they are assuming responsibility for. Patient / Patient Representative Signature (must be of legal age) Date (

10、actual date signed) Print Name Patient deemed competent, but declines or refuses to sign form: this box is checked whenever a patient is deemed competent through methods listed in section A, and adamantly refuses to sign the form. EMS Medic Signature: signature of medic completing the form. This sig

11、nature is only to verify that patient declined offers of care or transport and further declined to sign refusal form. (continued on next page) Clinical Protocols and Medical Directives25Calhoun County Emergency Medical Services (continued) Date actual date signed Print Name name of medic Witness Sig

12、nature (must be of legal age) Date actual date signed Print name name of witness PATIENT REFUSAL OF TREATMENT AND / OR AMBULANCE / AIR TRANSPORT Sections A. B and C completed by EMS Medic, Section D by patient or patient representative A.MEDICAL DECISION-MAKING CAPACITY: (Section must be completed b

13、y provider) 1.New onset of altered mental status?YE S NO 2.Known or suspected acute head trauma?YE S NO 3.Active suicidal ideations or evidence of recent self inflicted harm present? YE S NO 4. Does patient present as a significant life-threat to self or others (i.e., unable to care for minor (s) in

14、 their charge, continually attempts to enter an unsafe area, or exhibits unsafe behavior)? YE S NO 5. Is a communications barrier present and patient is unable to understand information in order to make an informed decision or communicate a choice? YE S NO 6. Is patient unable to comprehend the curr

15、ent situation and its consequences? YE S NO If YES is checked to any of questions 1-6. and patient is refusing EMS transport, they may not have adequate decision making capabilities. Contact an EMS Supervisor or Law Enforcement for resolution and patient disposition. B. ASSESSMENT / TREATMENT REFUSE

16、D: (Check any that apply) Patient deemed competent, declines all EMS care and further refuses all offers of ambulance transportation Patient deemed competent, accepts the following pre-hospital care; _ _ yet declines transport. Patient deemed competent, refuses; IV access Oxygen Spinal immobilizatio

17、n ECG application Vital signs Medication(s): _ Physical exam Other: _ but agrees to transportation Patient refuses Air-Medical (Helicopter) Transport, but agrees to ground ambulance transportation. (continued on next page) Run Number: Clinical Protocols and Medical Directives26Calhoun County Emergen

18、cy Medical Services C.PATIENT/ GUARDIAN / POWER OF ATTORNEY HAS BEEN ADVISED: (check all that apply) Of pre-hospital treatment and/or transportation options:_ That transport by means, other than by ambulance, could be hazardous and is not recommended based upon current condition / complaint, specifi

19、c injury or medical illness. That significant risk(s) could be involved with refusal of EMS treatment and / or transportation, related from, but not limited to: exacerbation of present complaint / condition / injuries, or the possibility of significant disability and/or death occurring from refusal

20、of emergent medical care or transportation. Patient has been informed of their right to refuse pre-hospital treatment and / or offer of transport to an appropriate medical facility (after being advised of potential complications) and appreciates consequences of his / her decision That it is the pref

21、erence of the Calhoun County EMS System to provide transport to the closest appropriate medical facility for further evaluation and treatment. D.PATIENT SIGNATURE: (This section to be completed by patient or patient representative) I (we), the undersigned, hereby certify that I (we) refuse recommend

22、ed treatment (as indicated under Sections B or C) and / or ambulance / air transportation to the closest appropriate hospital emergency department for: myself minor less than 18 Other: _ to preserve life / limb or promote recovery of health. I (we), having been so advised by the Emergency Medical Se

23、rvices (EMS) medics that above treatment and / or transportation is recommended, hereby accept all responsibility connected with my (our) refusal and release the Calhoun County EMS System, their employees, EMS paramedics, First responders, Medical Director, and administrative or executive officers f

24、rom any and all liability or claims resulting from any such refusal of advised care and / or transportation. I further understand that I should immediately contact the EMS system via 911 (or appropriate emergency number if no 911 system available), my personal physician, or emergency department phys

25、ician should further medical care be required. I acknowledge that I have received a copy of the Notice of Privacy Practices. A copy of this form is as valid as the original. _Date:_Print Name: _ Patient / Patient Representative Signature (must be of legal age) _Date:_Print Name : _ Witness Signature

26、 (must be of legal age) Patient deemed competent, but declines or refuses to sign form _Date: _Print Name: _ EMS Medic Signature _Date:_Print Name: _ Witness Signature (must be of legal age) Calhoun County EMS Multi-Patient Refusal of Care and Evaluation Form Clinical Protocols and Medical Directive

27、s27Calhoun County Emergency Medical Services INCIDENT INFORMATION Incident Location:_ Run Number: _ Date: _ 1.New onset of altered mental status?YESNO 2.Known or suspected acute head trauma?YESNO 3.Active suicidal ideations or evidence of recent self inflicted harm present? YESNO 4. Does patient pre

28、sent as a significant life-threat to self or others (i.e., unable to care for minor (s) in their charge, continually attempts to enter an unsafe area, or exhibits unsafe behavior)? YESNO 5. Is a communications barrier present and patient is unable to understand information in order to make an inform

29、ed decision or communicate a choice? YESNO 6. Is patient unable to comprehend the current situation and its consequences? YESNO If YES is checked to any of questions 1-6. and patient is refusing EMS transport, they may not have adequate decision making capabilities. Contact an EMS Supervisor or Law

30、Enforcement for resolution and patient disposition. I hereby refuse further examination and or treatment and release Calhoun County EMS, its employees, providers, and administrative officers from any liability or medical claims resulting from my refusal of care and/or transportation. I have been adv

31、ised that my condition may warrant further evaluation and / or treatment. I further understand that have I have been directed to contact my personal physician, hospital emergency department, or the EMS system (911) should I decide to consent to further medical evaluation. PATIENT 1 Patient Name: _ D

32、OB _/_/_ Signature of Patient or Legally Authorized Representative _ Date: _ I acknowledge that I have received a copy of the Notice of Privacy Practices. A copy of this form is as valid as the original. PATIENT 2 Patient Name: _ DOB _/_/_ Signature of Patient or Legally Authorized Representative _

33、Date: _ I acknowledge that I have received a copy of the Notice of Privacy Practices. A copy of this form is as valid as the original. PATIENT 3 Patient Name: _ DOB _/_/_ Signature of Patient or Legally Authorized Representative _ Date: _ I acknowledge that I have received a copy of the Notice of Pr

34、ivacy Practices. A copy of this form is as valid as the original. PATIENT 4 Patient Name: _ DOB _/_/_ Signature of Patient or Legally Authorized Representative _ Date: _ Clinical Protocols and Medical Directives28Calhoun County Emergency Medical Services I acknowledge that I have received a copy of

35、the Notice of Privacy Practices. A copy of this form is as valid as the original. WITNESS(ES) Witness Signature: _ Print Name: _ Witness Signature: _ Print Name: _ DESCRIPTION OF INCIDENT THIS FORM TO BE USED ON TWO (2) OR MORE PATIENTS ONLY Clinical Protocols and Medical Directives29Calhoun County

36、Emergency Medical Services This Page Intentionally Left Blank Clinical Protocols and Medical Directives30Calhoun County Emergency Medical Services Subject/Protocol:Intravenous (IV) Access and Therapy Last Revision:February 2010Protocol No.: C-1 Indications for Application: Patients whose medical or

37、traumatic history fit into any of the following categories should have an IV established: Respiratory or Cardio-respiratory Arrest Unconsciousness Respiratory Distress including illness refractory to pharmacologic therapies Major and Multi-system Trauma Anaphylactic reactions Major Burns Suspected M

38、I, Unstable Angina, Complicated CVA, or other life-threatening cardiac complications Suspected surgical cases including internal injuries/hemorrhage Patients whose condition may deteriorate during transport Any patient whose condition requires immediate medication or fluid administration via an intr

39、avenous route As directed by a specific protocol or a physicians order Contraindications: N/A General Guidelines and Standing Orders: Intravenous access may be instituted on this standing order when, based upon the patients condition, at least one of the above indications has been met When warranted

40、 by the patients condition, a fluid bolus of 250 ml NS may be administered on standing order. This order does not apply to patients with pulmonary edema, CVA, or Intracranial hemorrhage. When possible, obtain medical control authorization prior to bolus administration. Notes: IV therapy in the preho

41、spital setting is to be accomplished quickly. As a general guideline, multiple IV access attempts should be limited to two attempts. This is more of a time constraint and is not a medical limitation. The actual number of attempts must be decided by the medics caring for the patient or the physician

42、providing medical direction. Generally, intravenous access in the adult patient should be attempted first at a peripheral limb site. When multiple attempts (usually 2) have been unsuccessful and IV access is deemed by the medic in charge to be medically necessary, access to the external jugular vein

43、 may be attempted. (See Protocol C-2, “External Jugular Vein Access”). Multiple IV access attempts must not significantly increase on-scene time except in situations deemed to be immediately life threatening. For pediatric patients, intravenous access should first be attempted at a peripheral limb s

44、ite. When multiple attempts (usually 2) have been unsuccessful and immediate IV access is deemed by the medic in charge to be medically necessary (e.g. life-threatening condition), access via the intraosseous route should be attempted (See Protocol C-3, “Intraosseous Access”). IV access via the exte

45、rnal jugular route in the pediatric patient should only be attempted as a last resort in the patient considered having an immediately life-threatening condition. The vast majority of neonatal patients will not require intravenous access. In the neonatal patient requiring extensive resuscitation, the

46、 umbilical vein is the preferred initial site for IV access. Peripheral and/or Intraosseous access may be attempted if umbilical vein cannulation is unsuccessful. Umbilical vein cannulation must only be attempted by persons currently trained in this technique. IV catheters should be of an appropriat

47、e size based upon the type and severity of the patients condition. Major and multisystem trauma patients as well as those with suspected internal bleeding should have large bore catheters used for access. Other conditions may also require large bore catheters including poisonings, overdoses, anaphyl

48、actic reactions, and others that may cause hypotension. When medications with the potential to cause hypotension (and those that should be given in a large vein) are administered, consider establishing large bore IVs (e.g. verapamil, D50, adenosine, sedatives, etc.). Where this or any specific proto

49、col calls for IV access, a saline lock may be used instead provided the patient does not require fluid administration. Clinical Protocols and Medical Directives31Calhoun County Emergency Medical Services Subject/Protocol:External Jugular (EJ) Vein Access Last Revision:February 2010Protocol No.: C-2

50、Indications for Application: Adult patients whose medical or traumatic history fit into any of the categories listed in the indications for Protocol C-1, “Intravenous Access and Therapy”, AND WHEN: At least 2 attempts at peripheral IV access have been unsuccessful, AND The medic in charge of the pat

51、ient deems IV access to be immediately and medically necessary. Pediatric patients (greater than 8 years of age) whose medical or traumatic history fit into any of the categories listed in the indications for Protocol C-1, “Intravenous Access and Therapy”, AND WHEN: At least 2 attempts at peripheral

52、 IV access have been unsuccessful, AND The medic in charge of the patient deems IV access to be immediately and medically necessary. Contraindications: Inability to access the external jugular vein due to trauma or anatomical limitation (e.g. scarred neck) When C-spine immobilization may be compromi

53、sed by attempts to gain external jugular vein access. Patients less than 8 years of age General Guidelines and Standing Orders: When the indications for application have been met, standing orders for external jugular vein access are provided only when IV access is deemed to be immediately and medica

54、lly necessary. External jugular vein access must only be attempted by persons currently trained in this technique. Notes: The external jugular vein may provide adequate IV access when the vein is visible or palpable. In many critically ill or injured patients, this will not be the case. Attempts to

55、obtain IV access via the external jugular vein should not be made when the vein is not visible or not palpable. The external jugular (EJ) vein will be most visible when the patient is supine (assuming the patients condition will allow this). Turning the patients head slightly to one side may make th

56、e EJ vein more visible. Of course, this is not possible in the patient with a suspected C-spine injury. Once the vein is visible or palpable, place one finger of the non-dominant hand just beyond the anticipated venipuncture site. This will allow blood to fill the vein slightly and make it more visible. The remainder of the procedure is essentially identical to venipuncture of an extremity vein. Ensure the IV is adequately secured as this type of venipuncture site is easily dislodged by patient movement. Clinical Pro