NORTH COAST EMERGENCY MEDICAL SERVICES POLICIES AND PROCEDURES

NORTH COAST EMERGENCY MEDICAL SERVICES Policy # 2508

POLICIES AND PROCEDURES

Subject: Medical Direction

Med-Net Communication Guidelines

Associated Policies: 2502, 2503, 2505, 2506, 2507

I. Authority and Reference (incorporated herein by reference)

A. Division 2.5 of the Health and Safety Code.

B. California Code of Regulations, Title 22.

C. North Coast Emergency Medical Ser'vices Policies and Procedures.

II. Purpose:

To provide procedural guidelines by which base hospital and field providers may conduct Med-Net communications.

III. Policy

A. Enroute

1. Enroute to the scene, the field provider should advise the base hospital of:

a. Responding crew identification

b. Nature of the call and response code

c. Estimated time of arrival at scene (advise of transport time will be less than five minutes)

B. Initial report from the scene

1. In the event of life threatening emergencies, the field personnel may choose to contact the base hospital with an initial report. The initial report should serve to warn the base hospital (or the receiving hospital via the base hospital) of the impending arrival of a patient and possible resources needed to manage the patient. The initial report should be brief (about twenty to thirty seconds) and include at a minimum:

a. Medical vs. Trauma and severity level

(1) Mild or Level 1

(2) Moderate or Level 2

(3) Severe/Acute distress or Level 3

b. Unavoidable delays (i.e. extrication, over the bank rescue, transporting unit still enroute to scene, etc.)

c. Any brief additional patient information available:

(1) Mechanism of Injury or Medical Condition

(2) ABCs

(3) Anatomical region of major injury(s)

(a) Head/Throat

(b) Chest

(d) Spine

(e) Extremity(s)

(f) Etc.

(4) General type of injury

(a) Penetrating

(b) Blunt

(d) Fractures (also if suspected or obvious)

(5) Recommendation for activation of trauma team or thrombolytics if appropriate

C. Recommended EMS radio report content/format to the hospital

Items in BOLD are the minimum elements; items in normal type are recommended if time allows. Remember, this report should be brief, concise and pertinent to the patient's condition and ultimate survival.

1. Transport code, patient # (if more than one patient report on the most critical first)

and the ETA to the hospital.

2. Level of distress (Mild, Moderate, Severe/Acute or Level 1,2, or 3 as above) and whether Medical or Trauma patient.

3. Age, Gender and Weight.

4. Chief Complaint.

5. History of Present Illness (HPI) or Mechanism of Injury.

6. Past Medical History (PMH) with pertinent current medications or allergies.

7. Vital Signs (BLS may report vitals as "stable" if within normal limits)

* * a. Level of Consciousness (Glascow Coma Scale or other recognized equivalent)

(1) Eye opening--Spontaneous, responds to verbal, responds to pain, none.

(2) Verbal response--Oriented, disoriented, inappropriate, incomprehensible, none.

(3) Motor response--Obeys commands, purposeful movement, withdrawal from pain, extension to pain, none.

** b. Pulse rate with ECG reading if applicable.

** c. Respiratory rate with lung sounds.

** d. Blood pressure.

e. Skin signs including capillary refill.

f. Pulse Oximetry reading if available.

8. Physical Exam

a. Head to toe or other logical progression.

9 Procedures performed on Standing Orders or Radio Delay/Radio Failure and response to treatment or identify the standing order protocol followed and response.

10. Request for further treatment or orders.

11. Private MD and any other incident history or past medical history which may be needed prior to arrival.

** Remember that vital signs in children are late indicators of physiologic problems. Report findings from the Pediatric Assessment Triangle or APGAR in place of vital signs for pediatric or neonate patients.

D. Basic points of procedure

Identify both the hospital being called and the field unit with each transmission
Know what you are going to say before you begin your report. Give the report clearly and slowly enough that it can be written down.
Break often during long or multiple patient reports to allow for questions or interrupts.
If you are seeking a particular order(s), concisely provide the information which clearly shows the presence of indications and absence of contra-indications for the order(s) you seek.
Any order received by an EMT-II must be repeated back to the hospital giving the order for confirmation.
After the complete report is given, repeated contact is unnecessary unless a change in the patient's status or significant change in the ETA occurs.
If the transport time is short (two to five minutes) hospital contact should be made from the scene with at least a preliminary report.
If the transport time is longer than five minutes, initial hospital contact may be made from either the scene or during transport as determined by patient needs, but always at the earliest time possible prior to arrival.
The EMT shall make every reasonable attempt to establish voice communication with the base hospital or alternate base hospital via radio or telephone in a timely manner as soon as practical before arrival at the receiving facility.

E. Base Hospital Guidelines

1. Enroute to the scene

a. Start a new Emergency Department Communication Record when contacted by the field unit responding to an emergency.

2. Field reports

a. Prehospital personnel will contact the hospital according to section III-A above.

b. Complete the corresponding sections of the Emergency Department Communication Record during the field report.

c. If more than one person is involved in receiving the field report, it is essential that the information reported previously be passed on to the new receiving personnel.

3. Basic points of procedure

a. Keep communications with prehospital personnel brief, concise and pertinent to the patient's survival and the capabilities of the EMT-II or EMT-P (ie. do not ask for information not pertinent to care available in the field or not in preparation of the ED to receive the patient).

b. Only an authorized Mobile Intensive Care Nurse (MICN) or on-duty Emergency Department physician may take patient reports or give orders to field care providers via the phone or radio.

c. Speak slowly and clearly when communicating with field providers.

d. Sign the Emergency Department Communication Record.

e. Repeat vital signs, physical findings, etc., as needed to confirm you have the correct information.

f. During MCIs, consider distributing patients to more than one facility if possible.

4. Forward the report to the receiving hospital if other than the base hospital

a. Telephone the receiving facility immediately after the field report

b. Convey the following information

(1) Identify yourself and your facility.

(2) ETA of the field provider to the receiving facility.

(3) Medical patients: Chief complaint and related pertinent information.

(4) Trauma patients: Trauma information and related pertinent information.

(5) Procedures performed and response to treatment

(6) Any other pertinent information not categorized above.

5. Document the time and who received the report on the Emergency Department Communication Record.

Approved: Date:

Approved As To Form: Date: