Provisions of Patient Care EMS 484 Lect. 6

1. Provisions of Patient CareEMS 484 Lect. 6 Dr . Maha khalid

2. Protocols Protocols help define the scope of out-of-hospital care for an EMS agency

3. EMS providers must closely adhere to the protocols unless otherwise advised by online medical direction or clearly indicated by specific patient condition and reaction to usually employed therapies.

4. Standing Orders Standing orders are more specific and are usually included within a protocol when a delay in treatment could be detrimental to the patient’s medical condition • Examples of standing orders for A paramedic may include: • Defibrillation of a patient in ventricular fibrillation; • Advanced airway placement in an apneic patient; and • Medication administration for a cardiac arrest patient

5. Protocols and standing orders should be evidence-based and be heavily guided by current peer-reviewed medical literature when available, evidence-based national standards, and State and regional patient care guidelines

6. Online Medical Direction • Is the management of patient care by physicians through contact with the EMS providers by radio, phone, or other communication devices. EMS providers may seek online medical direction consultation to obtain orders, perform a procedure, or administer a drug that requires online approval. This communication allows for direct consultation on specific or unusual patient care situations and prepares the receiving facility for the incoming patient. This type of verbal communication may not always be given by the agency’s medical director but by a physician at a designated medical facility.

7. Offline Medical Direction • Offline medical direction involves the development, dissemination, and enforcement of written instruction. • Through offline medical direction, the EMS provider acts as an agent of the medical director. • Offline medical direction including protocols and standing orders.

8. Medical Director in the Field

9. Medical Director in the Field • Medical directors should routinely participate in field responses, making first-hand contemporaneous patient care evaluations of the EMS system. This may take the form of ride-along experiences with EMS personnel to gain field experience, or may involve an individual response or response with an officer or other EMS entity within the agency. This activity will help evaluate the agency’s effectiveness and the quality of service being rendered to ill and injured patients.

10. Incident Command System

11. Incident Command System • Whenever a medical director is participating with field operations, it is imperative that the Incident Command System (ICS) is understood and followed. This helps the medical director contribute to the management of the incident and not become a liability at the incident.

12. Incident Command System • The ICS is a standardized approach to manage emergency incidents and major events. The ICS is flexible and has a top-down organizational structure which begins when the first responder on the scene becomes the first Incident Commander (IC). The organizational structure can be expanded or contracted as necessary to accommodate the size of the incident

13. Incident Command System • When the medical director arrives on an emergency scene, they must immediately report to the Command Post for guidance, direction, and integration into the ICS, unless specifically directed to report to another area (e.g., Medical Branch or Staging) during their response to the incident scene. Properly trained medical directors can be of great value on the scene when they are fully integrated into the ICS.

14. Incident Command System • The three functions in the Medical Branch are Triage, Treatment, and Transport. Triage is the rapid assessment and sorting of patients. There are several models that are widely accepted within the EMS industry. One model is the Centers for Disease Control and Prevention (CDC) Sort, Assess, Life-Saving Interventions, Treatment and/or Transport (SALT) triage method

15. START triage model • Another popular triage tool is the Simple Triage and Rapid Transport (START) model. The START triage model sorts patients .into four color-coded categories