BOOK: Operations II SECTION: Emergency Medical Services Pg. 1 of 10

BOOK: Operations II SECTION: Emergency Medical Services Pg. 1 of 10

EMERGENCY MEDICAL SERVICES

TABLE OF CONTENTS

OPS/001 FIRST RESPONDER AGENCY

OPS/002 FIRST RESPONDER SYSTEM

OPS/003 MEDICAL CONTROL

OPS/004 MEDICAL RESPONSE GUIDELINES

OPS/005 EMSA - OCFD DISPATCH COMPUTER LINK PROCEDURES

OPS/006 RESPONSE TO VIOLENT OR POSSIBLE VIOLENT INCIDENTS

OPS/007 SCENE CONTROL

OPS/008 TRANSFER OF PATIENT CARE

OPS/009 PREHOSPITAL DEFIBRILLATION PROGRAM

OPS/010 CPR TRAINING PROGRAMS

OPS/011 EMERGENCY MEDICAL SUPPLY AND EQUIPMENT STANDARD INVENTORY

OPS/012 EQUIPMENT RETRIEVAL PROCEDURES

OPS/013 EQUIPMENT EXCHANGE PROCEDURES

OPS/015 STANDARD OPERATING PROCEDURES FOR CONTROLLED DRUGS

OPS/016 OXYGEN EQUIPMENT PROCEDURES

OPS/017 MEDICATION STORAGE

OPS/018ALL-TERRAIN MEDICAL RESPONSE

OPS/001FIRST RESPONDER AGENCY

The Oklahoma City Fire Department is certified through the Oklahoma State Department of Health (OSDH) EMS division as a First Responder agency. Oklahoma City Fire Department has documented its ability to provide proficient first responder care and has met all equipment, medical incident reporting, and certification requirements as outlined in the State Rules and Regulations of the Department of Health, Chapter 640, Emergency Medical Services, part 31, section 310:640-3-150.

First Responder certification requirements include:

1. OCFD must demonstrate a plan to ensure sufficient coverage throughout the municipality.
2. All OCFD personnel who respond to emergency medical incidents and will be rendering initial patient care must be certified by the state at the First Responder level or above.
3. In all patient care situations, the transport agency personnel will direct and supervise patient care.
4. In accordance with the Emergency Medical Services Code, Title 37A, Chapter 1, section 100.Z.3, the aforementioned requirements do not preclude any additional standards that may be required by the Medical Control Board for certification of providers at their skill level.

OPS/002FIRST RESPONDER SYSTEM

The First Responder is part of the overall EMS System OCFD is often able to arrive at the scene of an illness or injury before the EMS transport agency and are usually the first medical personnel to reach the patient. As a First Responder for the OCFD your responsibilities at the emergency scene will include the following:

1. Control of an incident scene to protect yourself and the patient.
2. Gain access to patients that may require extrication, forcible entry, or rough terrain access.
3. Initiate patient assessment, gather information from the scene and from bystanders.
4. Provide emergency care as outlined in the OCFD First Responder protocols.
5. If safety or care requires, move or reposition patient as per protocol.
6. Provide an orderly transfer of patient care to the transport agency.
7. All levels of medical personnel employed by the OCFD will not function above the Basic Life Support (BLS) level unless approved and authorized by the medical control board and the Oklahoma State Department of Health EMS Division.

OPS/003MEDICAL CONTROL

As a First Responder agency, the OCFD provides medical care under supervision of the Medical Control Board and the Physician Medical Director. Patient care delivered by OCFD personnel will be dictated by detailed medical care protocols that are provided by the Physician Medical Director, deviation from these established written protocols will not be acceptable. Refer to the First Responder Protocols for all patient care procedures.

OPS/004MEDICAL RESPONSE GUIDELINES

The priority dispatch system is utilized by EMSA to determine the nature and prioritization of all medical calls. This system is designed to dispatch fire apparatus on only those incidents where there is a legitimate need. The objective of this system is to obtain the most efficient and effective use of personnel and equipment while providing a high quality emergency medical response. There are four major medical priority dispatch system (MPDS) priority classifications, Alpha, Bravo, Charlie, and Delta level calls. Within this system life threatening calls are known as Delta level calls and possible life threatening calls are known as Charlie level calls. Automobile accidents with injuries are known as MPDS card # 29 and have the potential for life threatening injuries and environmental emergencies at all levels. The Fire Department will respond to all life threatening and possible life threatening medical emergencies known as Delta and Charlie level calls and automobile accidents with injuries known as MPDS card #29 at all levels within the medical priority dispatch system priority classifications. Listed below are samples of the Charlie, Delta dispatch system.

OPS/005EMSA - OCFD DISPATCH COMPUTER LINK PROCEDURES

The dispatch computer link is used by EMSA to request OCFD to first respond to emergency medical calls. OCFD must respond to all requests made though the dispatch link or when notified by EMSA by telephone.

1. Most emergency medical calls are requested using the 9-1-1 emergency number. Calls are received at the 9-1-1 center by call takers. When the call taker receives a request for emergency medical service the caller is transferred to EMSA and the caller information (name, address, telephone number and comments on, if any, the type of medical emergency) is sent to the OCFD dispatch computer. If the comments of the call indicate the call could be life threatening, possibly life threatening, or an automobile accident with injuries, the incident is immediately dispatched as an emergency medical incident. Once EMSA obtains the chief complaint on a call, the information is sent to the dispatch link computer at OCFD. At that time if there is any additional information OCFD can update the responding companies with the information.
2. Calls that are received by EMSA by other means than 9-1-1 are forwarded to the dispatch link computer at OCFD dispatch once EMSA determines that a first responder from OCFD is needed, OCFD will then dispatch the call as a medical emergency.

Maintenance and problem reporting

1. Dispatch link printer paper should be removed at 00:00 hours every shift. Print out is to be sent to the EMS Officer.
2. If paper gets jammed or needs new paper, reinstall paper.
3. If the printer does not seem to be printing, check the online button on the printer, press button to put printer online if off line.
4. If the printer is down for more than thirty minutes (data is still flowing on the computer) turn printer off and call the EMSA dispatch to report the problem.
5. Order supplies needed on the station supply order form.

OPS/006RESPONSE TO VIOLENT OR POSSIBLE VIOLENT INCIDENTS

If dispatch obtains information from the police, EMSA or by other means that the scene of an incident is possibility violent, dispatch will advise companies responding to avoid ingress to the scene until police have secured the area or the company officer determines the scene is secure. The responding company will go to level one staging or enter the scene if determined secure. When responding to a potentially violent scene and not advised by dispatch, the company officer will make the decision whether to stage or enter the scene. Incidents involving a violent nature are potential crime scenes. Police have the primary responsibility and authority for crime scenes and Fire Department personnel should use caution entering these scenes. Review Protocols for more information.

Potentially violent scene incidents:

1. Any incident where Police request staging.
2. Aggravated assault involving a weapon and the assailant is on the scene.
3. Attempted suicide where the patient is conscious and threatening.
4. Violent psychiatric patients.
5. Any other incident that presents an unreasonable danger to the responding companies.

OPS/007SCENE CONTROL

When any safety hazard exists at the scene of a medical emergency, the company officer will assume command of the scene and accept responsibility for the safety of the patient and rescue personnel. It may be necessary to delay patient care access by ambulance and Fire Department personnel if the officer feels that life hazards exist or that there is a threat of injury to rescue personnel. Any delay in patient care should be discussed with the lead paramedic of the transport agency.

When hazards exist at a crime scene or traffic safety hazards exist, the ranking Law Enforcement Officer on scene will be accountable for the safety of patients and rescue personnel.

Guidelines for Patients with Weapons

If a firefighter becomes aware of a firearm at the scene of an incident, either by admission of the patient or by actual observance of the firearm, the Oklahoma City Police Department should be requested immediately. The police officer will make the decisions regarding how to proceed with the firearm. The mere presence of a handgun should not indicate a threat to personnel safety. However, under no circumstances should personnel take any action that would compromise his/her safety or the safety of the public.

If the patient is unconscious, requires urgent care and the Police Department is not on-scene, Fire Department personnel may carefully separate the weapon from the patient if it is necessary to treat the patient and secure the weapon until the Police Department arrives. Every effort should be made to minimize physical contact with the firearm. The Officer in Charge shall assign personnel to remain with the firearm until the Police Department arrives and takes possession of the firearm.

If Fire Department personnel are at the residence of a compliant patient and the patient has a firearm on their person, personnel should instruct the patient to secure the firearm and leave it at the residence. If the patient is not compliant and refuses to secure the firearm in the residence, personnel should assess the situation and determine if the patient poses a threat to themselves or others. If the patient does not pose a threat to themselves or others, personnel may treat the patient and advise EMSA of the situation. If it is determined that the patient poses a threat, then personnel should evacuate the scene to a secure area and wait for the Police.

OPS/008TRANSFER OF PATIENT CARE

Fire Department companies arriving on the scene of a medical emergency before the transport agency will assess the patient and initiate treatment per Protocols. Fire Department personnel will document patient information and history including current medications taken by the patient.

When the transport agency arrives on the scene, the lead Paramedic with the transport agency or the Level III Paramedic will assume responsibility of the patient and direct all patient care. Fire Department personnel will assist or assume patient care. Fire Department personnel will provide the lead paramedic with a brief patient report that includes: assessment findings, pertinent medical history and care given. If possible, the transport agency will also be provided written documentation of patient information and current medications by Fire Department personnel.

If requested, Fire Department personnel will assist the transport agency with patient care while enroute to the receiving medical facility. Patient care that OCFD personnel are involved with while riding in with the transport agency should be added to the companies run report documentation.

OPS/009PREHOSPITAL DEFIBRILLATION PROGRAM

Defibrillation has become the standard of care for prehospital and in-hospital cardiac arrest. The most effective method of terminating Ventricular Fibrillation (VF) is with defibrillation. In the first few minutes of sudden death, 80-90% of patients will be in VF. If BLS CPR and defibrillation are not provided in the first few minutes, VF will convert to asystole. Survival from asystole is less than 1%.

All OCFD personnel that are licensed at the First Responder or above will be given training through the American Heart Association Healthcare Provider Course.

Ventricular Fibrillation protocols have been provided by the Medical Control Board and will be adhered to by OCFD personnel. All First Responders and above will complete quarterly inservices to ensure knowledge of procedures and to provide effective coordination during resuscitation efforts.

The Medical Control Board has the authority to modify protocols as necessary. To ensure compliance of all OCFD personnel, modifications will be introduced during the mandatory quarterly inservices.

OPS/010CPR TRAINING PROGRAMS

1. Personnel CPR Training

CPR training is provided for all OCFD personnel. American Heart Association (AHA) HealthCare Provider level CPR training is the minimum CPR training required for all suppression personnel. AHA standards and guidelines for performance of CPR during resuscitation attempts will be strictly adhered to by OCFD personnel.

1. Citizen CPR Training

The Oklahoma City Fire Department is actively involved in citizen CPR training. This will promote a good relationship with the public and will enable them to help us in saving lives. For our pre hospital defibrillation program to continue successfully, we need early Basic Life Support (BLS) to be initiated. Early CPR will help to increase an already successful save rate.

OCFD WILL ONLY OFFER THE FAMILY AND FRIENDS CPR COURSES TO THE PUBLIC. THEY WILL BE CONDUCTED EVERY FIRST AND THIRD SATURDAY FROM 0900 TO 1100.

American Heart Association course participation cards will not be issued for citizen CPR training.Refer to the CPR manual for complete information concerning CPR training.

OPS/011EMERGENCY MEDICAL SUPPLY AND EQUIPMENT STANDARD INVENTORY

The following is a list of supplies and equipment that should be carried on every apparatus. This list will be updated as changes occur in OCFD First Responder Protocols, please refer to this list when an inventory is being done on any First Response apparatus. Any company dispatched on an EMS incident should anticipate the possibility of severe trauma, several patients, or a full arrest. When on the scene of other incidents there is always the possibility of someone getting injured.

An OCFD approved and issued Trauma kit(s) should be carried on all suppression apparatus. Check out EMS supplies at the beginning of each shift to verify that each apparatus has the necessary supplies and equipment for the shift. The EMS supplies and equipment will have a complete inventory the fifteenth of each month. Supplies should not be below the EMS supplies and equipment standard inventory. (See following pages)

No supplies or equipment will be placed on any OCFD apparatus other than the itemslisted. If a new or different item is wanted for placement on an apparatus, permission must be first obtained from the EMS Officer through the normal chain of command.

Please note that some apparatus have approval to carry items that may not be listed below. It is that station's responsibility to ensure that those items are recovered or replenished as needed.

OCFD EMS Supplies and Equipment Standard Inventory Minimum Quantities RequiredFor All Rigs That Respond To Incidents

OPS/012EQUIPMENT RETRIEVAL PROCEDURES

1. Emergency Medical Equipment Retrieval Procedures
2. When any OCFD EMS equipment is used on a patient the company will wait 4 to 6 hours and go to the hospital, if within the company's district, and retrieve the equipment.
3. If the hospital is not within the company's district, the company will contact a company near the hospital to pickup the equipment and route back to the company.
4. If this is near shift change time, company will notify the shift coming on duty of the need to retrieve the equipment.
5. Go to the Chief Officer’s station in the rig’s district to get the equipment. (Extra equipment will be available at the Chief Officer’s Station.)
6. EMSA will go to each hospital every 2 or 3 days to retrieve equipment. If any OCFD equipment is found it will be delivered to the EMSA Service Center at 2323 S. Walker Av.

1. EMSA Service Center personnel will contact OCFD if any equipment is found.

OPS/013EQUIPMENT EXCHANGE PROCEDURES

The exchange program is for a one-for-one exchange of identical equipment at the scene only.

OPS/015STANDARD OPERATING PROCEDURES FOR CONTROLLED DRUGS

PURPOSE:

To provide security and accountability for controlled substances utilized by Fire Department Paramedics in the prehospital treatment of patients. The Oklahoma City Fire Department will adhere to all state, federal, and Medical Director's guidelines for obtaining, securing, storing, distributing and dispensing of controlled drugs.

SECURITY:

1. All controlled substances will be kept in a controlled and secured area.

a)The location of all controlled drugs on the ALS Engines will be in a locked box secured within the temperature controlledmedical cabinet or temporary use locked bag within designated compartment of the apparatus and is kept locked at all times. A key ring with a key to the lock box will be carried by the Lead Paramedic. No other station personnel will have access to the keys.

b)Overstock of controlled substances will not be kept at the ALS station.

c)All overstock will be kept at the EMS storage facility. Controlled substances will be in a double locked storage area.

d)The EMS Supply Officer will have the only extra key to the ALS Engine controlled substances lock boxes.

e)The Quality Assurance Officer and the EMS Supply Officerwill have direct access to the controlled substances storage cabinet.

EMS OFFICE ORDERING PROCEDURES: