Lafd Field Manual 4k4n4q

Preface

I

The EMS Field Manual, LAFD Book 35, is intended to serve as a convenient reference for all Advanced Life (ALS) and Basic Life (BLS) Fire Department personnel.

The condensed information contained herein was generated from existing policies and procedures that govern LAFD EMS operations. are required to maintain a thorough knowledge of Department of Health Services (DHS) and LAFD policies and procedures. To maintain a high standard of expertise, as qualified health care professionals, a periodic review of these writings is recommended.

Excerpts from the (DHS) Prehospital Care Policy Manual (LAFD Book 33), DHS Medical Guidelines, LAFD Training Bulletins, Departmental Bulletins, LAFD Manual of Operation, and EMS Updates were utilized in the compilation of this manual.

Book 35 is subject to periodic revisions as policy andlor procedures change. If field personnel identify areas that may require clarification or revision, please

I

the Quality Improvement Section at (2 13) 485-7 153.

EMS Field Manual (Book 35)

TABLE of CONTENTS FIELD PROCEDURES / PROTOCOLS LAFD Patient Assessment Guidelines

1.0

Simple Triage and Rapid Treatment (START)

1. 1

Acute Life Threatening Event (ALTE)

1.2

Broselow Pediatric Emergency Tape 1 PEDS Color Code

1. 2a

Patient Resolution Guide (PRG)

1.3

PRG Principles

1. 3a

Level of Consciousness

'

SECTION 1

1.4

Glasgow Coma Scale

1.4a

Revised Trauma Score

1.4b

Patient Refusal of Treatment andlor Transportation (AMA) IIn Custody

1.5

Child IElder IDependent Adult Abuse Reporting

1. 6

Determination of Death

1.7

Patients Determined to be Dead

1. 7a

Medical Patients in Cardiopulmonary Arrest

1. 7b

Crime ScenesIAccidental DeathsISuspected Suicides

1.7~

Procedures Following Pronouncement of Death

1. 7d

Documentationfor Reports

1. 7e

Prehospital Do-Not-Resuscitate (DNR) Orders Honoring Advance Health Care Directives (AHCD) Task Oriented EMS Standard Operating Guidelines (SOGs) [TasksIEquipment]

1. 8 1. 8a 1.9

Size-Ups

1. 9a

SOGs for EMS Incidents (e.g., Cardiac Arrest, Trauma, Medical Complaint)

1. 9b

Patient Transfer of Care from ALS to BLS

1.10

EMT-1 Expanded Scope of Practice

1.11

Poison Control System

1. 12

System-wide Mental Assessment Response Team (SMART)

1.12a

City Volunteer Programs

1. 13

Miscellaneous ICommunications During Emergencies

1. 14

Highest Ranking Medical Authority

1.14a

Body Armor Vests

1.14b

Medical Waste Disposal

1.14~

Management of Multiple Victim Incidents IMCI Short Form

Revised: 512005

PAGE1 OF 3

1. 15

EMS Field Manual (Book 35)

TABLE of CONTENTS PATIENT TRANSPORTATION 1 DESTINATION

SECTION 2

LAFD Patient Destination Guidelines /General Principles Patients Transported by BLS Personnel Patients Transported by ALS Personnel Transport to Specialty Care Centers: SART Centers, Trauma Centers, Trauma Triage CriteriaIGuidelines, Extremis Patients Trauma Catchment / Boundary Areas Pediatric Trauma Centers

LA County Trauma Center Maps Trauma Center Diversion / EDAP IPMC / PTC / Perinatal Burn Patients / Decompression Patient Destination Guidelines / EDAP / Patient Requests / Hospital Diversion Transporting Patients in Custody Hospital Refusal to Accept Rescue Ambulance Patients Service Area Hospitals Specialties / Exceptions Service Area Hospital Maps Los Angeles County Emergency Medical Service Receiving Facilities EMS and Battalion Offices Receiving Hospitals Sorted by EMS Battalion Captains Fire Station, Battalion, Division, EMS Battalion Chart LAFD Rescue Ambulance Locations

APPARATUS 1 EQUIPMENT

Apparatus Towing Apparatus Breakdown Procedures 1 Documentation Apparatus Maintenance CAV and NAV Obtaining a Spare Gurney Multi-Casualty Medical Supply Cache Disaster Cache Box (Amy1 Nitrite IMark I Kit) Base Hospital Hailing and Working Channel Assignments

Revised: 512005

PAGE2 OF 3

SECTION 3

EMS Field ~ a k a (Book l 35)

TABLE of CONTENTS

RECORDS / DOCUMENTATION

4. 0

Records and Documentation The Journal (F-2) Hazardous Substance Exposure Report (F-3) Stores Requisition (F-80) Rescue Equipment Loan Slip (F-215M) EMS Report (F-902M) Controlled Medication Inventory (F-903) LAFD Situation Report (F-904) The Health Insurance Portability and ability Act (HIPAA) CAL I OSHA and FED I OSHA Notifications Communicable Disease Exposure (Contaminated Needle Puncture) Procedures I Exposure Categories ,

1 '

Communicable Disease Exposure and Notification Report (F-420) Communicable Disease Decontamination Suspected Child AbuseINeglect Reporting Guidelines Suspected Elder and Dependent Adult Abuse Reporting Guidelines Communication Failure Protocol Mnemonics Abbreviations Bibliography Record of Revisions

Revised: 512005

SECTION 4

PAGE3 OF 3

Section 1: Field Procedures 1 Protocols

LAFD PATIENT ASSESSMENT GUIDELINES

/ SKIN SIGNS

^

SCENE Â Safety (BSI PrccautionsJPPE) + Environment Â Mechanism of Injury + Number of Patients

^ GENERAL

IMPRESSION

+ What you see!

+ Color + Temperature + Moisture

^

AIRWAY

^

BREATHING (AssistfOxygen)

^

CIRCULATION (RadialICarotid) + Pulses + Capillary Refill + Control Severe Bleeding (PRN)

^

CHIEF COMPLAINT (SignsISymptoms)

+ +

Objective Observation Subjective Findings (What they say!)

FIRST- PERFORM FOCUSED BODY CHECK (Determinedby LOG, Chief Complaint, and History) 4 4 4

P U LS E (Rate, Rhythm, Quality) RESPIRATION (Rate, Rhythm, TV) B P (Systolic/Diastolic) [Orthostatic's PRN]

Glasgow Coma Scale (GCS) ASSESS BILATERAL BREATH SOUNDS for patients with chest injuries, difficulty breathing, and I or signs of shock

\

-

COMPLETE BODY CHECK

j LO 0 K F E EL

for Tissue Damage, Scars, Deformities, Abnormal Behavior I Motion, Fluids for Tenderness, Instability, Crepitus

4

HEAD

4

BREATHSOUNDS

4 NEUROLOGICAL

4

NECK

4

ABDOMENIPELVIS

4 BACK

4

CHEST

4

EXTREMITIES (UpperILower)

4 MEDICAL TAGS,

DEFORMITY

BURNS

CONTUSION

TENDERNESS

ABRASION

LACERATIONS

PUNCTURE1 PENETRATING

SWELLING

TRACKS, TRAUMA

PULSES MOTOR SENSORY

Revised: 1212001

Section I: Field Procedures 1 Protocols

LAFD PATIENT ASSESSMENT GUIDELINES

FOCUSED HISTORY

S SignsISymptoms

0 Onset P Provokes

A

Q Quality

E EpilepsyIEnvironment

Alcohol1Apneal Anaphylaxis1

T Trauma

A Allergies 1 Infection

M Medications P Past History

RegionIRadiationl Recurrence

/

Insulin

L Last AteIDrank

S Severity

0 Overdose

E Events Preceding

T Time

U Uremialunderdose

StrokeIShockl Seizure

C Cardiovascular

AIRWAY (OIP, Mask)

SPINAL PRECAUTION

BREATHING (Position IBVM 102)

GLUCOSE

CIRCULATION (Direct Pressure IPosition Patient)

OB ASSISTANCE

CONTROL BLEEDING

BANDAGING 1 SPLINTING

ONGOING ASSESSMENT

REPEAT. Initial and Focused exam: Priority patients every 5 minutes Stable patients every 15 minutes

1 Have a Plan! Route! Code 3? Treatment En Route?

Ã

Motor Response

Ã

Verbal Response

1

REVISED TRAUMA SCORE (RTS) ,. ... . (Uoded Values) SBP + RR + GCS

Revised: 1212001


SIMPLE TRIAGE and RAPID TREATMENT

START

-\

ASSESS

RespiratiodRate

-

b ABSENT

REPOSITION

Airway and REASSESS

Respiration

ASSESS

Circulation

0 < 2 sec. /

RADIAL PULSE

PRESENT

I

Y

ASSESS

Mental Status

*

,

Simple Triage and Rapid Treatment Revised: 1212001


ACUTE LIFE-THREATENING EVENT (ALTE) An ALTE may occur during sleep, wakefulness, or feeding in the pediatric patient. It is described as an episode that is frightening to the observer and characterized by a COMBINATION of:

* * *

Transient Apnea

*

Choking 1 Gagging

Color Change Marked Muscle Tone Changes

Upon EMS arrival this pediatric patient may appear completely normal and asymptomatic. However, a complete and accurate history of the event is critical in determining ALTE.

Base Hospital is required. If the circumstances surrounding the incident are vaguelunclear it is the base station MICNs responsibility to determine the appropriate destination for the patient.

ALTE may be a symptom of many specific disorders including, but not limited to, gastrointestinal reflux, infection, seizures, airway abnormality, hypoglycemia, metabolic problems, or impaired regulation of breathing during sleep and feeding. ALTE was previously called a "Near-miss SIDS."

THE MOST IMPORTANT DIAGNOSTIC STEP IS TO OBTAIN A CAREFUL HISTORY OF THE CURRENT COMPLAINT FROM THE PERSON WHO WITNESSED THE EVENT.

The evaluation and history taking for ALTE patientsconsists of:

* * * * * * * * * *

Color (red, pale, cyanotic) Respiratory Effort (apnea, obstruction, irregular) Sleep Status (awake, asleep) PositionMotor (prone, supine, uprightllimpness) Breathing PatternINoises (choking, stridor) Eye Movement (closed, startled, rolled, fluttering) Relationship to Feeding Fluid in the Mouth Duration Need for Intervention

* Age 1-3 years: Base andor Transport is required. Age 0- 12 months: Transport regardless of chief complaint andor mechanism of injury.

'

ALTE patients age 12 months and under: BASE m g .J TRANSPORT to a PCCC is required.

Revised: 1212001

PAGE 1 OF 2


BROSELOW PEDIATRIC EMERGENCY TAPE The Broselow Pediatric Emergency Tape is a mandatory piece of equipment carried on all ALS units in Los Angeles County. The Broselow Tape is used to estimate weight, drug dosages, and correct size of equipment for pediatric patients up to 74 pounds [34 kg]. It is mandatory to use the Broselow Tape on all ALS pediatric patients. [Refer to "EMS Update 2001 '7 After determining the correct color code, document the three-digit color code in the Peds Color Code Box, Incident Info Section of the EMS Report [F-902Ml. For billing purposes, convert the kilograms to pounds and document in the weight box. Use only the color code when reporting to the Base Hospital. The color coding system is designed to reduce calculation errors associated with medication istration. If the infant's size falls into the "gray" area [first section of the tape: 3 kg., 4 kg., or 5 kg.] it is necessary to report the specific weight and color to the Base Hospital. For all other color coded sections it is only required to report the color code.

GY3 YEL

GY4 WHT

GY5 BLU

PNK ORG

RED GUN

PUR -

Placement of the Broselow Tape for measuring from the standing or supine position is as follows : Place the RED end of the tape for.. ....

STAND IN G : To the heel of the foot and measure to the top of the head. SUPINE:

To the top of the head and measure to the heel of the foot [while extending the leg].

Note: The pediatric drug dosages are only to be taken from the "Color Code Drug Doses LA County Kids" (laminated cards) that are carried on each ALS unit. THE BROSELOW TAPE IS ONLY TO BE USED TO DETERMINE THE COLOR CODE.

Revised: 512005

PAGE 2 OF 2


LEVEL of CONSCIOUSNESS

EMS personnel shall perform a patient assessment to determine orientation and level of consciousness an each patient they encounter. This assessment should determine patient's state of awareness and orientation to time, place, person, or purpose [A & 0 X 3 per LA County Medical Guidelines]. Inappropriate aggressiveness or hostility should alert to the possibility that the patient's thinking process may be impaired. EMT-Is shall access an EMT-P resource any time a patient is unable to reasonably answer one or more of the following questions:

+ Name

^

+ Day of the week I year I time of day

+ Where helshe lives I where they are now

GLASGOW COMA SCALE (GCS)

21HLD (12 months to 14 years)

ADULT ( % 14 year) Spontaneous

Spontaneous

To Voice

To Voice

To Pain

To Pain

None

-

None

Obedient

Obedient

Purposeful

Localizes

Withdrawal

Withdrawal

Flexion

Flexion

Extension

Extension

None

-

Oriented Confusion Inappropriate Incomprehensible None

5 4

3 2 1

I

None Oriented Confusion Inappropriate

1

Incomprehensible None

In addition to the numerical Glasgow Coma Scale (GCS), document a brief descriptive assessment on the EMS Report Form (F-902M) . The GCS is required to assess neurological status on all patients greater than twelve (12) months of age. This includes patients who do not have an altered level of consciousness. After consultation with the primary care giver, the patient examiner shall estimate the appropriateness of the response for the younger child that is not able to communicate (motor response-obedient and verbal response-oriented).

Revised: 512005

PAGE1 OF 2


REVISED TRAUMA SCORE

(RTS)

The Revised Trauma Score (RTS) is a physiological scoring system to determine the survival probability of trauma patients. If the patient (age one year and above) meets trauma center criteria and is transported to a Trauma Center or PTC the RTS shall be completed and documented on the EMS Report Form (F-902M).

THREE assessment elements comprise the RTS:

+ SYSTOLIC BLOOD PRESSURE (SBP) + RESPIRATORY RATE (RR) + GLASGOW COMA SCALE (GCS) ASSESSMENT ELEMENT IS GIVEN A "CODED VALUE" (CV). THE "CVS" ARE THEN TOTALED TO GIVE THE RTS ("0-12").

The "coded value" (sum) of the: SBP + RR + GCS =

RTS

CALCULATING

RTS

=

(2+2+3)

N x : If unable to auscultate or palpate a blood pressure due to hypo-perfusion7enter a value of "1 ." (The lower the score the more critical the patient.) Document the rational for a palpated blood pressure in the F-902M Comments section . The RTS is heavily weighted toward the GCS to compensate for major head injury without multi-system trauma or major physiological changes.

Revised: 512005


PATIENT REFUSAL of TREATMENT 1 TRANSPORTATION

EMT-Is may allow a patient to refuse treatment I transport if glJ the following conditions are met: The patient's condition does not meet any criteria on the Patient Resolution Guide (PRG).

*

The patient does not meet altered level of consciousness criteria as described in DHS, Ref. No. 809. The patient understands the severity of their condition and has a plan for follow-up medical care. Patient understands and signs the F-902M in the space provided. Additionally, the patient receives the Patient After Care Instruction form [back of the F-902M Pink copy].

Note: * *

IF THE PATIENT DOES NOT MEET THE ABOVE CRITERIA, AN ALS RESOURCE SHALL BE REQUESTED TO DOCUMENT THE PATIENT'S REFUSAL (AMA). A PARAMEDIC WORKING ON A BLS RESOURCE MAY NOT HANDLE AMA'S IN LIEU OF AN ALS RESOURCE.

A BLS resource shall request a Paramedic RA. EMT RA shall request the closest ALS resource e.g., Paramedic Engine, ALS RA. The ALS resource shall make base hospital while with the patient. Advise base hospital of all circumstances, patient's condition, and the reason for refusal.

*

Have the patient or legal guardian sign the AMA form [back of the F-902M White copy]. If the patient refuses to sign the AMA form, this shall be documented in the Comments section of the F-902M. Refer to Book 35, Section 2.0: "Patient Destination Guidelines". An EMS Battalion Captain shall be requested to respond to the incident if the Paramedics are uncomfortable with any aspect of the AMA. (Dept. Bulletin No. 01-10)

.'\

PATIENTS IN CUSTODY

,

.

Patients under the care or in custody of law enforcement often pose a challenge for pre-hospital care providers. These patients represent a very high degree of medical-legal risk. Patient care, documentation, and transportation must be in accordance with existing policies and procedures. are required to conduct a complete Initial and Focused assessment which includes vital signs, pertinent negative findings and a statement on the F-902M (EMS Report) which outlines the chief complaint and/or the reason for the 9- 1- 1 call. must that the history on these patients should be suspect due to the possibility of the patient being under the influence of illicit drugs, may not have access to their prescription medications, or may have sustained trauma with no obvious signs or symptoms; and patient care should not be based solely upon the history obtained. All are reminded that patients in custody may refuse care BUT cannot refuse transportation to an emergency department for evaluation. Patients who refuse treatmentltransport and whose chief complaints meet the PRO Section I and I1 or Reference 808 criteria require transport and/or base hospital . Transporting Restrained Patient's (Reference No. 838) Restraint equipment (handcuffs, plastic ties, or "hobble" restraints) applied by law enforcement officer: Must provide sufficient slack to allow patient to take full tidal volume breaths. Requires the officers continued presence (the officer shall accompany the patient in the ambulance) Must not compromise the patients respiratory/circulatory systems. (Transport patient in supine position.) Must not cause vascular, neurological, or respiratory compromise.

Patient's restrained extremities shall be evaluated for pulse quality, capillary refill, color and temperature, nerve and motor function immediately following application and every 15 minutes thereafter. Documentation is necessary to justify actions done or not done if unable to perform the above. Restraints may be attached to the frame of the gurney but not to the movable side rails. Revised: 512005

PAGE 1 OF 1


CHILD / ELDER / DEPENDENT ADULT ABUSE

EMT-Is and EMT-Ps are required to report all cases of suspected abuse and/or neglect as soon as possible.

,,

ABUSE

punishment, willful cruelty, unjustifiable punishment, or sexual assault.

Failure of any person having the care and/ or custody of a child, elder, or dependent NEGLECT adult to exercise that degree of care which a reasonable person in a like position would exercise. CHILD ELDER

Any person under 18 years old.

1.

Request OCD to notify and have the appropriate law enforcement agency report to the incident location or hospital if the patient is to be transported.

2-

The law enforcement agency will assign an investigator. If the patient does not require immediate transport wait for the responding law enforcement agency unless a responsible adult (other than the ab) remains on scene.

1 I

3. The member in charge of patient care shall

Any person 65 years old or older.

Any person between the ages of 18 and 64 years that cannot fully care for DEPENDENT himherself due to physical and/or ADULT mental limitations.

-

4.

,

forward the completed Department of Social Services Report to the appropriate EMS Battalion Captain within 36 hours. Make a Journal (F-2) entry, that shows the report was completed and forwarded. \

N B : While on scene obtain names, addresses, and telephone numbers of witnesses, victims, siblings, parents, and law enforcement / investigating officer (s) involved with the incident, Field may obtain copies of the Social Services (8572) form "Suspected ChildAbuse Report" from the concerned EMS Battalion Captain or find the form listed in the Prehospital Care Policy Manual, Book 33, Reference No. 822.2. The Social Services form "SuspectedDependent Adult/Elder Abuse may also be found in Book 33, Reference No. 829.2. "

Revised: 712003

DETERMINATION OF DEATH \

A patient may be determined dead if in addition to the absence of respiration, cardiac activity, and neurological reflexes, one or more of the following conditions exists (DHS, Reference # 814):

)

+

+ + + 4 + + + +

Decapitation. Massive crush injury. Penetrating or blunt injury with evisceration of the heart, lung, or brain. Decomposition. Incineration. Extrication time greater than 15 minutes, with no resuscitative measures performed prior to extrication. Pulseless, non-breathing victims of a multiple victim incident where insufficient medical resources precluded initiating resuscitative measures. Drowning victims, when it is reasonably determined that submersion has been greater than one hour. Rigor mortis requires assessment (as described in Section 1.7a ).

Patients Determined to be Dead If the initial assessment reveals rigor mortis andor post-mortem lividity &, EMS personnel shall perform the following assessments: (NN: Assessment steps may be performed concurrently.) RESPIRATORY

* Assuring that the patient has an open airway * Look, listen, and feel for respiration (This includes auscultation of the lungs for a minimum of 30 seconds) CARDIAC

* Auscultation of the apical pulse for a minimum of 60 seconds * Adults and children: Palpation of the carotid pulse for a minimum of 60 seconds Infants: Palpation of the brachial pulse for a minimum of 60 seconds NEUROLOGICAL

* Assess pupil response with a penlight or flashlight * Check for a response to painful stimuli

A

Resuscitative measures shall not be initiated on patients who have been determined dead (according to this policy) or on patients who meet DHS, ~ e fNo. . 815, "HonoringPrehospital DNR Orders"

Medical Patients in Cardiopulmonary Arrest Initiate immediate resuscitation and ALS intervention for patients who do not meet conditions described in Section 1.7. In general, these patients shall be: ,

* Treated in the field long enough for possible resuscitation to occur.

* Rapidly transported if an adequate airway or venous access cannot be established. * Treated and transported if the patient is: A suspected drug overdose, hypothermic, in refractory ventricular fibrillation or ventricular tachycardia. Revised: 1212001

PAGE1 OF 2


Crime Scenes I Accidental Deaths I Suspected Suicides

+ Responsibility for patient health care management rests with the most medically qualified person on scene.

+ Authority for crime scene management shall be vested in law enforcement. It may be necessary to ask law enforcement officers for assistance to create a "safe path" into the scene to access the patient, while minimizing scene contamination.

+ If law enforcement is not on scene, prehospital care personnel shall attempt to create a "safe path" and secure the scene until their arrival.

Procedures Following Determination of Death

All therapeutic modalities initiated during the resuscitation must be left in place. (This includes ET 1 ETC tubes, IV catheters, EKG electrodes, and oral 1 nasal pharayngeal airways.) The deceased shall not be moved without the Coroner's authorization.

', 1 -

N B : It may be necessary to move the deceased if the scene is unsafe or if the deceased is creating a hazard. In such emergent situations, field personnel may relocate the deceased to a safer location or transport to the most accessible receiving facility.

Documentation for Reports

+ The criteria used to determine death. Â

(Listed in Section 1.7a.)

The condition of the patient and what, if any, resuscitation interventions were initiated.

+ If the deceased was moved, document the location and the reason why.

If movement of the deceased was authorized by the Coroner document: The case number and the representative who authorized the movement.

--

Revised: 1212001


PREHOSPITAL DO-NOT-RESUSCITATE (DNR) ORDERS '

-\

, FOR PULSELESS AND APNEIC

PATIENTS WITH VALID DNR ORDERS: EMT-Is shall a begin R or attach defibrillator EMT-Ps shall a begin R or attempt ALS procedures (Combi-tube, ET, cardiotonic drugs, etc.)

1.

Identification by witness who can absolutely identify patient/ID bands; and

1.

Identification by witness who can absolutely identify patient1ID bands; and

2.

Written physicians order in patient's chart, such as:

2.

Presence of an original (or copy):

Â

No Code

Â

NoR

+

Do-Not-Resuscitate; or

Â

Los Angeles County Do-Not-Resuscitate (DNR) Form (Ref No. 815.1)

Â

State Prehospital Do-Not-Resuscitate (DNR) Form (Ref No. 815.2)

3. Verbal physician's order (in person) which must be followed immediately in writing.

1. Check the "DNR" box on the F-902M, (EMS Report form).

1.

Check the "DNR" box on the F-902M (EMS Report form).

2.

2.

Briefly describe in the Comments section:

3.

Briefly describe in the Comments section: Â

Any care given

Â

Any care given

Â

The physician's name and telephone number

Â

The physician's name and telephone number

Â

The date the DNR order was originally signed

Â

The date the DNR order was originally signed

Attach a photocopy of the facility's DNR order to the F-902M (White copy).

. 3.

If available, attach page 2 of the DNR form (provider agency copy) to the F-902M (White copy) prior to forwarding. If the provider agency copy or photocopy is not available, record all DNR information on the F-902M. Do a take the patient's copy if it is the only copy on scene.

In the prehospital setting, a Living Will or Durable Power of Attorney are non-acceptable DNR forms.

Revised: 1212001

PAGE1 OF 2


A

PREHOSPITAL DO-NOT-RESUSCITATE (DNR) ORD'ERS

Resuscitation shall begin immediately and paramedics shall the base hospital for further direction if there is any objection or disagreement by family or caretakers about withholding resuscitation; or if prehospital personnel have any reservations about the validity of the DNR order.

For patients who are a pulseless and apneic with valid DNR orders, EMT-Is and EMT-Ps shall provide for their comfort, safety, and dignity by using the following appropriate ive measures:

EMT-IS: +

Maintain Airway (Oropharyngeal 1Nasopharyngeal Airways) and Suctioning

+

ister Oxygen

+

Control External Hemorrhage Apply Dressings, Bandages, and Slings

+

Immobilize Skeletal Injuries

+

Position of Comfort

+

EMT- Ps :

(In addition to the above)

+

Visualize airwaylremove foreign bodies by means of a laryngoscope and Magill forceps

+

base hospital if IV access andlor pain medication is necessary

*

In the event of deterioration of the patient's vital signs, level of consciousness, or of cardiopulmonary arrest, continue transporting to the designated receiving facility (even though it may not be the most accessible). Transport to the patient's requested treating facility.

*

If the patient's caretaker is unable to provide care, advise transport. (A private ambulance may be suggested.)

*

Generally, emergency transport is not necessary but left to the discretion of EMS personnel. (Emergency transportation may be necessary for such cases as hemorrhage, unmanaged airway, severe pain, etc.). (DHS, Reference # 8 15)

Revised: 121200 1

PAGE2 OF 2


ADVANCED HEALTH CARE DIRECTIVES (AHCD)

California law on AHCDs recognizes that adults have the fundamental right to control the decisions relating to their own health care, including the decision to have life-sustaining treatment withheld or withdrawn. The AHCD enables patients (over the age of 18) who are unable to speak for themselves (e.g., coma, Alzheimer's, etc) to provide their health care instructions. A VALID AHCD MUST MEET THE FOLLOWING REQUIREMENTS:

4 Patient is unable to make their own life decisions d d d d d

Power-of-Attorney Health Care Agent is designated with effective DATE End of Life Decision box is designated (checked) Two witness signatures and DATED, or Notary Public Signed by a Patient Advocate or Ombudsman if the patient is in a skilled nursing facility

Note: An AHCH has reciprocity between states and must be honored if all the above are completed. If the patient's caretaker is unable to provide care, advise transport. (A private ambulance may be suggested.) Generally, emergency transport is not necessary but left to the discretion of EMS personnel. Emergency transportation may be necessary for such cases as hemorrhage, unmanaged airway, severe pain, etc. (DHS, Reference # 818) GUIDELINES FOR PREHOSPITAL CARE PERSONNEL: Provide the level of care according to the patient's wishes and/or medical condition when dealing with Advanced Health Care Directives and bbDo-Not-Resuscitate(DNR)" orders. _

AJ-S and BLS shall provide for the patient's comfort, safety, and dignity by using (he following appropriate measures:

+

ASSIST VENTILATIONS (via a bag-valve-mask device)

+

CHEST COMPRESSIONS

+

AUTOMATED EXTERNAL DEFIBRILLATOR (AED) (only ifBLS is on scene prior to the arrival of ALS)

ADVANCE AIRWAY MANAGEMENT + DEFIBRILLATION

+

pulmonary resuscitation, defibrillation, drug therapy, and other life saving measures.

+

+

CARDIAC DRUGS: Adenosine Epinephrine Atropine Lidocaine

Dopamine

CARDIOVERSION

AIRWAY MANEUVERS (including removal offoreign body)

+

HYDRATION 1 DIURESIS

SUCTIONING

+

GLUCOSE ISTRATION

+

OXYGEN ISTRATION

+

PAIN CONTROL (i.e., morphine)

+

HEMORRHAGE CONTROL

+

Revised: 812003

PAGE1 OF 1


TASK ORIENTED EMS STANDARD OPERATING GUIDELINES tf

EMS Standard Operating Guidelines (SOGs)are intended as guidelines to establish pre-determined tasks for each member of the company. Company Commanders shall assign taskslresponsibilities based upon the expertise of each team member. Additionally, the tasks designated for each of the following four positions are not intended to supersede any pre-existing duties assigned to the member. The medical condition of the patient determines the work flow and sequencing of tasks.

,

The "A-B" (Airway-Breathing)person who assesses the airway; applies oxygen; determines the respiratory rateltidal volume; and any signs of distress while checking breath sounds. In cases of cardiac or respiratory arrest, the "A-B" person inserts the airway and performs bag-valve-mask (BVM) ventilation.

A-B Person

c

The "C" (Circulation) person is responsible for preserving the circulation by stopping any overt bleeding, and obtains the pulselrate and blood pressure. For pulseless patients: applies the automated external defibrillator (AED); attempts defibrillation; and provides chest compressions for R, as necessary.

Person

The "D" (Disability) person is responsible for preventing further patient disability by assessing the current degree of disability and applies splintslspinal immobilization as necessary. In cardiac arrest cases: assists with equipment needs (such as oxygen bottles, backboard, and gurney); assists the paramedics with IV line preparation and equipment needs. In many situations, the fourth member of the company is unavailable since the Engineer has apparatus responsibilities. However, the Engineer may assist the rescue as described above and may be able to assist when the patient is outside of a structure.

D Person

E

The "E" (Executive) person ensures that all of the other team are properly performing their tasks. In cardiac arrest cases, the "E"person assists the "C" person set up the automated external defibrillator (AED) to ensure rapid application. The "E" person assesses the scene for safety, initiates the F-902M, keeps records of interventions and their delivery times, interacts with family to obtainlrecord patient information which includes: medical history, allergies, a current medications list, current address (include ZIP code), and (if available) Medi-Cal number.

Person

Even when dispatched simultaneously (with an ALS unit), fire company shall perform the above tasks (including defibrillation) as a team. Suggested personnel for each EMS team assignment and equipment to be carried to the patient:

\

. ./Â¥

A-B

FF or FF/PM

c

Firefighter

D

Engineer or A 0

E

Captain

Revised: 1212001

PAGE 1 OF 4

Oxygen, BVM, and airway managementJsuction bag AED and medical box Flashlight, splints, backboard, gurney as needed F-902M and Radio


Note: ALL personnel shall exercise good judgment and follow Department policy regarding equipment and medical supplies carried to the patient(s) on initial approach.

Medicallstarter Box

Medicallstarter Box

Medicallstarter Box

MedicallTrauma Box

Oxygen (with respiratory supplies)




Defibrillator

Trauma Box

Disposable OB Kit

Defibrillator

Additionally, for incidents occurring above the first floor ,the gurney shall be brought in. SIZE-UPS

Size-ups shall be given to additional resources responding with the fire company. In particular, a size-up for an EMS incident shall be provided under the following conditions: +

Requests for an ALS unit when a BLS unit is dispatched for an "A" or "B" category call.

+

Additional resources requested beyond the original dispatch.

When multiple resources are dispatched to a single incident, the first unit on scene shall provide a brief size-up and may cancel or down grade, to non-emergency, the additional resources when appropriate. It is not uncommon for a BLS Engine, a Paramedic Assessment Engine, and a Paramedic Rescue to be dispatched on a single incident. Exercise good judgment in of additional resources to proceed through, and if so, whether emergency or non-emergency. In addition, if the patient is stable but still requires transport or an ALS resource for documentation only, consideration shall be given to have that resource proceed through nun-emergency. The "EMS size-up" (given on TAC 10) shall include the following information and be very brief (vital signs normally are not included):

Revised: 121200 1

PAGE2 OF 4


To further describe the tasks to be performed by each team member, the following examples of EMS incidents (with the SOGs for fire personnel) are listed:

TEAM

COMPANY PERSONNEL

FF or FFPM

TEAM

TASKS

Assess airway; suction as needed; basicladvanced airway, BVM; observe for chest rise and gastric distention. Announce 10-second time intervals when the paramedic performs intubation.

Firefighter

Utilize the automated external defibrillator (AED) to analyze EKG rhythm; defibrillate as needed; chest compressions of R; carotid pulse checks; if applicable, obtain the AED Code Summary and initiate the F-901 (Cardiac Arrest Outcome Data Sheet).

Engineer or A0

Anticipate and provide necessary equipment; direct paramedics t o the patient; assist with IV line preparation; gather and properly dispose of medical waste.

Captain

Person with Supervise team; assess scene safety; assist bbC" AED rapid application; interact with familyhystanders. Initiate F-902M; record patient assessment data (and times); interventions (and times); patient's medical history and list of medications, and (if available) Medi-Cal number, address (include ZIP code). Give a brief size-up to the paramedics. TASKS

COMPANY PERSONNEL

ister Oxygen at 15Llmin.; auscultate lungs to determine equal breath sounds; assess: airway, rate of respirations, and tidal volume. As needed: suction, BVM, provide and maintain cervical .

A-B

Firelighter

Check for: pulse and rate; blood pressure; perform total body check; control bleeding. Assess: LOC, skin signsleyes. Determine GCS I RTS, chief complaint, and obtain medical history. Apply dressings, bandages, splints, and spinal immobilization as needed.

Engineer or A0

Anticipate and obtain necessary equipment. Provide lighting. Direct paramedics to the patient; obtain gurney; assist with IV line preparation; gather and properly dispose of medical waste.

Captain

Supervise team; assess scene safety; determine the need for additional resources; interact with farnilyhystanders; initiate F-902M. Record patient assessment data (and times); record interventions (and times); obtain patient's medical history and current medications list, and (if available) Medi-Cal number, address (include ZIP code). Give a brief size-up to the paramedics.

-

Revised: 912003


MEDICAL COMPLAINT

TEAM

COMPANY PERSONNEL FIRE

A-B

c Engineer

D

or

A0

E

Captain

-

Revised: 1212001

CHEST PAIN

SEIZURE

DIABETIC PATIENT

TASKS

BLS & ALS

ALS RA PM

Assess: airway, respiratory rateltidal volume. Auscultate lungs for breath sounds. As needed: ister Oxygen, suction, BVM.

BLS RA FF

Assess: pulselrate, blood pressure, skin signs, eyes. Complete total body check. Determine LOCIGCS. Obtain chief complaint and medical history.

BLS RA FF

Anticipate and obtain necessary equipment (gurney). Direct paramedics to the patient. Assist with IV line preparation. Gather and properly dispose of medical waste.

ALS RA PM

Supervise team. Assess scene safety and additional resource needs. Interact with familyhystanders. Obtain the patient's correct address (include ZIP code), Medi-Cal number (if available), medical history, allergies and list of current medications. Initiate the F-902M, record patient assessment data (and times), interventions (and times). Give a brief size-up to the paramedics.

Section 1:

Field Procedures 1 Protocols

PATIENT TRANSFER OF CARE FROM ALS TO BLS UNIT

)

The decision to transport a patient is governed by:

*

The patient's medical condition

The patient's chosen receiving facility

DHS policies and guidelines

Medical judgment of the on-scene medical authority

LAFD policies If the patient does not require ALS level care, the patient may be transported by a BLS ambulance. shall include the following steps when transferring care from an ALS unit to a BLS unit: Base hospital approval is required if the patient meets base hospital criteria. Obtain agreement from the BLS receiving team to accept responsibility for the patient. Advise the BLS receiving team of the patient's condition, history, physical assessment, and all treatment rendered. The ALS unit initiates the F-902M EMS Report and completes the appropriate sections ensuring that the unit and team member numbers are clear and legible.

*

The Green copy of the F-902M report shall be retained by the ALS unit. All other F-902M report copies are given to and completed by the BLS [transporting] unit.

Revised: 1212001

PAGE 1 OF 1


EMT-1 EXPANDED SCOPE OF PRACTICE County of Los Angeles EMS Agency (Ref. No. 802) EMT-I Expanded Scope - ofpractice (Treatment Protocols, Interfacility, andlor 9- 1- 1responses)

Prior to arrival of paramedics or transport: Â Place patient in position of comfort

Approved by transferring physician: Â Nasogastric (NG) tubes

Â

High flow 02

Â

Gastrostomy tubes

Â

Monitor vital signs

Â

Heparin locks

Â

Shock position PRN

+

Foley catheters

Â

Tracheostomy tubes

+ +

Indwelling vascular access lines CVP monitoring devices

+

Arterial lines including Swan Ganz catheters

Monitor, maintain, and adjust preset rate: + Glucose solutions

+

Isotonic salt solutions (e.g., Normal Saline or Ringer's Lactate) (May turn off i f infiltrated)

Adjusted to TKO rate by hospital personnel: Â

Folic acid-max

+

Multi-vitamins-ma.

Â

Thiaminemax 100 mg/1000 ml

If available and indicated, assist patient or allow self-istration if criteria is met:

+

1 mg/1000 ml

*

1 vial/1000 ml Â

+

+ If assistance is given, EMT-Is shall not cancel EMT-P response. + An ALS resource shall be requested if one has not been dispatched. + In life-threatening situations, consider

May be implanted or external: Â Insulin Â

Morphine

revised: 121200 1

Epinephrine device (Auto-Injector) reaction (Respiratory distress or hypoperfusion)

Chemotheraputic agents with required precautions (Spill Kit)

Demerol (Meperidine)

Bronchodilator inhaler or nebulizer

* Signs and symptoms of severe allergic

Total Parenteral Nutrition

+

Systolic BP greater than 100

* Alert enough to use inhaler

Require infusion pump at preset rate: KCL-max 20 mEq11000 ml

+ + +

Sublingual nitroglycerine aerosol or tablets

BLS transport if ALS arrival is longer than BLS transport time.

PAGE1 OF 1

1


POISON CONTROL CENTER The California Poison Control Center is a facility that provides information and advice regarding the management of individuals who have or may have ingested or otherwise been exposed to poisonous or possibly toxic substances.

1

ACCESSING A POISON CONTROL CENTER:

1

9-1-1 PROVIDERS

I

(800) 404- 4646

Health Professionals

(800) 41 1- 8080

Public Hotline

(800) 876- 4766

1

1

SYSTEM-WIDE MENTAL ASSESSMENT RESPONSE TEAM

-

In 1993 the Department of Health Services in cooperation with the Los Angeles Police Department committed resources to staff a system-wide mental assessment response team (SMART) in the City. SMART is designed to provide a cooperative, comionate mental health 1 law enforcement response team to assist affected citizens in accessing available mental health services. The team is able to assist in providing quick resolutions without unnecessary incarceration or hospitalization. SMART consists of nine teams including a supervisory team. Each team will be composed of one police officer and one Department of Mental Health clinician. The SMART goals are to:

* Prevent unnecessary incarceration andlor hospitalization of mentally ill individuals.

* Provide alternate care in the least restrictive environment through a coordinated and comprehensive system-wide approach.

* Prevent the duplication of mental health services. * Allow police patrol units to return to service sooner.

1

1

HOURS of OPERATION

SMART

Telephone: (213) 485-4188

1

Day Watch:

1

0700 hours to 1530 hours

1

1

PM Watch:

1

1530 hours to 2400 hours

1

SMART personnel shall request an ambulance to transport a person when: * The person is in need of immediate medical attention requiring transportation by EMS personnel

* The person is extremely violent and requires restraint to the extent that they must be transported in a recumbent position.

* The violent person is injured or physically ill and is in need of immediate medical attention. N B : When a mentally disordered andor violent person is transported by ambulance, at least one police officer shall accompany the patient. Revised: 121200 1

PAGE1 OF 1

Section 1: Field Procedures 1 Protocols b

CITY VOLUNTEER PROGRAMS /

CRISIS RESPONSE TEAM [CRT]

On November 25, 1998, under the direction of the Mayor's Office, Volunteer Bureau, Crisis Response Teams began City-wide operation. Crisis Response Team (CRT) are trained civilian volunteers who respond, on request, to FirelPolice emergencies to perform immediate andlor short term on-scene intervention to victims, families, witnesses, and survivors of traumatic events. These teams do not perform counseling functions and will not function in the capacity of Department Critical Incident Stress Debriefing Teams for Firefighters and/or Police Officers.

CRT may be requested for any incident which, in the judgment of the incident commander, necessitates rapid intervention and referrals for humanitarian services such as : Grief management Shelter Food acquisition Abused/neglected children Death Drive-by shootings

Drownings Fires with displaced occupants Homicides Major traffic accidents Suicides

The goal of the CRT is to allow emergency responders to complete operational duties while the CRT team provides humanitarian services. Requests for CRT shall be made through Operations Control Dispatch Section [OCD]. OCD will coordinate notification with the appropriate Police Division. CRT are identifiable by their jackets and picture identification. They are instructed to report to the incident commander upon their arrival. Any questions regarding the CRT may be directed to the Bureau of Human Resources, Bureau Liaison Officer, [2131 485-3396.

COMMUNITY EMERGENCY RESPONSE TEAM [CERT] The Community Emergency Response Team [CERT] are civilian volunteers [trained by the Fire Department] who assist their communities during the initial phase of a disaster, e.g., major earthquake. The purpose of the CERT Program is to improve community self-reliance and, therefore, survival in the event of a large disaster. It is known that emergency service resources will be depleted, to the extent that some individuals or neighborhoods will need to rely on themselves during the first 24 to 72 hours.

Note: The management of City Volunteer Programs is delineated in LAFD Training Bulletin 71 Revised: 0 112003

PAGE 1 OF 1

\,

-.

9 '


MISCELLANEOUS

shall use the following to indicate the urgency of the situation when requesting police response through Operations Control Dispatch (OCD): Fire Department needs " H E L P

I'

Use this term when there is imminent grave danger to LAFD personnel e.g., are being attacked, attack is imminent, or other immediate hazardldanger. Assigned to response: ALL AVAILABLE POLICE UNITS IN THE AREA (one unit dispatched Code 3 and other units ASAP) FIRE COMPANY BATTALION CHIEF AND/OR EMS BATTALION CAPTAIN (if EMS incident)

Fire Department needs " A S S I S T A N C E

"

Use this term when there is a large hostile crowd and apparent danger to LAFD personnel or apparatus. Assigned to response: ALL AVAILABLE POLICE UNITS IN THE AREA (one unit dispatched Code 2 and other units ASAP) BATTALION CHIEF AND/OR EMS BATTALION CAPTAIN (if EMS incident)

I

"BA CK

- U P " the Fire Department

Use this term when there are belligerent individuals and a likelihood of physical altercation. Assigned to response: ONE POLICE UNIT ASSIGNED, CODE 2

" M E E T " the Fire Department Use this term when requesting LAPD to accompany you to a known "trouble area" or when the Incident Commander requests LAPD for traffic or crowd control. Assigned to response: ONE POLICE UNIT ASSIGNED, CODE 2 Revised: 512005

Section I: Field Procedures I Protocols

MISCELLANEOUS +

THE HIGHEST RANKJNG MEDICAL AUTHORITY on scene (generally a paramedic) is responsible for the overall.medical care rendered to patients.

+

The Incident Commander is responsible for scene management, this includes: Scene Safety Resource Allocation Communications

+

In order to effectively supervise EMS incidents, officers are expected to have a clear understanding of-and the ability to apply-the following: Department of Health Services policies and procedures (Prehospital Care Policy Manual, LAFD Book 33):

1 1 1

802 806

1

808 814

1

834 502, 508, 5 10, 511, 512, 515, 518,519,520 822,829

1 1 1

1

1

EMT- 1 Scope of Practice Procedures Prior to Base Hospital Base Hospital and Transport Criteria Deteminatioflronouncement of Death in the Field Patient Refbsal of Treatment or Transport

I I 1 1

1

Patient Destination Policies Suspected Abuse Policies and Procedures

BODY ARMOR VESTS The BODY ARMOR VEST shall be donned prior to entering a potentially hostile environment. Protection from an attack depends on concealment of the vest so the attacker cannot purposefblly aim at or attack the unprotected area of the body. The vest shall be covered by a brush jacket, EMS safety coat, or firefighting turnout coat. shall wear their vests to the following incidents:

+ + + +

Assault with a Deadly Weapon (ADW) Domestic Violence 1 Family Dispute Shooting Stabbing I Cutting

+ + + +

Sniper Incident 1 Police Standby Tactical Alert Incidents in Known "Trouble Area" Other Violent Crimes or Conditions

N d : A vest may be worn anytime a member feels it is necessary. Revised: 512005

PAGE2 OF 3

7

Section I: Field Procedures 1 Protocols

MISCELLANEOUS MEDICAL WASTE DISPOSAL Before leaving the scene collect all usedcontaminated materials and place in zip-lock bags for discard in the biohazard containers at the hospital. Place the disposable sharp supplies into a puncture resistant container. Leave these containers at the receiving hospital when 314 fbll and secured properly.

Revised: 512005 PAGE 3 OF 3

Section I: Field Procedures I Protocols 7

MANAGEMENT OF MULTIPLE VICTIM INCIDENTS Normally BLS resources will not have the responsibility of medical incident control of multiple victim incidents. However, they may be the first resource on the scene of such an incident. An ALS resource shall be requested for incidents involving the transport of five or more patients and for patients whose condition meets the Patient Resolution Guide (PRG) criteria. The BLS resource shall obtain the following assessment information and initiate patient triage tags prior to the arrival of the ALS resource. (Refer to Book 35?Section 1.1,START; U F D Book 70, Multi-Casualty Incident Procedures; DHS, Reference No. 519.) ROLE OF THE PROVIDER AGENCY: Institute ICS as necessary. Implement START as necessary. Establish communication with either the MAC or base hospital for the purpose of patient destination andor medical direction. In general, the Medical Alert Center (MAC) should be ed for 10 or more patients and the base hospital for less than 10 patients. Additional BLSIALS transporting units may be requested fi-om Operations Control Dispatch as necessary. Request?if necessary?the hospital based medical resources from the MAC?as outlined in DHSyRef. No. 8 17?Hospital Emergency Response Team (HERT).

+ + t

t

+

1

PROVIDE THE FOLLOWING SCENE INFORMATION TO THE MAC OR BASE HOSPITAL,: N A T U m OF INCIDENT

t

t

SEVERITY STATUS: estimated number of immediate?delayed?minor, and deceased patients. If indicated?include total number and category of pediatric patients.

t

RECEIVING FACILITIES closest to location to include trauma centers?PTCs, PMCs, and EDAPs.

v @ PROVIDE THE FOLLOWING PATIENT INFORMATION AS TIME PERMITS: vv 1. Patient number [e.g., patient # 3 of 81 '# 2. Chief complaint vv 3. Age vv 4. Gender 5. Brief patient assessment vv 6. Brief description of treatment provided vv 7. Sequence number Transporting provider and unit number?destination, and ETA 8. '# vv v vvvvvvvvvvvvvvvvvvvvvvvvvvvvvvvvvvvvvvvvv.

~*A*A*A*A*A*A*A*A*A*A*A*A*A*A*A*A*A*A*A*A*A*A*A*A*A*A*A*A*A*A*A*A*A*A*A*A*A*A*A*A*A

Revised: 512005

PAGE1 OF 2

Section I:Field ProcedureslProtocols

MCI EMS REPORT SHORT FORM

The Multiple Casualty Incident (MCI) Short Form has been developed by the Los Angeles County EMS Agency as an optional form for use by providers in situations where multiple patients are encountered on scene. The form is a "shortened" version of the Los Angeles County EMS form that encomes the essential data for the incident while providing a valuable timesaving tool to providers for multi-patient incidents. The MCI short form may be used in place of the standard EMS Report Form in MCl's.

Page one

Page one (back copy) Patient Release

When more than ten (10) patients are encounteredl the provider has the option of using the MCI Short Form. When this form is usedl a standard EMS Report Form (F-902M) does not need to be filled out. During a mass casualty incidentl the MCI Short Form can be used as a standalone forml used along with a triage tagl or used in place of a triage tag (these options are at the discretion of the department or provider). (Refer to Departmental Bulletin No. 04-19) Each MCI EMS Report Short Form can accommodate up to four patients and is formatted in quadruplicate. The back of the first page allows the patient to release the Fire Department from liability. Use this section ONLY when patients that DO NOT meet the criteria of the LAFD PRG or the LAFD Book 33, Ref. No. 808 * are released from the scene. The fourth page has an adhesive backing and could be placed on the patient for tracking. Once the patient is released from the scenel the patient can keep the adhesive copy for their records. This adhesive copy can also be used as a record for the receiving facility! if the patient seeks medical treatment on their own. The MCI EMS Report Short Form will be carried by all companies and will be included in the MCI packet.

* Patients who meet the above criterial require an EMS Report Form F-902M completion and base hospital . Revised: 512005

PAGE 2 OF 2

Section 2: Patient Transportation 1 Destination

LAFD PATIENT DESTINATION GUIDELINES

prepared to receive emergency cases and ister emergency care appropriate to the needs of the patient, in the absence of "decisive factors to the contrary." 4 ALS units utilizing Standing Field Treatment Protocols (SFTPs) shall transport patients in accordance with this policy. 4 The most appropriate health facility for a patient may be that facility which is d with the patient's health plan. Depending upon the patient's chief complaint and medical history, it may be advantageous for the patient to be transported to a facility where helshe may be treated by a personal physician and/or the individual's personal health plan where medical records are available. 4 The MAR facility may or may not be the closest facility geographically. Transport personnel shall take into consideration traffic, weather conditions, or other similar factors which may influence transport time when identifying which hospital is most accessible. + Patients shall @ be transported to a medical facility that has requested diversion due to "Internal Disaster."

PATIENTS TRANSPORTED BY BLS PERSONNEL Stable patients requiring only basic life (BLS) shall be transported to the MAR, regardless of its diversion status (Exception: Internal Disaster). For pediatric patients, the MAR is the most accessible Emergency Department Approved for Pediatrics. For perinatal patients, the MAR is to be the most accessible Perinatal Center. BLS personnel may honor patient requests provided that the patient is stable, requires basic life measures only, and the ambulance is not unreasonably removed from its primary area of response. I

- Transport patients to the MAR unless: * * *

The base hospital determines that a more distant hospital is more appropriate to meet the needs of the patient. The patient meets criteria or guidelines for transport to a specialty care center. The patient requests a specific hospital [provided the patient's condition is considered stable to tolerate additional transport time, the receiving hospital agrees to accept the patient, and the EMS provider has determined that such a transport would not unreasonably remove the unit from its primary area of response]. * If transport to the desired hospital involves an extended transport time [> 20 min.] notify OCD of the extended time and the receiving facility to determine if they will accept the patient. * If the desired hospital is unreasonably far, request the EMS Battalion Captain. N A : On an "as needed basis", the EMS agency may extend maximum transport time. grequests cannot be honored, the provider should attempt to arrange for alternate transportation i.e., private ambulance. ALS units may be directed to an alternate "open" facility when the medical facility has requested diversion of patients requiring ALS, if:

* * *

The patient does not exhibit an uncontrollable problem in the field (e.g., unmanageable airway, uncontrolled hemorrhage). The ALS unit estimates that it can reach an alternate facility within 15 minutes (Code 3) from the incident location. There are no "open" facilities within this time frame, ALS units shall be directed to the MAR regardless of its diversion status (Exception: Internal Disaster). N:On an "as needed basis,'' the maximum transport time may be extended. Revised: 512005

PAGE 1 OF 1

CALIFORNIA

- -

1

CENTINEIA FREEMANMEMORIAL CAMPUS

ADULT

1

12 & OLDER 16 & OLDER

1

-

COMMUNITY OF LONG BEACH

ADULT

PEDIATRIC

IACIUSC

ADULT

PEDIATRIC

LITTLE COMPANY OF MARYTORRANCE L I E COMPANY OF MARY SAN PEDRO

1 1

ADULT

1

I

ADULT

SAN GABRIEL VALLEY

I

ADULT

SANTAMONICAIUCLA

I

ADULT

1

1

I I

PEDIATRIC

14 & OLDER PEDIATRIC

1

1 1 1

"Sexual Assault" refers to patients who state they were sexually assaulted or if EMS personnel suspect the patient was a victim of sexual assault. Prehospital personnel shall notify the local law enforcement agency of sexual assault victims regardless whether the patient complains of physical injuries. EMS personnel, in conjunction with law enforcement, are highly encouraged to transport suspected sexual assault patients, who deny physical injuries, to a designated SART Center. ( D M Reference No. 508)

Revised: 512005

PAGE 1 OF 2

1

\

Trauma patients shall be secured and transported from the scene as quickly as possible, consistent with optimal trauma care. EMT-Ps shall make base hospital with the area's trauma hospital, when it is also a base hospital, on all injured patients who meet Base and Transport criteria, trauma triage criteria and/or guidelines, or in the paramedic's judgment it is in the patient's best interest to be transported to a trauma hospital. Hospital shall be accomplished in such a way as not to delay transport. Patients who fall into one or more of the following categories are to be transported directly to the area's designated trauma hospital, if transport time does not exceed 20 minutes. If existing field resources at the time of transport allow, patients may be transported an additional 10 minutes (to a maximum of 30 minutes). Transport pediatric trauma patients to the designated PTC. (DHS, Reference No. 506)

Systolic Blood Pressure: Adults < 90 Children < 70

Penetrating injury to neck

Abnormal capillary refill

Patients surviving falls from heights > 15 feet

1 No spontaneous eye opening Penetrating cranial injury Penetrating thoracic injury within

Blunt injury to chest with unstable chest wall (Flail chest)

Diffuse abdominal tenderness

Intrusion of motor vehicle into enger space

I Cardiopulmonary arrest with penetrating torso trauma

Blunt head injury associated with altered consciousness (GCS equal to or less than 14, excluding patients < 1 year old), seizures, unequal pupils, or focal neurological defecit Open or closed injury to the spinal column associated with sensory deficit or weakness of one or more extremities

Mechanism of injury is the most effective method of selecting critically injured patients before unstable vital signs develop. Paramedics and base hospital personnel shall consider mechanism of injury when determining patient destination. Transportation to a trauma hospital is advisable for:

* * * * *

Survivors of vehicular accidents (in which fatalities occurred) who complain of injury Pedestrians struck by automobiles Patients ejected from vehicles Patients requiring extrication The very young, very old, and patients with precarious previous medical histories

The following extremis patients require immediate transport to the most accessible receiving (MAR) facility:

* *

Patients with an obstructed airway

*

Patients whose lives would be jeopardized by transportation to any but the most accessible receiving (MAR) facility, as determined by the base hospital personnel

Cardiac arrest from traumatic injuries (Exception: Transport a penetrating torso injury to a Trauma Center)

Revised: 512005

PAGE 2 OF 2


When base hospital cannot be made, for any reason, paramedics shall decide the destination for trauma patients using the guidelines set forth. BLS personnel shall transport patients to the most accessible receiving (MAR) facility

/

trauma catchment/boundary area is a geographical area surrounding a trauma hospital in which the trauma hospital has agreed to accept trauma patients. The boundaries may either be defined by streets1 freewaysllandmarks or transport time. (DHS, Reference # 504)

*

Secure Catchment Boundaries1 Area: A catchment area around a trauma hospital strictly defined by streetslfreeways or other physical landmarks. Hospitals with secure catchment areas will only accept trauma patients from incident locations within the defined area.

* Open Catchment BoundariesIArea: A catchment area around a trauma hospital defined by transport time (i.e., a hospital will accept patients who can be transported to its facility within a 30-minute, Code-3 transport time). The boundaries of a trauma hospital with an open catchment area will vary throughout any given day due to variations in weather and traffic patterns. ALS personnel responsibilities include: (1) Maintaining current knowledge of which geographic areas are securelopen catchment areas or areas undesignated for trauma within the assigned area; (2) Advising the base hospital of the designated trauma hospital covering the incident location when making base on a trauma patient.

SECURE Catchment 1 Boundaries for ADULT and PEDIATRIC Trauma Patients: Henry Mayo Newhall Memorial

Huntington Memorial (PMC)

St. Francis Medical Center

St. Mary Medical Center (PMC)

\

Northridge Medical Center-Roscoe Campus

I SECURE Catchment 1 Boundaries for ADULT and OPEN Catchment I Boundaries for PEDIATRIC Trauma Patients: Cedars-Sinai Medical Center (PMC ,PTC)

UCLA Medical Center (PMC, PTC)

Long Beach Memorial (PMC, PTC)

California Medical Center

F ~ ~ a t c h m eI nBoundaries t for Trauma Patients: Childrens Hospital L. A. (PMC, PTC) HarborIUCLA Medical Center (F'MC, PTC)

Providence Holy Cross

LACAJSC Medical Center (PMC, PTC)

Trauma patients from incidents occurring in an undesignated area shall be transported to: * The assigned Air Ambulance Trauma Transport Program hospital (Antelope ValleylEast County only); or * The closest/open County-operated trauma hospital within the 30-minute transport guidelines, by groundlair; or * The most accessible receiving hospital (Extremis) (EDAPfor pediatric patients). Revised: 512005

PAGE

1 OF 2

1

1

139

1

CEDARS SINAI

1

1

145

1

CHILDRENS

1

1

PAGE632-J1

1

PAGE

594-A4

TORRANCE

PAGE

764-A6

LA

PAGE

635-B3

LA

248

HARBOR

438

LAC~USC

533

LONG BEACH MEMORIAL

LONG BEACH

PAGE

792-E2

818

UCLA MEDICAL CENTER

LA

PAGE

632-B2

/

UCLA

All Pediatric Trauma Centers (PTCs) have an OPEN trauma catchment area for pediatric trauma patients. Pediatric patients (14 years of age or younger), who meet Trauma Center Criteria and/or Guidelines, shall be transported to a designated PTC

1

1

133

CALIFORNIA

TRAUMA

139

CEDARS-SINAI

TRAUMA

145

CHILDRENS

248

HARBOR /UCLA

TRAUMA

270

HENRY MAY0

305

HOLY CROSS

324

1 HUNTINGTON MEM.

533

EDAP

PERINATAL

PMC

EDAP

PERINATAL

PMC

EDAP

PMC

EDAP

PERINATAL

TRAUMA

EDAP

PERINATAL

TRAUMA

EDAP

PERINATAL

1 TRAUMA 1

PMC

LONG BEACH MEM.

TRAUMA

PMC

571

NORTHRIDGE

667

1

EDAP

NICU

PTC

NICU

PTC

NICU

PTC

NICU

1 PERINATAL 1 N I C U 1 PERINATAL

NICU

TRAUMA

EDAP

PERINATAL

NICU

ST. FRANCIS

TRAUMA

EDAP

PERINATAL

NICU

134

ST. MARY

TRAUMA

PMC

EDAP

PERINATAL

NICU

818

UCLA

TRAUMA

PMC

EDAP

PERINATAL

NICU

1 TRAUMA 1

PMC

1 USC

Revised: 512005

1

EDAP

PAGE 2 OF 2

J

x

EDAP

438

x x

1 PTC

PTC

1 PERINATAL 1 N I C U 1 PTC 1

X

1

x x x x x I

1

- -

CALIFORNIA MEDICAL CENTER [CALI

ADULT

CEDARS SINAI MEDICAL CENTER [CSM]

ADULT

PEDIATRIC

--

CHILDRENS HOSPITAL OF LOS ANGELES [CHH]

1 1

PEDIATRIC

HARBOR I UCLA MEDICAL CENTER [HGH]

ADULT

HENRY MAY0 NEWHALL MEMORIAL [HMNI

ADULT

PROVIDENCE HOLY CROSS MEDICAL CENTER [HCHI

ADULT

HUNTINGTON MEMORIAL HOSPITAL [HMH]

ADULT

LAC I USC MEDICAL CENTER [USC]

ADULT

PEDIATRIC

LONG BEACH MEMORIAL MEDICAL CENTER [LBM]

ADULT

PEDIATRIC

NORTHRIDGE HOSPITAL MEDICAL CENTER [NRHI

ADULT

ST. FRANCIS MEDICAL CENTER [SFM]

ADULT

ST. MARY MEDICAL CENTER [SMM]

ADULT

UCLA MEDICAL CENTER [UCL]

ADULT

Revised: 0512005

PAGE 1

of 26

PEDIATRIC

PEDIATRIC

LA C O U N T Y T R A U M A CENTERS

Revised: 512005

PAGE

2 of 26

CALIFORNIA MEDICAL CENTER TRAUMA CENTER CATCHMENT AREA

DESTINATION CRITERIA OPEN catchmentl boundaries for PEDIATRIC trauma patients and

SECURE catchmentl boundaries f o r ADULT trauma patients.

1 LEGEND THOMAS GUIDE MAP

CAL

CALIFORNIA

Revised: 05/2005

133

EDAP, PERINATAL, TRAUMA, SART

PAGE 3

of 26

BOOK PAGE

634-D6

-

"1

CALIFORNIA MEDICAL CENTER TRAUMA CENTER CATCHMENT AREA

California Medical Center Trauma Center Catchment Area

PHASE 2 Target Date: 02101105 CAL

CaliforniaMedical Center

Ã‘Ã

-

TRAUMA CENTER

TRAUMA AREA BOUNDARIES FREEWAYS M A J O R STREETS

NORTHERNBOUNDARY Sanla Monica (10) Freeway Western Avenue

EASTERNBOUNDARY Central Avenue

SOUTHERNBOUNDARY Century Blvd (PHASE 2) WESTERNBOUNDARY Crenshaw Boulevard

Crealed: 1110Z041PLN

Revised: 0512005

PAGE 4

of 26

s

CEDARS-SINAI MEDICAL CENTER

"1

I

TRAUMA CENTER CATCHMENT AREA

MULHOLLAND DR

/

CAHUENGA

/

GRIFFITH PARK AREA

(PARAMEDIC / BASE HOSPITAL JUDGEMENT)

SANTA MONICA

MOTOR AVE

1

(10) FREEWAY

1 SANTA

MONICA

(10) FREEWAY

DESTINATION CRITERIA

OPEN catchment1 boundaries for PEDIATRIC trauma

patients

and

SECURE catchment1 boundaries for ADULT trauma patients.

THOMAS GUIDE MAP BOOK PAGE

CSM

CEDARS SINAI

139

PMC, EDAP, PERINATAL, TRAUMA, PTC

632-J 1

UCL

UCLA

818


632-B2

145

PMC, EDAP, PEDIATRIC TRAUMA CENTER (PTC)

5 94-A4

CHH

cH'LDRENs HOSPITAL

Revised: 0512005

PAGE 5

of 26

CEDARS-SINAI MEDICAL CENTER TRAUMA CENTER CATCHMENT AREA

Revised: 0712004

PAGE

6 of 26

/ UCLA HOSPITAL CENTER CATCHMENT AREA

1


Harbor 1 UCLA Medical Center has a n OPEN catchment area and will accept patients w h o can be transported t o its facility within a 30-minute, Code-3 transport time. The times may vary throughout any given day because of variations in weather and traffic patterns.

1 LEGEND THOMAS GUIDE MAP BOOK PAGE

1

HARBOR 1 UCLA HOSPITAL TRAUMA CENTER CATCHMENT AREA

Revised: 0512005

PAGE 8 of 26

HENRY MAY0 NEWHALL MEMORIAL HOSPITAL TRAUMA CENTER CATCHMENT AREA

1

DESTINATION CRITERIA SECURE catchment area for ADULT and PEDIATRIC trauma patients.

1

LEGEND THOMAS GUIDE MAP BOOK PAGE

1

HMN

1

I1 I1 HcH

NRH

HENRY M A Y 0 NEWHALL PROVIDENCE HOLY CROSS NORTHRIDGE

Revised: 0712004

1 270

EDAP, PERINATAL, TRAUMA

EDAP, PERINATAL, TRAUMA I


PAGE

9 of 26

1

530-J2

HENRY M A Y 0 NEWHALL MEMORIAL HOSPITAL TRAUMA CENTER CATCHMENT AREA ,-

Revised: 0312003

PAGE

10 of 26

6.b PROVIDENCE HOLY CROSS MEDICAL CENTER "1


1


Providence Holy Cross Medical Center has an OPEN catchment area and will accept patients who can be transported t o its facility within a 30-minute, Code -3 transport time. The boundaries will vary throughout any given day because of variations in weather and traffic patterns.

1


I I

PROVIDENCE

I

CHILDRENS HOSPITAL

145

NORTHRIDGE

571

HcH

cHH

I

NRH

HOLY CROSS

305

I

I

I


1


I I HMN

NEWHALL

Revised: 05/2005


PAGE 1 1

of 26

501-HI 5 94-A4

PMC, EDAP, PTC

--

HENRY MAY0

1 1

I

530-J2 4554%

I

I

PROVIDENCE HOLY CROSS MEDICAL CENTER TRAUMA CENTER CATCHMENT AREA

Revised: 0312003

PAGE

12 of 26

HUNTINGTON MEMORIAL HOSPITAL TRAUMA CENTER CATCHMENT AREA

DESTINATION CRITERIA SECURE catchment area for ADULT and PEDIATRIC trauma patients. A secure catchment area is strictly defined by streetdfree ways or other physical landmarks.

1


HMH

USC

HUNTINGTON MEMORIAL LAC/USC MEDICAL

Revised: 0512005

324 438

PMC, EDAP, PERINATAL, TRAUMA

565-H6

PMC, EDAP, PERINATAL, TRAUMA, PTC,

635-B3

SART

PAGE

1 3 of 26

HUNTINGTON MEMORIAL HOSPITAL TRAUMA CENTER CATCHMENT AREA

COUNTY

Revised: 0312003

PAGE 14 of

26

LAC 1 USC MEDICAL CENTER TRAUMA CENTER CATCHMENT AREA

1

DESTINATION CRITERIA OPEN catchment area for ADULT and PEDIATRIC trauma

patients.


USC

HMH

CHH

LAC/USC MEDICAL

HUNTINGTON MEMORIAL CHILDRENS HOSPITAL

Revised: 0312003

438

PMC, EDAP, PERINATAL, TRAUMA, PTC, sART

635-B3

324

PMC, PERINATAL, EDAP, TRAUMA

565-H6

145

PMC, EDAP, PEDIATRIC TRAUMA CENTER

594-A4

PAGE

15 of 26

LAC 1 USC MEDICAL CENTER TRAUMA CENTER CATCHMENT AREA

Revised: 0512005

PAGE

16 of 26

LONG BEACH MEMORIAL HOSPITAL

@


ORANGE COUNTY LINE

1

DESTINATION CRITERIA SECURE catchment area for ADULT trauma patients

OPEN catchment area for PEDIATRIC trauma patients.


I 1

1

LBM SMM SFM

I 1

1

MEMORIAL

1 1


1

795-E2

ST. MARY MEDICAL

1 134 1


I

795-~6

667


LONG BEACH

ST. FRANCIS MEDICAL

Revised: 0512005

533

1 1

PAGE

17 of 26

1

705436

LONG BEACH MEMORIAL HOSPITAL TRAUMA CENTER CATCHMENT AREA

Revised: 0712004

PAGE

18 of 26

NORTHRIDGE MEDICAL CENTER TRAUMA CENTER CATCHMENT AREA

DESTINATION CRITERIA SECURE catchment area for trauma

patients and will accept patients w h o can be transported t o its facility within a 30-minute, Code -3 transport time. The times may vary throughout any given day because of variations in weather and traffic patterns.

LEGEND

s NRH

THOMAS GUIDE MAP BOOK PAGE

PROVIDENCE HOLY CROSS

5 0 1- H I

NORTHRIDGE

530-J2

Revised: 0712004

PAGE

19 of 26

NORTHRIDGE MEDICAL CENTER ROSCOE TRAUMA CENTER CATCHMENT AREA

Revised: 0712004

PAGE

20 of 26

ST. FRANCIS MEDICAL CENTER TRAUMA CENTER CATCHMENT AREA

DESTINATION CRITERIA SECURE catchment area for trauma

patients and will accept patients who can be transported to its facility within a 30-minute, Code - 3 transport time. The times may vary throughout any given day because of variations in weather and traffic patterns.


SFM

ST. FRANCIS MEDICAL

Revised: 0512005

667


PAGE 2 1 of 26

705-B6

S T . FRANCIS MEDICAL CENTER TRAUMA CENTER CATCHMENT AREA

Revised: 0512005

PAGE 22 of 26

ST. MARY MEDICAL CENTER TRAUMA CENTER CATCHMENT AREA

1


SECURE catchment area for trauma patients and will accept

patients who can be transported t o its facility within a 30-minute, Code -3 transport time. The times may vary throughout any given day because of variations in weather and traffic patterns.

1 LEGEND THOMAS GUIDE MAP BOOK PAGE

sMM LBM

1

ST. MARY MEDICAL LONG BEACH MEMORIAL

Revised: 0512005

1 134 1 533

EDAP, PERINATAL, TRAUMA PMC, EDAP, PERINATAL~TRAUMA,PTC

PAGE 23

of 26

1

795-~6

795-E2

ST. MARY MEDICAL CENTER TRAUMA CENTER CATCHMENT AREA

Revised: 0712004

PAGE

24 of 26

UCLA MEDICAL CENTER TRAUMA CENTER CATCHMENT AREA

1


OPEN catchment

area for

PEDIATRIC trauma patients and

SECURE catchment area for ADULT trauma

patients.


CSM

CEDARS-SINAI

139


632-J 1

NRH

NORTHRIDGE

57 1

EDAP, PERINATAL, TRAUMA,

530-J2

UCL

UCLA

818

EDAP, PMC, PERINATAL, TRAUMA, PTC

632-B2

Revised: 0512005

PAGE

25 of 26

UCLA MEDICAL CENTER (UCL) TRAUMA CENTER CATCHMENT AREA

I

Revised: 0512005

Pacific Ocean

Page 26 of 26

Section 2: Transportation 1 Destination

TRAUMA CENTER DIVERSION \

v

When the designated trauma hospital requests diversion to trauma, transport the patient to: The closest open County-operated trauma hospital within the 30-minute transport guidelines, by ground or by air; The closest open trauma hospital with an open catchment area within the 30-minute transport guideline by ground (DHS Reference # 504)

For multiple victim incidents (five or more patients), secure catchment boundaries shall be adhered to. It is understood that during a multiple victim incident, as a result of normal triage procedure, trauma patients may ultimately be transported to a trauma hospital as the next closest facility (crossing the catchment/ boundary) as receiving hospitals in the surrounding geographic area of the incident are utilized to their maximum capacity. Added to the guidelines for identifying critically ill or injured pediatric patients requiring transport to a PMC is ALTE (Acute Life Threatening Event). In 2003, the new category of Pediatric Trauma Center (PTC) was added to the list of Specialty Care Centers. Pediatric patients meeting Trauma Center CriteriaIGuidelines will be transported to the most accessible PTC that may be reached within 30 minutes. In cases when a PTC cannot be reached within this time frame, transport to an adult trauma center.

EDAp / PMC / PTC

\

Factors to consider prior transport to an EDAP, P M C , or a PTC:

* * * *

Severity of illness or injury and stability of the child's condition Current status of the pediatric receiving facility Anticipated transport time Destination request by family or physician if patient's condition allows

Does not meet PMCRTC transport

Critically ill (MEDICAL)

Critically injured (TRAUMA)

Transport time to PMC is > 30-min.

Severe respiratory distress Cyanosis

Trauma criteria and1 or guidelines *

BLS transport when ALS unit is not available

ALTE 2 12 months of age

Transport time does not exceed 30 minutes *

Uncontrollable, life threatening situation ( e.g., unmanageable airway or uncontrollable hemorrhage, respiratory or cardiac arrest) (Refer to the PRG, Principle)

Persistent altered mental status

*

For patients who meet DHS Ref.# 506

Status epilepticus Cardiac dysrhythmia

Transport to the most accessible Perinatal Center: Patients who are at least 20 weeks pregnant and who appear to be in active labor or have perinatal complications, chief complaint is related to the pregnancy, and injured perinatal patients who do not meet trauma criteria or guidelines. For patients who have made previous arrangements for OB care, honor patient destination request if: Patient condition permits such transport, transport to requested OB facility would not exceed 20 minutes, and would not unreasonably remove the transporting unit from its area of primary response. (DHS, Reference # 5 11) Revised: 0512005

PAGE 1 OF 1


BURN PATIENTS Destination for patients sustaining bum injuries shall be determined as follows:

*

Patients who meet trauma or PTC criteria and/or guidelines shall be transported to the appropriate trauma hospital or PTC.

*

Patients who do not meet trauma or PTC criteria and/or guidelines shall be transported to the most accessible receiving (MAR) appropriate for their age. (DHS, Reference 5 12)

Note: Firelighter's, who sustain bum injuries, that do not meet base station criteria, shall be TAKEN DIRECTLY to either the Grossman Burn Center at Sherman Oaks Hospital or Torrance Memorial Hospital Burn Center. To expedite the appropriate care associated with the complexities of bums when a firelighter sustains a bum injury, no matter how slight, the following shall be adhered to :

+ 4

4

Firelighter medically evaluated by paramedics. Request for the concerned EMS Battalion Captain shall be made through OCDS. Transport consistent with DHS, Reference 512. However, when the bum injury does not meet base criteria, the member shall be transported directly to one of the above bum centers.

This is particularly directed at minor bums that are recognized as a first-degree with high probability of progressing to a second-degree and any second-degree bum. Serious bums require base as noted in DHS Reference No 808. Bums secondary to or associated with injuries meeting trauma center criteria shall be transported to a trauma center prior to a bum center.

1

DECOMPRESSION

Paramedics should simultaneously establish base hospital with LACIUSC Medical Center and the Medical Alert Center (MAC) via the Hospital Emergency istrative Radio (HEAR) for any patient suspected of having a decompression emergency. LAC/USC Medical Center will provide medical orders for patient care and determine if the patient should be transported directly from the incident location to a hyperbaric chamber. MAC will determine which hyperbaric chamber is most appropriate to the needs of the patient and coordinate transportation to the chamber for the patient and medical personnel. (Factors considered include: patient condition, distance, altitude, ETA of available transportation, and limitations of various aircraft.) *Obtain dive incident history of the patient and dive partner, if able. 'Coordinate patient transportation to the appropriate receiving facility. *Retrieve patient's dive equipment (e.g., regulator, tank, gauges, weight belt, etc.) and transport with patient. As a general rule, the integrity of the dive equipment should be maintained and not tampered with except by investigating authorities. (Refer to DHS, Reference No. 518.)

N A : If MAC cannot be accessed directly fi-om the field and another base hospital is ed, that base hospital should MAC for coordination of treatment and transport.

Revised: 512005

PAGE 1 OF 2

1


1

DECOMPRESSION

Paramedics should simultaneously establish base hospital with LAC/USC Medical Center and the Medical Alert Center (MAC) via the Hospital Emergency istrative Radio (HEAR) for any patient suspected of having a decompression emergency. LACNSC Medical Center will provide medical orders for patient care and determine if the patient should be transported directly from the incident location to a hyperbaric chamber. MAC will determine which hyperbaric chamber is most appropriate to the needs of the patient and coordinate transportation to the chamber for the patient and medical personnel. (Factors considered include: patient condition, distance, altitude, ETA of available transportation, and limitations of various aircraft.)

* Obtain dive incident history of the patient and dive partner, if able. * Coordinate patient transportation to the appropriate receiving facility. Retrieve patient's dive equipment (e.g., regulator, tank, gauges, weight belt, etc.) and transport with patient.

As a general rule, the integrity of the dive equipment should be maintained and not tampered with except by investigating authorities. (Refer to DHS, Reference No. 518.) ,)

N A : If MAC cannot be accessed directly from the field and another base hospital is ed, that base hospital should MAC for coordination of treatment and transport.

Revised: 1212001

PAGE

2 OF 2


PATIENT DESTINATION GUIDELINES EMS personnel shall use the following guidelines when making patient destination decisions:

-a'

-V

, 1

PATIENTS 0-14 YEARS OLD: Transport to themost accessible EDAP I PMC I PTC

1 PATIENTS 15 YEARS or OLDER: Transport to the most accessible receiving (MAR) facility 1 Emergency Departments Approved for Pediatrics (EDAP) Harbor/UCLA Medical Center * * + Robert F. Kennedy Brotman

Henry Mayo Newhall Memorial

California

Huntington Memorial

Cedars Sinai

**

+

**

St. Francis St. John's

Kaiser - Woodland Hills

St. Mary Medical Center

Centinela Freeman-Centinela KingIDrew

San Gabriel Valley

Centinela Freeman-Memorial

LAC/USC Medical Center ** +

Santa Monica - UCLA

Childrens Hospital LA * * +

Little Company of Mary-San Pedro

Simi Valley

Columbia - West Hills

Little Company of Mary-Torrance

Torrance Memorial

Downey Regional

Long Beach Memorial

East LA Doctors

Northridge - Roscoe Campus

Valley Presbyterian

Encino Tarzana - Tarzana

Pacifica of the Valley

Verdugo Hills

Gardena Memorial

Providence Holy Cross

White Memorial

Glendale Adventist

Providence St. Joseph

**

+

UCLA Medical Center * * +

Glendale Memorial

** PMC

+ PTC

Italics denotes "Trauma Center"

If the patient is stable, honor the patient's or physician's request. Normally, the transportation time shall not exceed 20 minutes (non-emergency). Extended transport times require authorization from OCD.

Internal Disaster:

No BLS or ALS Transport

Emergency Room (ER) Saturation:

No ALS Transport

Neuro, CT Scan, Trauma, PTC:

No ALS Transport (for patients requiring these specialties)

"Service Area" hospitals may @ divert except for INTERNAL, DISASTER. Diversion transportation time is 15 minutes (Code 3) to an open emergency room (ER). If ER is open, within the 15 minute transport time, transport to the most accessible ER.

Revised: 512005

PAGE 1 OF 1

1'


TRANSPORTING PATIENTS IN CUSTODY

Utilize the following procedural guidelines when requested by LAPD (or other law enforcement agencies) to transport a patient in custody:

+

A law enforcement officer shall ride in the back of the rescue ambulance with the patient at all times.

+

Patients shall be transported to the most accessible medical facility. (Patient's from the Central Jail or Parker Center shall be transported to LACAJSC's 13th floor Jail Ward, unless in extremis).

+

Restrained patients shall not be transported in the prone (facelchest downward) position. Such patients shall be transported in the left lateral position.

+

Restraint equipment, applied by EMS personnel, must be either padded leather or soft restraints. Restraint methods must allow for quick release. (DHS Reference # 838)

+

Restrained extremities shall be evaluated for pulse quality, capillary refill, color, nerve, and motor status every 15 minutes or less.

REQUIRED DOCUMENTATION ON THE EMS REPORT FORM (F-902M) SHALL INCLUDE:

2

The type of and reason restraints were needed. Identity of agencylmedical facility applying restraints. Assessment of the circulatory and neurological status of the restrained extremities. Any abnormal findings require the restraints to be removed and reapplied or ing documentation. Assessment of the cardiac and respiratory status of the restrained patient.

HOSPITAL REFUSAL TO ACCEPT RESCUE AMBULANCE PATIENTS Personnel encountering serious problems at a hospital emergency room (i.e., refusing patient) shall OCD and request an EMS Battalion Captain to respond to their location. It shall be the responsibility of the EMS Battalion Captain to investigate the circumstances and ensure that proper base hospital notification/docurnentation is made. Journal entries of the incident shall be made and the Station Commander notified. Once a patient arrives inside the intended emergency room, the patient shall remain.

Revised: 512005

PAGE 1 OF 1

hospitals have an agreement with the EMS Agency that only those patients within a given boundary will be transported to their facility. Service area hospitals may honor patient requests from outside of their service area; however, they are not obligated to do so. All LAFD ambulances with any ALS or BLS patient, within a defined service area, will transport to the service area hospital, maintaining the service area hospital agreement. (In most instances the service area hospital is also the MAR.)

Patients who meet criteria or guideline for a specialty care center (e.g., EDAP, PMC, Trauma, Perinatal) not provided by the service area hospital, shall be transported to the appropriate specialty care center. Patients exhibiting uncontrollableproblems in the field will be transported to the most accessible medical facility regardless of incident location. Patients from multiple casualty incidents may have to cross boundaries, depending on incident location or direction from the base hospital or Medical Alert Center.

N:-

Service area hospitals shall not be on diversion for any categories other than Internal Disaster.

It is the responsibility of BLS and ALS personnel to recognize the appropriate receiving hospital based on the patient's condition and incident location.

CALIFORNIA MEDICAL CENTER

EDAP

PERINATAL

NICU

CENTINELA FREEMAN-CENTINELA

EDAP

PERINATAL

NICU-

CENTINELA FREEMAN-MEMORIAL

EDAP

PERINATAL

NICU

EAST LA DOCTORS

EDAP

PERINATAL

GOOD SAMARITAN

1

MEMORIAL HOSP. OF GARDENA WHITE MEMORIAL MED. CENTER

NICU

PERINATAL I

I

1

EDAP EDAP

1

I

PERINATAL

1

PERINATAL

1 NICU

Patient requests for transport to a service area hospital when the incident location is outside the hospital's defined service area or inside the service area of another hospital may be honored by:

1 BLS Resource (For BLS patients): The receiving hospital agrees to accept the patient. The transporting unit is not unreasonably removed from its primary response area.

1 ALS Resource: Base Hospital concurs that the patient's condition is stable to permit the estimated transpoi-t time. The requested hospital agrees to accept the patient. The transporting unit is not unreasonably removed from its primary response area.

N :*

The receiving hospital may be ed directly if the ALS unit is transporting a BLS patient.

Revised: 512005

PAGE 1 OF 1

/-^ 1

Section 2: Trans~ortation1 Destination

Good Samaritan Hospital & California Hospital

Good Samaritan Hospital and California Hospital have the above service area boundaries and are divided by Olympic Blvd. If BOTH hospitals are listed as emergency department "SATURATED," adult patients from incident locations: NORTH of Olympic B1vd.-transport to Good Samaritan Hospital. SOUTH of Olympic B1vd.- transport to California Hospital.

1 DESTINATION C R I T E R I A Rescue ambulance personnel shall access the Mobile Data Terminal (MDT) to determine the hospital emergency department status prior to initiating transport. If either hospital is listed as an emergency department "SATURATED," service area patients shall be taken to the other hospital.

California Medical Center

CAI,

1

I

GSH

I

1 Good Samaritan Hospital 1 220 [PERINATAL, NICU

Revised: 512005

Thomas Guide Pg. 634-D6

133 EDAP, PERINATAL, NICU I

I

1 Thomas Guide Pg. 634-D3 1

HOSPITAL OF THE GOOD SAMARITAN &

CALIFORNIA MEDICAL CENTER Service Area

Revised: 512005

PAGE 2 OF 8

Section 2:

Transportation I Destination

Centinela Freeman-Centinela & Centinela Freeman-Memorial

Patients fiom incident locations:

4 Within the "Secondary

Service Area'' may be transported to Centinela FreemanMEMORIAL (DFH) o r CENTINELA FREEMAN-CENTINELA (CNT).

4

West of the 405 Freeway, may be transported to Centinela Freeman- MARINA (DFM).

4 All PEDIATRIC patientsy age 14 or less not meeting pediatric trauma or PMC criteria, shall be transported to Centinela Freeman- MEMOFUAL Hospital.

4

All adult patients, age 3 5 2 , with the chief complaint of CHEST PAIN or SYMPTOMATIC DYSRHYTHMIAyshall have A L S transport to CENTINELA FREEMANCENTINELA Permissible EXCEPTIONS to transporting patients to this destination are: d Incidents involving patients requiring transport to a specialty care facility (trauma center or pediatric critical care center). 4 When honoring a patient request in accordance with Department customer service guidelines. d When facility is closed due to internal disaster.

BMC Brotman Medical Center CNT

Centinela Freeman-CENTINELA

172

EDAP

Thomas Guide Pg. 672-Gl

141

EDAPyPERINATAL, NICU

Thomas Guide Pg. 703-D4 Thomas Guide Pg. 762-B6

DFM Centinela Freeman MARINA

457

DFH Centinela Freeman MEMORIAL

153

kl?W Kaiser-West LA

362 PERINATAL

Revised: 512005

PAGE

EDAP, PERINATAL, NICU

3 OF 8

Thomas Guide Pg. 703-D2 Thomas Guide Pg. 632-J6

Secondary Service Area: The Secondary Service Area will become effective when all receiving hospitals within 15 minutes from the incident location7in the Secondary Service Area7have requested diversion to ED saturation. In this instance, patients may be transported to DFH or CNT.

I

Manchester Ave. Boundary: When both DFH and CNT have requested diversion due to ED saturation7patients will be transported as follows: Patients NORTH of MANCHESTER Ave. will be transported to DFH. Patients SOUTH of MANCHESTER Ave. will be transported to CNT.

Revised: 512005

Section 2: Transportation I Destination

Memorial Hospital of Gardena

LEGEND

1

MHG Memorial Hospital of Gardena

EDAP, PERINATAL

Thomas Guide Pg. 734-A5

CNT

Centinela Hospital-CENTINELA

EDAP, PERINATAL, NICU

Thomas Guide Pg. 703-D4

MLK

KingDrew

EDAP, PERINATAL

Thomas Guide Pg. 704-G7

SFM

St. Francis

EDAP, PERINATAL, TFUUMA

Thomas Guide Pg. 705-B6

HGH

HarborRJCLA



Revised: 512005

PAGE

5 OF 8

MEMORIAL HOSPITAL OF GARDENA Service Area

Revised: 512005

PAGE

6 OF 8

Section 2:

Transportation 1 Destination

White Memorial Medical Center (Including E a s t L A D o c t o r s )

k


While in the White Memorial Service Area, rescue ambulance personnel shall transport to the most accessible, open hospital within the Service Area, e.g., White Memorial Medical Center, East Los Angeles Doctors, or LACAJSC Medical Center..

LEGEND WMH White Memorial Med.Cent.

1 ELA l ~ a sLos t Angeles Doctors 1 157 1 EDAP, PERINATAL

1 I

PMC, PERINATAL, NICU, pTc (USE) LAC/USC Medical Center 438 TMw,

Revised: 512005


970 EDAP, PERINATAL, NICU

PAGE

7 OF 8

1 Thomas Guide Pg. 635-D7 1

1

Thomas Guide Pg. 635-B3

WHITE MEMORIAL MEDICAL CENTER Service Area

Revised: 512005

PAGE

8 OF 8

Section 2: Patient Trans~ortation1 Destination

1

LOS ANGELES COUNTY EMS RECEIVING FACILITIES

1

/Al hambra Hospital Beverly Hospital

* A *

Brotman Medical Center

1 California Hospital Medical Center

.

* A

1 Cedars-Sinai Medical Center ** A 1 Centinela Airport Medical Center 1 Centinela Freeman-Centinela * A

I

I 1 1

Centinela Freeman-Marina Centinela Freeman- Memorial

*A

(626) 570-1606

1

100 S. Raymond Ave., Alhambra, 91801

(323) 726-1222

309 W. Beverly Blvd., Montebello, 90640

(310) 836-7000

3828 Delmas Terrace, Culver City, 90231

(213) 748-2411 (310) 855-5000

(310) 673-4660

1 1338 S. Hope St, Los Angels, 90015

1 8700 Beverly Blvd., Los Angeles, 90048 1 9601 S. Sepulveda, Los Angeles, 90045 1 555 E. ~ a r d y ~ tInglewood, ., 90301

(310) 823-8911

4650 Lincoln Blvd., Marina Del Rey, 90291

(310) 674-7050

333 N. Prairie Ave., Inglewood, 90301

(323) 660-2450

4650 Sunset Blvd., Los Angeles, 90027

(562) 868-3751

13100 Studebaker Road, Norwalk, 90650

(818) 676-4000

7300 Medical Center Dr., West Hills, 91307

(562) 904-5000

11500 Brookshire Ave., Downey, 90241

1

1

Century City Hospital (ER CLOSED 4/04)

* **

Children's Hospitalo f Los Angeles Coast Plaza Doctors

*A

Columbia West Hills Medical Center

*A

Downey Regional

1 East Los Anaeles Doctors

1 1 1

*A

JEncino Tarzana Regional -Encino

1 Encino Tarzana Regional -Tarzana

* A

* A

Garfield Medical Center

Good Samaritan

* A

* A A

* ** A Henry Mayo Newhall Memorial * Harbor/UCLA Medical Center

Huntington Memorial

.

* ** A

1 Kaiser Hospital - Baldwin Park

1 I

1

A

A 1 Kaiser Hospital - South Bay A Kaiser Hospital - Sunset (LA) A 1 Kaiser Hospital - Panorama City A 1 Kaiser Hospital - West Los Angeles Little Company of MayTorrance

Revised: 512005

(818) 881-0800

(818) 409-8111

Kaiser Hospital Bellflower

Kaiser Hospital -Woodland Hills

(818) 995-5000

1 4060 E. Whittier Blvd., Los Angles,90023 1 16237 Venture Blvd., Encino, 91436 1 18321 Clark St., Tarzana, 91356>

(818) 502-1900 (213) 977-2121

.

, 1420 S. Central Ave., Glendale, 91225-7036 616 S. Witmer St., Los ~n~eles,~~fl017 ' , ' -

1

1000 W. Carson St., Torrance, 90509

(661) 253-8000

23845 W. McBean Parkway, ~alencia,91355

(626) 397-5000

100 W. California Blvd., Pasadena, 91109

1 1011 Baldwin Park Blvd., BaldwinPark,91706 1 9400 E. Rosecrans Ave., Bellflower, 90706

(562) 461-3000 I

1

1 A

* A

* A

1 I

1509 Wilson Terrace, ~lendal'e,91206-

(310) 222-2345

(626) 851-1011

1

525 N. Garfield Ave., Monterey Park, 91754

(626) 573-2222

Glendale Adventist Medical Center Glendale Memorial

(323) 268-5514

t

(310) 325-5111

1 25825 S. Vermont Ave., Harbor City, 90710 1 I

(323) 783-4011

4867 Sunset Blvd., Los Angels, 96027

(818) 375-2000

1 13652 Cantara St., Panorama City, 91402

a ?

(323) 857-2000

1 6041 Cadillac Ave., Los ~ n g e I.e ~ 9 . Q w

(818) 719-3800

5601 De Soto Ave., Woodland Hills, 91367

(310) 540-7676

4101 Torrance Blvd.,Torrance, 90503

PAGE 1 OF 2

I

1


^

1 Little Company of Mary-San Pedro * 1 Long Beach Community * A

A

* ** A

Long BeachMemorialMedicalCenter

LA County Olive View Medical Center LAC/USC Medical Center

A

** * A

Martin Luther King JrDrew Medical Center * A

*A

Memorial Hospital of Gardena

(310) 832-3311

1300 W. 7th St, San Pedro, 90732

(562) 498-1000

1720 Terrnino Ave., Long Beach, 90804

(562) 933-2311

2801 Atlantic Ave., Long Beach, 90806

(818) 364-1555

14445 Olive View Dr., Sylrnar, 91342-1495

(323) 226-2622

1200 N. State St, Los Angeles, 90033

(310) 668-4321

12021 S. Wilmington Ave., Los Angeles, 90059

(310) 532-4200

1145 W. Redondo Beach Blvd., Gardena,

I

I

I (818) 787-2222 I 14850Roscoe Blvd., PanoramaCity,91402

Mission Community Hospital Monterey Park Hospital A

(626) 570-9000

900 S. Atlantic Blvd., Monterey Park, 91754

Olympia Medical Center

(323) 938-3161

5925 San Vicente Blvd., Los Angeles, 90019

(562) 595-1911

2776 Pacific Ave., Long Beach, 90806

(818) 767-3310

9449 San Fernando Road, Sun Valley, 91352

(818) 365-8051

15031 RinaldiSt, Mission Hills, 91345

(818) 843-5111

501 S. BuenaVista St, Burbank, 91505

(310) 603-6000

3630 Imperial Highway, Lynwood, 90262:

(310) 829-5511

2103 Santa Monica Blvd., Santa Monica, 90404

(562) 491-9000

1050 LindenAve., Long Beach, 90813

*A Santa M o n i c a - UCLA Medical Center * A

(626) 289-5454

218 S. Santa Anita St, San ~~bri$l,91776>

(310) 319-4000

1250 Sixteenth St, Santa Monica, 90404

Sherman Oaks Community Hospital

(818) 981-7111

4929 Van Nuys Blvd., Shennan OW, 91403

Pacific Hospital o f Long Beach Pacifica Hospital of the Valley

A * A

Providence Holy Cross Medical Center

* A

Providence Saint Joseph Medical Center

* A

* A

Saint Francis Medical Center

Saint John's Hospital and Medical Center Saint Mary Medical Center

*

A

San Gabriel Valley Medical Center

1 U C L A M e d i c a l C e n t e r * ** A 1 Valley Presbyterian Hospital * A 1 Verdugo Hills Hospital * A 1 White Memorial Medical Center

*

* A

Revised: 512005

EDAP

**

PMC

,

.

1 (310) 825-9111 1 10833 Le ConteAve., Los Angeles, 9@24 1 1 (818) 782-6600 1 15107 Vanowen St, Van Nuys, 91405 1 I (818) 790-7100 1 1812Verdugo Blvd., Glendale, 91208, I (323) 268-5000 1 1720 Cesar Chavez Ave., Lo8 Angeles, 90033 1

"Italics" Denotes TRAUMA CENTER

*

"1

PTC

A

PAGE 2 OF 2

PERINATAL


B A T T A L I O N

Revised: 712004

O F F I C E S

PAGE 1 OF 1

>


RECEIVING HOSPITALS SORTED BY EMS BATTALION OFFICE

California, Orthopaedic Glendale Adventist, Glendale Memorial, Huntinaton Memorial Hudson Clinic Centinela Airport Clinic, Centinela FreemanCentinela, Centinela Freeman-Marina, Centinela Freeman-Memorial Children's, Kaiser Los Angeles, Queen of AngelsIHollywood Presbyterian HarborIUCLA, Kaiser South Bay, Little Company of Mary-San Pedro, Little Company of Mary-Torrance, Long- Beach Memorial, Pacific of Long Beach, St. Mary, Torrance Memorial Alhambra, Beverly, East Los Angeles Doctors, Garfield, ~ a i s e Baldwin r park; LACIUSC, Monterey Park, San Gabriel Valley, White Memorial St. John's, Santa MonicaIUCLA, UCLA, Veterans istration Wadsworth Encino Tarzana-Encino, Sherman Oaks, Valley Presbyterian Good Samaritan Henry Mayo, Kaiser Panorama City, Mission Community, Olive View, Pacifica, Providence Holy Cross, Verdugo Hills Coast Plaza Doctors, Downey Regional, Gardens Memorial, Humphrey Clinic, Kaiser Bellflower, KingIDrew, St. Francis Providence St. Joseph Northridge-Roscoe, Simi Valley Columbia West Hills, Encino Tarzana-Tarzana Kaiser Woodland Hills Brotman, Cedars-Sinai, Century City, Kaiser West Los Angeles, Olympia PAGE 1 OF 1


39

1

3

1

10

78

1

14

14 PAGE 1 OF 1

114

1

A 1

1

3

5

1

11

1

1

1

21

26

n


LAFD RESCUE AMBULANCE LOCATIONS

1

1

1

I

3

1

1

5

1

I

11

1

I

I

21

26

33

1 (213) 485-6201 , '

1

7

1

2230

N. Pasadena Ave.

1

Lincoln Heights

1 pg. 595

1

1

1

108

N.FremontAve.

1

Bunker Hill

1

634 F-3

1

4

I

6621

W. Manchester Ave.

1

Westchester

1

702 F-3 l(213) 485-6205

1

1

1

1

430

E. Seventh St.

1

Civic Center

1

634 F-5

1(213)485-6209

1

1

11 1 1 8 1 9

W.SeventhSt.

1

Westlake

1

634 C-3 1(213)485-6211

1

1

11

I

1206

S. Vermont Ave.

1

Pico Heights

1

634 A-4 l(213) 485-6213

1

1

3

I

915

W. JeffersonBlvd.

1

USC Campus

1

634 B-7 (213) 485-6215

1

1

1

1

1601

S. Santa Fe Ave.

1

Industrial Eastside

1

634 H-7

1

9

1

12229

W. Sunset Blvd.

1

Brentwood

1

631 G-3 (310)575-8519

1

3

11187

E.52ndSt.

1

South Los Angeles

1

674 E-4

1 (213) 485-6221 1

1 V824 1

12

I

9411

Wentworth St.

1

SunlandlShadow His

1

503 D-3

1 (8 18) 756-8624 1

I

826

I

3

I

2009

S. Western Ave.

1

West Adams

1

633 H-6

1 (2 13) 485-6226 1

1

828

1

15

1

11641

Corbin Ave.

1

Porter Ranch

1

500 E-1

1 (818) 756-9728 1

18%

I

13

I6406

S.MainSt.

1

South Los Angeles

1

674 C-6

1 (2 13) 485-6233 1

I

5

I

N. Hillhurst Ave.

1

Los Feliz

1

594 A-4 l(213) 485-6235

803

I811

1

351- I

Revised: 512005

835

1601

PAGE 1 OF

3

A-7

1 (213) 485-6203 1

1 (2 13) 485-621 7 1

1

Section 2: Patient Trans~ortation1 Destination

A

I

2

1 1410

Cypress Ave.

I

Cypress Park

1

595 H-4

(213) 485-6244

1

1

7

1 4575

E. Huntington Dr. S.

1 Monterey Hills

1

595 D-6 l(213) 485-6247

1

1 V849 I

6

1 400

Yacht St.,Berth 194

1 Wilmington

1

824 F-1

1(310)548-7549

1

51

I

1

4

1 10435

Sepulveda

I LAX

1

702 0-5

] (213) 485-6251

1

55

1

1

2

I 4455

E. York Blvd.

I Eagle Rock

1

594 J-1

l(213) 485-6255

1

57

1 57 1257 1 V857 1

13

1 7800

S. Vermont Ave.

1 South Los Angeles 1

704 A-1

1(213)485-6257

1

59

1

59

1

1

9

1 11505

W. Olympic Blvd.

1 West Los Angeles

I

632 B-6

I(310) 575-8559

1

161

1

61

1

1

18 15821

W.ThirdSt.

1 Park LaBrea

1

633 D-1

1(213)485-6261

1

1

4

Shell Ave.

1 Venice

1

671 J-5

l(310) 575-8563

1

1

13 11525.

E.103rdSt.

1 watts

1

704 F-5

l(213) 485-6265

1

1

18

I 5023

W. Washington Bl.

1 Mid-City

1

633 D-5

1(213)485-6268

1

1

15

1 9861

Reseda Blvd.

1 Northridge

1

500 J-5

1(818)756-8670

1

1

17

1 681 1

De Soto Ave.

1 Canoga Park

1

530 C-6

l(818) 756-8672

1

1

12

1 7777

Foothill Blvd.

1 Tujunga

1

503 H-3 l(818) 756-8674

1

1 V876 I

5

I 31 11

N. Cahuenga Bl.

1 Cahuenga

1

593 D-1

l(213) 485-6276

1

1 V878 I

14

1 4230

Coldwater Cyn. Av

1 Studio City

1

562 E-5

l(818) 756-8678

1

World Way West

1 LAX Crash Rescue 1

702 E-5

l(213) 485-6280

1

1

44

1

1

47

1

1

49

1

I

51

I

1

55

1

1 1 \

1 47

844

1

1

65 16512651

1

68

I

68

1

Il-70 1

I

74

80

I

74

1

Revised: 512005

I

1

861

868

1 1930

- ---

691 1

-

-

PAGE

2 OF 3

Section 2: Patient Trans~ortation/ Destination

1

81

1

81

1

1

83

1

83

1

881

Nordhoff St.

1 Arleta

I P ~ . 502

I 5001

BalboaBlvd.

1

Encino

1

561 D-3 1(818)756-8683

1

6

I

1331

W. 253rd St.

1

Harbor City

1

794 A-4 l(310) 548-7585

1

1

15

1 10241

Balboa Blvd.

1

Granada Hills

1

501 C-4 l(818) 756-8687

1

1 North Hollywood

1

532 G-5 l(818) 756-8689

1

1

482 A-4 l(818) 756-8691

1

1

702 J-5 l(213) 485-6295

1

1

12 114123

1

10

1

B-7

1 (818) 756-8681 1

1

87

1

87

1

1

89

1

89

1

1

14

1 7063

Laurel Canyon Blvd.

1

91

1

91

1 V891 1

12

1 14430

Polk St.

1

95

1

95

1

4

1 10010

International Rd.

1

1

97

1

14

1 8021

Mulholland Drive

1 Laurel Canyon

1

592 J-1 l(818) 756-8697

1

9

9

1 9 910 1 14145

Mulholland Drive

1 Beverly Glen

I

562 A-7 l(818) 756-8699

1

1

103

1 103 1

1

109

1

Ill

889

1

1 V897 1

- -

LA Airport

1

15

1 18143

Parthenia St.

1 Northridge

1

531 A-1 l(818) 756-8603

1

I

I V909 1

10

I 16500

Mulholland Drive

I Encino Hills

1

561 E-7 l(818) 756-8609

1

]

I

I

6

I 1444

S. Seaside, Berth 256

1 Fish HarborlTenn Is. 1

824 D-5 l(310) 548-7541

1

8060

Balboa Place-Air Ops

114 Legend: "V"

I = Variable

Revised: 512005

Van Nuys Airport

Staffing PAGE 3 OF 3

. !

,

Section 3: Apparatus 1 Equipment . . . .

APPARATUS TOWING / BREAKDOWN PROCEDURES

1

1

0630-2300 HOURS 1. Notify OCD and Battalion Commander of status. 2.

OCD shall the Shops or mechanic to determine: tow, repair, or if a relief apparatus is required.

1. Notify OCD and Battalion Commander of status. 2.

Company Commander shall determine if field repair or towing is required.

Battalion Commander shall arrange transportation. 3- Company Commander shall arrange for a relief apparatus and change over. 4. OCD shall report time towing contractor was notified. 4. After change over, notify OCD that a tow 5 . Tow to nearest S&M facility; if accident, tow to is needed. Central Shops. 5 - A member shall accompany the apparatus or 6- A member shall accompany the apparatus or meet the contractor at the Shops for security and meet the contractor at the Shops for security to validate the tow invoice. and to validate the tow invoice. 3-

2300-0630 HOURS 1-

\

'

2300-0630 HOURS

Notify OCD and Battalion Commander of status. Company Commander shall determine if repairs may be made by or Heavy Rescue; and if a relief apparatus is required.

3,

Update OCD of status.

4.

Tow utilizing procedures 5 and 6 above.

1.

Notify OCD and Battalion Commander of status.

2.

Company Commander shall arrange for repair or change over to a relief apparatus.

3.

Update OCD of status.

4.

Store apparatus in quarters overnight and tow utilizing towing procedures above.

If the Shops are closed and Rescue Maintenance is not in quarters, OCD on the telephone outside of the office for entry. Use the gate keys in the lock box to open the yard and leave apparatus. Leave a note to briefly describe the apparatus type, problems, and status. Secure yard before leaving.

The following information is needed for the tow invoice: 1.

Name of towing service

2.

Make, year, and Shop No. of apparatus

3.

Address where towing was initiated

4.

Date and time tow contractor was notified

5.

Time towing service arrived on scene

6.

Time towing was completed

Sign the receipt, include your assignment and telephone number, then forward to S&M at: Mail Stop 253. An F-80 is required for the repairs, but not for the towing. Revised: 1212001

PAGE

1 OF 1

Section 3: Apparatus 1 Equipment

APPARATUS MAINTENANCE

Maintenance procedures are performed periodically based on the pre-described maintenance schedules set forth in Volume 3-710 and Department Log Books. The Station Commander is ultimately responsible for the condition of apparatus under hislher command, but each member shares equally in the responsibility of maintaining Department apparatus. To increase the performance and life of Department apparatus, daily, weekly, monthly, and bi-monthly preventive maintenance checks are preformed. Certain basic procedures in daily maintenance pre-checks on all apparatus shall be accomplished at the beginning of each shift or at any time a change of relief occurs. Refer to LAFD, Book 8, Drivers Training Manual, Module 4. The Preventive Maintenanceform [F-3 771 RA applies to all Rescue Ambulances (active, reserve, and standby) that are serviced by field personnel. It is used to record the preventive maintenance performed and problems discovered. Refer to MOP, Volume 3- 711-48.32. The form is: + Completed monthly by the responsible member. + Original forwarded to Battalion Commander within the first two weeks of each month (prior to Battalion inspection). + Copy retained in Apparatus Log Book until replaced by original from Battalion. + Original retained in Log Book for one year. All needed repairs will be reported as directed in MOP, Volume 4,813-40.40 and 40.50 (this includes brake adjustment, emergency lighting, steering, warning devices, etc.).

Revised: 12/2001

PAGE

1 OF 1

-

1

Section 3: Apparatus / Equipment

CAV / NAV AVI

1

k

Available within 60 seconds (1 minute) Available within 180 seconds (3 minutes) Fire Resources Available within 60 seconds (1 minute) ALS 1 BLS Rescue Ambulance

NAV

Not available for dispatch

Mobile Data Terminal (MDT) unit status shall be updated and correct at all times while AVI (Available), CAV (Conditionally Available), or NAV (Not Available). A Journal (F-2) entry shall be made for CAV / NAV status (include times and reason).

Resources that are CAV shall maintain radio watch a t all times. CHANNEL 4: METRO (RESCUE ONLY) CHANNEL

18: FRANK HOTCHKIN MEMORIAL TRAINING CENTER [FHMTC]

CHANNEL 7: METRO CHANNEL 8: VALLEY

Provide the following information to OCD when requesting CAV status:

e The amount of time (before the resource will be available to respond - within 1-3 minutes).

+

The CAV status reason:

,

1 38 1

37

Routine Training

1 1

Required Training Mechanical --

41

1

44

CAV Other Must Specify

45

Fire Prevention

-

Non-Emergency Move-up

Returning From Incident

47

Continuing Education

Community Relations

48

Oil Change

49

EMT Training

#

42

StafFing

I46

39 r ~ e t u r n i From n ~ Move-up 40

43 I

1

Equipment1 Supplies Restock -

--

-

Provide the following information to OCD when requesting NAV status: + The location where the resource will be NAV. (This may be a fire stationsfirst-in district or a location code.) + The NAV status reason: 26 27 29 30 31 32 33 34 35 Revised: 912003

PAGE

1 OF 1

1

1 1

1 m

1

Routine Training EMT Re-certification Decontamination Annual Apparatus Testing NAV Other - Must Snecifi Change Over No Hospital Beds Oil Change Required Training - -

I

1 1

I1

.Section 3: Apparatus 1 Equipment - . . .

OBTAINING A SPARE GURNEY

A cache of spare gurneys is maintained at each EMS Battalion Office. The procedure to obtain a spare gurney is as follows:

* Notify the Station Commander and EMS Battalion office. * Ascertain the availability of spare gurneys at the EMS Battalion office. * Take the defective gurney to the EMS Battalion office and attach an F-175 tag stating the problem.

* Label the new gurney with your RA designation, using 2%'' red decals. Place decals on each side of the gurney.

* Make appropriatejournal entry when you return to quarters.

Use Extreme Caution at all times when operating gurneys to prevent patient injury andlor private property damage. Particular attention shall be given when: Repositioning into a chair position, moving through confined areas and doorways, transporting combative andlor altered mental status patients, and loading patients inlout of an ambulance. Active measures are required by to assure the safe position of the patients hands and extremities to prevent injuries.

Revised: 912003

PAGE 1 OF 1

tion 3: Apparatus 1 Equipment

MULTI-CASUALTY MEDICAL SUPPLY CACHE caches are designed for rapid deployment of emergency medical supplies to a multi-casualty incident, major catastrophe, or at the Incident Commander's discretion. Each cache weighs approximately three1 hundred pounds and consists of six plastic boxes, 12 wooden backboards, and a full complement of dressing and bandaging material; and each cache is designed to provide basic first-aid and EMT-I level treatment for 15 to 50 patients. They are transportable inside Department helicopters, heavy apparatus, plug buggies, and rescue ambulances. The following deployment locations provide for geographic coverage, potential need, and transport considerations:

, \

The Medical Supply Trailer is available for immediate response to disasters, MCI's, or at IC discretion. Can be deployed for "Special Event" venues. They can be towed by any pick-up or larger vehicle with a tow package.

HAZARDOUS MATERIALS C A C H E

,

)V HAZARADOUS CHEMICAL AGENT EMERGENCY

-

For signs and symptoms of Cyanide : poisoning ister Amyl Nitrite in conjunction with decontamination.

+ CYANIDE POISONING EXPOSURE: Special considerations: Wear PPE and ensure decon procedures are completed prior to treatment and transpod.

Apply high flow oxygen via mask, observe for deterioration, monitor respirations and LOC. Cardiac monitor and venous access. MAKE BASE . Decontaminate if indicated. ister antidote, if indicated. d Crush ampule d Place in a 4x4 Gauze I (tape inside MasWBVM) d Allow victim to hold antidote and inhale vapor for 60 sec. (ventilate for 60 seconds) d Remove ampule 1 ventilate for 15 sec. d . a new ampule every 2-3 min.

CONTENTS:

Mark I Kit - 30 Amyl Nitrite - 36 (3 boxes of 12)

MAC: 7-323-722-8073 whencacheboxisopenedandused. Inventory documentation includes recording the disaster cache lock number on the F-903 and F-2. (7-03)

Repeat all steps until IV antidote is available in the ED. Treat cardiac dysrhythmias, seizures, and hypotension as indicated per LA Co. Treatment Care Guidelines and Ref # 806. Revised: 0312004

PAGE 1 OF

2

Section 3: Apparatus 1 Equipment

H A Z A R D O U S M A T E R I A L S CACHE v

+ MARK I KIT:

FOR NERVE AGENTS

Indications for use include poisoning with organophosphate nerve agents with at least one sigdsymptom listed: Respiratory distresslmesty SOB Muscle twitchinglseizure Generalized weaknesslparalysis Copious secretions (SLUDGE) Hold auto-injector by the plastic clip with non-dominant hand. The larger auto-injector is on top and held at eye level. With the other handycheck your injection site for any obstacles such as buttons or objects in the pocketsy which may interfere with the injections.

PULL THE SMALL GREEN-TIPPED AUTO-INJECTOR (ATROPINE) OUT OF THE CLIP. REMOVE THE SAFETY CAP (yellow on Atropine; gray on 2PAM-DO NOT TOUCH THE C O L O W D END OF THE INJECTOR after removing the safety cap, since it will inject into the &ngers or hand if any pressure is applied). HOLD IT LIKE A PEN OR PENCIL, BETWEEN THE THUMB AND FIRST TWO FINGERS. POSITION THE GREEN TIP OF THE AUTO-INJECTOR AGAINST THE INJECTION SITE (ANTEROLATERAL THIGH). APPLY FIRM, EVEN PRESSURE (not a jabbing motion) TO THE INJECTOR until it pushes the needle into the thigh or buttock. HOLD THE INJECTOR FIRMLY IN PLACE FOR AT LEAST 10 SECONDS. Carehlly remove and then massage the area. PULL THE BLACK-TIPPED 2-PAM AUTO-INJECTOR OUT OF THE CLIP AND INJECT IN THE SAME MANNER.

Revised: 0 112003

PAGE

2 OF 2

BASE HOSPITAL HAILING AND CHANNEL ASSIGNMENTS

Beverly

(Closed)

Cedars-Sinai

1,

1

# 95

#94

I

,

1

--

5E 1B -

--

1

,

1

4E 6B

Glendale Adventist

#I7

8C

* NA

HarborIUCLA

#64

4D

7D

Henry Mayo Newhall

#81

4A

5A

Holy Cross

#42

6A

2A

Huntington Memorial

#92

5F

2A

LACIUSC

#28

4C

6C

Little Co. of Mary-Torrance

1

#I6

2D

Methodist Hosp. of So. Cal.

#49

8F

3F

Northridge (NRH)

#29

1A

8A

# 25

7F

Pomona Valley I

3E

8E

Q of A IHwd. Pres. (Closed 04/04)

#75

3C

7C

Robert F. Kennedy (Closed W 0 4 )

1

# I8 #71

1

I

4F 85

1 1

* NA 35

St. Francis

#53

1E

8E

St. Joseph

#35

5A

3A

#24 on 7

7E

4E

St. Mary Torrance Memorial UCLA

Revised: 512005

I

1

1

5A

#84

1

1

I

Presbyterian Intercomm. Citrus Valley

1

#79 #59

PAGE 1 OF 1

I

1

3D

2B

I

-1.

3A 3B

I1

Section 4: Records 1 Documentation

RECORDS AND DOCUMENTATION

THE JOURNAL (F-2) is maintained by each company and is used to record a history of all pertinent .iformation relative to the daily operation of the command. Entries will appear in a chronological order. Accuracy, clarity, and completeness of entries are essential on all emergency and non-emergency incidents. Incidents where unusual circumstances exist (e.g., crime fatalities, patient refusal of treatment and/or transport, etc.) require a more thorough Journal entry. making entries in the Rescue Ambulance Journal shall adhere to the instructions outlined in the Manual of Operation, Volume 5, 917-00.00. FORMAT

COLOR O F INK: The following entries shall be made in RED ink: + Date (centered at the top of each page and the first available line when a new calendar day begins * Move-up (resulting from an alarm), + Alarm information (emergency and non-emergency). All other entries shall be made in BLUE or BLACK ink. PLATOON CHANGE ENTRIES: + Time, on duty (include member ID # and assignment), + The status of equipment (cell phone, 800 MHz radio, LAPD ASTRO radio), fuel card, and controlled medications. INCIDENT ENTRIES: + Incident type (e.g., traffic, chest pain, shooting, etc.) and the F-902M sequence number (entered in the margin). + Time of alarm. Underline "Location of Incident." 1 Patient Information: Patient number (in cases of multiple patients), name, age, sex, chief complaint, complete vital signs, and treatment rendered. + Disposition: Transport destination, time complete, time in quarters. Documentation may include ride-a-longs, interns, drills, training sessions, equipment loans and repair, change of rescue staffing during the shift, apparatus placed out of service, injuries, illness, exposure, patient in custody (include LAPD unit number) or any other occurrences incidental to the tour of duty. PHYSICAL SECURITY OF ALL REPORTS, RECORDS, OR DOCUMENTS CONTAINING PATIENT HEALTH INFORMATION (PHI) SHALL BE SECURED AND NOT LEFT UNATTENDED ON DESKS OR TABLES AT ANY TIME, THIS INCLUDES THE JOURNAL (F-2).

Refer to LAFD Departmental Bulletin No. 03-1 1 THE HAZARDOUS SUBSTANCE EXPOSURE REPORT (F-3) is generated when a member has been or is suspected of being exposed to a hazardous substance. An F-3 is available on the Station Network Staffing System. Instructions are outlined in the Manual of Operation, Volume 5,917-00.00. STORES REQUISITION (F-80)

1s per Department policy, the F-80 is used to request services or supplies as shown in Volume 4,817 Service and Supplies /Requisition and Delivery. Four copies of the F-80 are initiated by concerned member. Forward part 1 (white), part 2 (canary) and part 3 (pink) to concerned Department subdivision. Retain part 4 (goldenrod) until delivery is received. EXCEPTION: Copies of the F-80 Medical Supply order shall be maintained in the combined file at the fire station for a period of three years. Revised: 512005

PAGE 1 OF

3


THE RESCUE EQUIPMENT LOAN SLIP (F-215M) As per Department policy, all LAFD equipment is to be clearly marked. Complete a "Rescue Equipment Loan Slip" (F-215M) in duplicate when equipment is left at a receiving facility. Clearly document on the F-2J5M the following information:

d The incident date and number dHospital arrival time

d Patient's name (or hospital patient file number) d FD member's name/assignment

A responsible person, from the receiving facility, shall sign and retain a copy of the F-2 15M (loan receipt). The original copy, containing the initiating member's name and assignment clearly printed, is to be retained by the rescue ambulance until the equipment is retrieved. A Journal (F-2) entry is also required. RECORDS AND DOCUMENTATION

THE EMERGENCY MEDICAL SERVICE REPORT (F-902M) is a subpoenable legal, medical, and billing document that becomes a permanent part of the patient's medical records. First on scene prehospital care providers shall initiate an F-902M for ALL calls dispatched, except "returned by radio." Refer to LAFD, Book 5 (F-902M Instruction Manual). MEDICAL SUPPLIES AND PHARMACEUTICALS procedures are outlined in Departmental Bulletin No. 01-1 3. Refer to DHS, Ref. No. 702.2 and Ref. No. 703 for inventory requirements. O N N E L SHAL.L: Perform a daily inventory check. Document entries of the controlled medications (on hand) on the Controlled Medication Inventory [F-9031 form and in the Journal (F-2), any time there is a change in personnel or controlled medication. Following an incident, all units shall replenish their apparatus inventory of medical supplies and pharmaceuticals immediately upon returning to quarters. Individual paramedic units are provided with a minimum inventory list of EMS supplies to be maintained onboard and intended to supply a resource for an average 24-hour shift. However, to meet specific needs, it may be necessary to increase the established minimums of certain medications andlor supplies. Each fire station shall order EMS supplies and medications (other than controlled medication) on a monthly basis. Attach the monthly use summary to the F-80 cover sheet and forwarded to Supply and Maintenance for processing.

Revised: 512005

PAGE

2 OF 3

Section 4:

Records 1 Documentation

H E CONTROLLED MEDICATION INVENTORY (F-903) form shall be maintained on the apparatus until completed. Completed forms shall be retained on file, at the assigned location of A copy of the com~letedControlled the ALS unit, for a minimum of THREE YEARS. Medication Inventory form shall be forwarded monthly to the concerned EMS Battalion Office .)

m:

A Journal (F-2) entry will be made of the amount of controlled drugs on hand at shift change;

whenever controlled drugs are received and/or delivered; and any time there is a change of responsible personnel. Notify the EMS Battalion Captain between the hours of 0630-0800 of the need for re-supply of controlled medication and report the current levels of each controlled medication. When a controlled medication is used, provide the original F-902M BLUE to the EMS Battalion Captain in exchange for the replacement medication. When the medication is issued, the paramedic receiving the medication will sign in places: The EMS Battalion Captain's (controlled medication) log and the "Receiving Personnel" column of their individual unit copy of the Controlled Medication Inventory form. (Refer to the Departmental Bulletin No. 0 1- 13.) THE LOS ANGELES FIRE DEPARTMENT SITUATION REPORT (F-904) is used to facilitate resolution and to inquiries regarding the emergency medical service and/or other Department related critical issues. The data gathered will assist in identifying areas of concern relative to performance, patient care issues, and Department training needs. Refer to LAFD Departmental Bulletin No. 01-06. THE HEALTH INSURANCE PORTABILITY AND ABILITY ACT (HIPAA) is a federal legislation for the protection and security of personally identifiable health care information. are to take reasonable and prudent measures to secure patients' protected health information (PHI).

The Department has implemented policies and procedures regarding "Notice of Privacy Practices" (NPP). shall provide each patient with a written NPP utilized by the LAFD. Acknowledgement of the NPP shall be accomplished by obtaining the patient's signature on the back of the F-902M White copy. Enter NPP given in "Comments" or Transfer of Care" section. If patients are unable to acknowledge receiving the NPP, the NPP shall be left with the patient at the receiving facility. Exception, when the patient is unable, due to altered mental status, age, or in police custody. Document the reason why the patient was unable to sign and that the NPP was provided. (Refer to: LAFD Department Bulletin No. 03-1 1 and Book 5.)

Revised: 512005

PAGE

3 OF 3


CALIOSHA and FEDIOSHA NOTIFICATIONS The senior ranking (EMS) member on the rescue ambulance shall make a CallOSHA notification of serious industrial injuries, illness, or death (other than a traffic accident). If no Department ambulance has responded, the Incident Commander shall make the notification. If the patient is a Los Angeles Fire Department member, the station commander (where the member is regularly assigned) is responsible for making the CallOSHA notification. A serious injury or illness is any injury or illness that may require ission to a hospital for 24 hours or more (for other than observation), treatment for the loss of any body part, or serious permanent disfigurement (i.e., serious bums). The reporting member shall journalize (F-2) the CallOSHA notification including the name of the person notified and the time of notification.

CALIOSHA

Metro/West/South LA

(2 13) 576-745 1

DowntownIEast LA

(562) 949-7827

Harbor Area

(3 10) 5 16-3734

San Fernando Valley Area

(818) 901-5403

N x : For Federal Employees :

FEDIOSHA

(800) 475-4020 or (619) 557-2909

Additionally, AS SOON AS POSSIBLE, the District Attorney's Office for all incidents involving: Industrial Related Death or Near Death

1

1

District Attorney Command Post telephone number

1

( 2 13) 974-3607

The following information will be required for all notifications: Incident Date and Time Patient's Name and Age Patient's Home Address Patient's Occupation Name of Employer Employer's Address On-site Supervisor's Name and Telephone Number Incident Address Patient Destination (Receiving facility) Extent of Injury Description of Incident

Revised: 0212003

PAGE 1 OF

1

1

1


limited to merely being in the presence of a person suspected of having a communicable disease.

LEVEL I

1

LEVEL I1

LEVEL I11

1

Contamination of clothing or equipment by blood and/or body fluids. Exposure of skidmucus or conjunctival membranes to blood and/or body fluids (e.g., vomitus, urine, feces). This category includes ingestion of "possible" contaminated food, needle puncture, and human bites. (Refer to LAFD, Training Bulletin No. 82.)

For known or suspected exposure to an infectious/cornrnunicabledisease, blood and/or body fluids, or if the member sustains a contaminated needle wound, do the following:

1 1. 1 1 2. 1

Immediately cleanse the affected area. Notify your Station Commander. -

3.

Notify the appropriate EMS Battalion Captain of all "Level 111" exposures.

4.

On the F-902M, check "Inquiry Requested" box and document in the Comments section.

5.

Complete and forward an F-420; complete an F-225 or F-166A; and D WC Form 1 for all "Level I1 and 111" exposures.

1 6. 1

Ensure a detailed entry in the Journal (F-2) and the member's Personal Record Book. shall not seek or receive "first care" until consultation and direction has been received from the Medical Liaison Unit and/or the EMS Battalion Captain.

COMMUNICABLE DISEASE EXPOSURE AND NOTIFICATION REPORT (F-420) The F-420 shall be carried on all LAFD apparatus and shall be completed by the concerned member who may have been exposed to a "Reportable Communicable Disease" and/or received a contaminated needle wound. The F-420 original copy is given to the hospital. Reportable Communicable Diseases Include:

+ AIDS + Hepatitis + Meningitis + Syphilis + Tuberculosis Revised: 512005

PAGE 1 OF

2

1 1

1


Department equipment which has been contaminated with blood or other body fluids, shall be decontaminated by wearing disposable rubber protective gloves as follows:

+

Rescue equipment such as traction splints, backboards, KED boards, blood pressure cuffs, bag-valve-mask device, airway management instruments, etc., shall be washed with a disinfectant-detergent solution and hot water then air dried.

+

Delicate electronic equipment such as scope/defibrillators,radios, etc., shall be wiped down with a 1:10 bleachlwater solution (1 part bleach to 10 parts of water) as soon as possible post incident.

t

The rescue ambulance patient area should be scrubbed with a 1:10 bleachlwater solution, rinsed with clear water and air dried.

Needles are to be handled with extreme care. The Department supplies sharp containers that are to be used for all dirty needle disposal. If self-covering IV catheters are not being used, the contaminated needles shall be recapped for safety of personnel. Place the cap on a flat surface and replace the needle in the cap using a "one-handed method."

Note: Do not stick needles in RA seat cushions.

Revised: 1212001

PAGE

2 OF 2

Section 4: Records I Documentation

SUSPECTED CHILD ABUSE I NEGLECT REPORTING GUIDELINES /'

The primary purpose of the Department of Justice Suspected Child Abuse Report form SS 8572 (DHS, Ref. No 822.2) is to make all agencies aware of possible abuselneglect. In order to facilitate this process in Los Angeles County, it is recommended that a prompt verbal report be made to both the Department of Children and Family Services (DCFS) and local law edorcement. However if the child is in imminent danger, local law enforcement should be notified immediately. To make a verbal report to DCFS, call the

CHILD ABUSE HOTLINE at: (800) 540- 4000 This should be done as soon as possible. It is recommended that the Child Abuse Report form be completed prior to making verbal notification. The Suspected Child Abuse1 Neglect report is to be completed according to the instructions on the back of the form

DCFS 3075 Wilshire Blvd. Los Angeles, California 90010

SUSPECTEDELDERAND DEPENDENTADULTABUSE REPORTING GUIDELINES

Paramedics and EMTs, as health care practitioners, are mandated reporters and have a legal obligation to report known or suspected elder and dependent adult abuse. An elder is a person 65 years of age or older. A dependent adult is a person 18-64.yearsold, who

have physical or mental limitations that restrict their ability to protect their own rights or carry out normal activities. DEPARTMENT SHALL MAKE A REPORT WHENEVER: + The member observes or has knowledge of an incident that reasonably appears to be abuse, or + The member is told of an incident by the victim, or + The member reasonably suspects abuse. Mandated reports of physical abuse, sexual abuse, isolation, abandonment, financial abuse, neglect, and self-neglect are to be made immediately or as soon as practically possible by telephone. The follow-up written report must be SENT WITHIN TWO WORKING DAYS to the agency to which the telephone report was made. Voluntary reports of other types of abuse, such as mental abuse or abduction, may be made either !bytelephone or by means of the written report mailed or faxed to the appropriate agency.

Revised: 0912003

PAGE 1 OF

3


SUSPECTEDELDERAND DEPENDENTADULTABUSE REPORTING GUIDELINES

When the abuse or neglect is suspected to have occurred in a LONG-TERM CARE FACILITY report either to the local law enforcement agency or to:

Long Term Care Ombudsman 1527 Fourth Street, Suite 250 Santa Monica, CA 90401 Telephone: (800) 334-WISE (8001 334-9473) Fax: (3 10) 395-4090 Afler hours telephone: (800) 23 1-4024 (State Crisis Line)

*

LONG-TERM CARE FACILITY : Includes, but is not limited to, the following facilities: 1. Any long-term health care facility, such as a nursing facility, a skilled nursing facility, a congregate living health facility, a licensed respite care facility, or an intermediate care facility, including habilitative and nursing intermediate care facilities for the developmentally disabled. 2. A community care facility, such as an adult day care facility, an adult day center, an adult residential facility, or a social rehabilitation facility, whether licensed or unlicensed. 3. A swing bed in an acute care facility, or any extended care facility* A licensed residential care facility for the elderly. 4. When abuse, neglect, or self-neglect is suspected to have occurred ANYWHERE ELSE, report either to the local law enforcement agency or to: ,

Los Angeles County Adult Protective Services Centralized Intake Unit 3333 Wilshire Blvd., Suite 400 Los Angeles, CA 90010 Telephone: (888) 202-4-CIU (888) 202-4248 Fax: (213) 738-6485 Afler hours telephone: (877) 4-R-SENIORS (877) 477-3646 TELEPHONE REPORT: Reports are to include as much of the following information, as possible:

1. The name, address, telephone number, and occupation of the person making the report. 2. The name, address, and age of the elder or dependent adult. 3. The names and addresses of family or any other person responsible for the elder or dependent adult's care.

4. The nature and extent of the elder or dependent adult's condition.

5. The date and place of the abuse incident.

6. Any other information requested by the receiving agency, including information that led the reporter to suspect elder or dependent adult abuse. 7. Information about the suspected perpetrator. Revised: 09D003

PAGE

20 ~ 3

*

'\

J


S U S P E C T E D E L D E R AND D E P E N D E N T A D U L T A B U S E REPORTING GUIDELINES A

#i

WRITTEN REPORT: The Report of Suspected Dependent AdultElder Abuse (Ref. No. 829.1) must be completed and submitted to the agency initially ed. Upon completion, immediately forward the report to the involved EMS Battalion Captain. The EMS Battalion Captain shall review and Fax the report to the appropriate agency.

THIS PROCESS SlULL NOT EXCEED TWO (2) . . WORKING DAYS (48 HOURS) OF THE TELEPHONE REPORK

0 WITHIN 48 HOURS

PARAMEDICS AND EMTS ARE MANDATED REPORTERS. IF YOU SUSPECT ABUSE, NEGLECT, OR SELF-MGLECT, YOU AFU3 REQUIRED BY STATE LAW TO WPORT IT. RECORD YOUR OBSERVATIONS OF ELDER D U S E AS YOU DO FOR CHILD ABUSE.

LOS ANGELES COUNTY ELDER ABUSE HOTLINE:

(877) 4- R-SENIORS (877) 477-3646

Shortage of food

Unkempt, odorous

Unemployed

Excessive trash

ive or afraid

Substance ab

1 Bruises, scratches, cuts H o w reeks of urinelfoul odors 1 Confhed

Utilities are turned off

Insect and vermin infestation

1 Calls 911 fiequently I

Broken whdowslcode vioIations, etc.

1 Mental disorder 1 Uncooperative Speaks for dependent person I

Tells you there is neglect or abuse Aggressive or controlling

N P E S OF ABUSE:

Physical

Financial

Isolation

Neglect

Sexual

Abandonment

Abduction

Neglect by self

others

Psychological I

ADULT PROTECTIVE SERVICES (APS) Social Workers investigate reports of suspected abuse and neglect (24-hours a day in life-threatening situations). YOUR OBSERVATIONS HELP WITH THE INVESTIGATION.

ELDERS: 65 years of age or older DEPENDENT ADULTS: 18-64 year olds who have physical or mental limitations that restrict their ability to protect their o m rights or carry out normal activities.

Revised: 912003

PAGE

3 OF 3

1 1

I


COMMUNICATION F A I L U R E P R O T O C O L

Communication Failure Protocols (DHS, Ref. No. 810) are followed when paramedics are unable to establish andor maintain base hospital communications and a delay in treatment may jeopardize the life of a patient. In those cases the following procedures will be adhered to: Perform a thorough patient assessment and record all findings on the F-902M. Initiate the appropriate treatment protocol(s) for the patient's presenting signs1symptoms as per the EMT-P Communication Failure Protocol Quick Reference. Transport to a general acute care hospital in accordance with LA County Policies. Transport as quickly as possible consistent with optimal patient care (may occur at any point in the standing orders). Make vigorous attempts to establisldmaintain voice with physician or MICN while en route to the receiving hospital. IMMEDIATELY make a VERBAL REPORT to the on-duty emergency room physician or MICN at the assigned base hospital. Complete the ALS Communication Failure Report Form as described in DHS, Ref. No. 8 10. Non compliance with this policy may be construed as hctioning outside the supervision (scope) of medical control under the Health and Sdety Code l798.2OO(c)(lO). WRITTEN REPORT : Within 24 hours of the incident, involved paramedics shall complete Section A and forward the form to the Base Hospital Medical Director at the assigned base hospital. WITHIN

Revised: 912003

PAGE 1 OF 1

24 HOURS

>

y, ,


COMMUNICATION F A I L U R E P R O T O C O L / /

Communication Failure Protocols (DHS, Ref. No. 810) are followed when paramedics are unable to establish andor maintain base hospital communications and a delay in treatment may jeopardize the life of a patient. In those cases the following procedures will be adhered to: 1. Pedorm a thorough patient assessment and record all findings on the F-902M.

2. Initiate the appropriate treatment protocol(s) for the patient's presenting signs/symptoms as per the EMT-P Communication Failure Protocol Quick Reference. 3. Transport to a general acute care hospital in accordance with LA County Policies.

4. Transport as quickly as possible consistent with optimal patient care (may occur at any point in the standing orders).

5. Make vigorous attempts to establishlmaintain voice with physician or MICN while en route to the receiving hospital. 6. IMMEDIATELY make a VERBAL REPORT to the on-duty emergency room physician or MICN at the assigned base hospital.

7. Complete the ALS Communication Failure Report Form as described in DHS, Ref. No. 8 10. 8. Non compliance with this policy may be construed as hctioning outside the supervision (scope) of medical control under the Health and Safety Code 1798.200(~)(10). \

-4

WRITTEN REPORT : Within 24 hours of the incident, involved paramedics shall complete Section A and forward the form to the Base Hospital Medical Director at the assigned base hospital. WITHIN

Revised: I212001

PAGE

1 OF 1

24 HOURS


, Mnemonics (memoryjoggers) are effective tools used to assist EMS personnel in conducting more thorough assessments. The following are a few examples to assist with patient assessments.

1

SECONDARY (FOCUSED) 'SURVEY

1

BURN INJURY (DCAPP-BTLS)

(SAMPLE / 3 "T's") S A M P L E

-Signs/Symptoms -Allergies -Medications -Past medical history -Last oral intake. -Event preceding.

T T T

-Tags (Medical) -Tracks -Trauma

1

NEUROLOGICAL

I

D C A P P

I 1

-Deformities -Contusions -Abrasions -Penetration -Paradoxical movement

LEVEL OF RESPONSIVENESS

1

(AVPU)

E R M

-

-Depth of coma -Eyes -Respiratory status -Motor response

INJURED EXTREMITY (Distal to Injury)

A V P U

1

-Alert -Responds to Verbal stimulus -Responds to Painful stimulus -Unresponsive

TO ELICIT PERSONAL HISTORY

I

(PMS) W H A M

BONY AREA EXAM

1

-

PAGE 1 OF

-

SIGNS OF A TENSION PNEUMOTHORAX

P U N T Revised: 1212001

-Weight -History of medical problem -Age, allergies -Under D's care

2

(PUNT) -Progressive Dyspnea -Unilateral Breath Sounds -Neck Vein Distension -Tracheal Deviation

1


1

CAUSES OF ASYSTOLE

ET DRUG ISTRATION

1

(4-H Police Department) H H H H P D

-Hypoxia -Hyperkalemia -Hypokalemia -Hypotherrnia -Pre-existing Acidosis -Drug Overdose

h

NARCOTICS INHIBITED BY NARCAN

DRUG CHECK PRIOR TO ISTRATION

-

D I C C E

Many Doctors Practice Tender Loving Care Many Hours Daily

1

(DICCE) -Drug/Dose -1ntegritylIndications -Clarity -Concentration/Contraindications -Expiration date

ABDOMINALPAIN

1

(DR. GERM)

1

POSSIBLE CAUSES OF PEA M A T C H E D

1

D R G E R M

(MATCH (X4) ED) -Myocardial Infarction (massive acute) -Acidosis -Tension Pneurnothorax -Cardiac Tamponade -Hypoxia, Hypovolemia, Hyperkalemia, Hypotherrnia -Pulmonary Embolus -Drug Overdose

-

L P Revised: 912001

-Fever -HeadTrauma -Epilepsy (medically diagnosed) -Low blood sugar1 chemical disturbances -Poison/overdose

ASSESSMENT TOOL (SOAP)

COMMON CAUSES OF PEDIATRIC SEIZURES

F H E

-Distention -Rigidity -Guarding -Ecchymosis -Referred Pain -Masses

NEUROVASCULAR COMPROMISE ("5 P's")

Pain Pulse Paresthesia Paralysis Pallor

PAGE

2 OF 2

Where, what's causing it? Is there a distal pulse in the injured extremity? Any abnormal sensation at the site? Indicates peripheral nerve damage or circulatory impairment. Check color, temperature, and capillary refill.


Abdomen

ABD

Anterior

Abortion

AB

Apical Pulse

Abrasion

ABR

Appointment

-

1 ANT --

Accelerated Junctional Rhythm

AJ R

Approximately

Accelerated Ventricular Rhythm

AVR

Arterial Blood Gases

Accident

ACC

Artery

Acquired Immune Deficiency Syndrome

AIDS

As Needed

Acute Life Threatening Event

ALTE

As Soon as Possible

Acute Myocardial Infarction

Aspirin

Adult Respiratory Distress Syndrome ARDS

Assault

~

P

--

I APPRO:

ASAP

1 1

1

ASA AST

Advanced Health Care Directive

AHCD

Assaulted with a Deadly Weapon

Advanced Life

ALS

Asystole

ASY

Advised

ADV

At Once

STAT

After Care Instructions

ACI

Atrial Fibrillation

AF I

Atrial Flutter

AFL

After I Past I Post Against Medical Advice

AMA

Atrioventricular

Agonal

AGO

Attempted Suicide

Airway 1 Breathing I Circulation

ABC

Auscultation

Alcohol On Breath

AOB

Automated External Defibrillator

-

ADW

k-

-

Alert & Oriented times 3 Parameters (Purpose, Time, Place)

Axillary

Allergies

ALG

Backboard

BBD

Altered

ALT

Bag of Waters

BOW

Altered Level of Consciousness

ALOC

Bag-Valve-Mask

BVM

Ambulance / Ambulatory

AMB

Base Hospital Medical Director

BHMD

Amount

AMT

Basic Life

Ampule

AMP

Before

Antecu bital

Revised: 512005

PAGE 1 OF 9

T

1

BLS

Section 4: Records / Documentation

Cervical Vertebrae ---.-

C-1, C-2, etc.

Chest Pain Chief Complaint

-

Chronic Obstructive Pulmonary Disease

COPD

Chronic Renal Failure

CRF

Circulation, Sensation, Movement

CSM

-

Clean and Dress

-

Clear

CLR

Communication Failure Protocol

CFP

-

Complains Of

Carbon Dioxide

Complete Blood Count

CBC

Complete Heart Block

CHB

Congestive Heart Failure

CHF

Not Attempted

CNA

Contagious Disease Contusion

CONT

Coronary Artery By Surgery

CABS

Cardioversion

CAR

Coronary Artery Disease

CAD

Catheter

CATH

Coronary Care Unit

ccu

Centigrade / Celsius

C

Corrected To

C/T

Central Nervous System

CNS

Cubic Centimeter

Cerebrospinal Fluid

CSF

Date of Birth

DOB

Cerebrovascular Accident

CVA

Dead on Arrival

DOA

Certified Nurse Assistant

CNA

Decrease

DECR

Cervical Spine

C-SP

Defibrillation

DEF

Revised: 512005


ABBREVIATIONS Delirium Tremens

1

DT9s

Equal and Reactive

E&R

Dextrose 5 Percent in Water

Esophageal Gastric Tube Airway

EGTA

Diabetes Mellitus

Esophageal Obturator Airway

EOA

Diabetic Ketoacidosis

Estimated

EST

-Diagnosis

DX

Estimated Blood Loss

Dilation and Curettage

D&C

Estimated Time of Arrival * ,

Discontinue

Ethyl Alcohol

ETOH

Distal

DIST

Evaluation

EVAL

Do-Not-Resuscitate

DNR

Examination

EXAM

Drop

gtt

Expected Date of Confinement

EDC

Dry Sterile Dressing

DSD

Expected Date of Delivery

1

EDD

Duodenal Ulcer

Expiratory

EXP

Dyspnea on Exertion

External

EXT

Each, Every

Eyes, Ears, Nose, and Throat

EENT

Fahrenheit

F

Family History

FH

Fetal Heart Tones

FHT

Electrocardiogram

1 ECG (EKG]

Electroencephalogram

EEG

Emergency Department

ED

Emergency Department Approved for Pediatrics

EDAP

Fever of Unknown Origin

FUO

Emergency Medical Service (System)

EMS

Fixed and Dilated

F&D

Emergency Medical TechnicianAdvanced Airway

Fluid

Emergency Medical Technician

Emergency Medical Technician-Paramedic EMT-P

Follow Up

Emergency Room

Foreign Body

FB

Esophageal Tracheal Combitube

Four Times a Day

QID

Fracture

FX

Endotracheal Tube

Revised: 512005

ET

PAGE

3 OF 9


ABBREVIATIONS Frequent

FREQ

Hypertension

1 HTN

Gallbladder

GB

Hyperventilation

I

Gastroenteritis

1 GE

1

ldioventricular Rhythm

Gastrointestinal

Immediate Danger to Life & Health

IDLH

Genitourinary

Increase

INCR

Glasgow Coma Scale

GCS

Inhaled

Grain

Injury

Gram

~"-"

Gravida

G

Gunshot Wound Has Been Drinking

1 1

INJ INSP

Insulin Dependent Diabetes

IDD

-

Intake and Output

HBD

Headache

Heart Block Heart Block- (1st 1 2nd 1 3rd ) Degree

IN

Inspiration

- - -

GSW

I 1

Intensive Care Unit

ICU

International Unit

IU

Intramuscular

IM

Intrauterine Pregnancy

IUP

Intravenous

IV

Intravenous Piggyback

IVPB

Intravenous Push

IVP

Involuntary

INVOL

I

Heart Rate I Hour

HR

1

Heart Sounds Height -

Hemorrhage

HEM0

Irrigation

History

HX

t

JT

Jugular Vein Distention

JVD

Junctional Rhythm

JR

History of Present Illness

1

Hospital

1 HOSP

HPI

I 1

Hospital Emergency istrative Radio

HEAR

Keep Vein Open

KVO

Hospital Emergency Response Team

HERT

Kilogram

kg

Knock Out

KO

Human Immunodeficiency Virus

1 HIV

I

-- -

Laboratory

Revised: 512005

PAGE 4 OF

9

1

LAB

Section 4: Records / Documentation

--

Laceration

Middle

Large

Midline

Last Normal Menstrual Period

-

-

LNMP

Military Anti-Shock Tros

LAT

Milliequivalent

MAST

I

Lateral

@

Left / Liter Left Bundle Branch Block

LBBB

Milligram

m!3

Milliliter

mL

Minimal Blood Loss

MBL

Mobile lntensive Care Nurse

MICN

Mobile lntensive Care Unit

MICU

Left Lower Extremity

1 LLE

Left Lower Quadrant

LLQ

Left Upper Extremity

1 LUE

Left Upper Quadrant

LUQ

Moderate

MOD

Level / Loss of Consciousness

LOC

Month

MO

Licensed Vocational Nurse

Morning

AM

Liquid

Morphine Sulfate /Multiple Sclerosis

Liters per Minute

LIMIN

Most Accessible Receiving (facility) MAR

Long Backboard

Motor Vehicle Accident

Lumbar Spine Lumbar Vertebrae

Motorcycie Accident

L-I , L-2, etc.

Meconium

Multifocal

Medical

Multiple

Medical Doctor

Myocardial Infarction

Medications

Nasal Cannula

Mental Retardation ---

Nasogastric Tube

--

Mentally Disordered Person

MDP

Microdrop

MCIGlT

Midclavicular Line

MCL

Revised: 512005

Moves All Extremities

Nasopharyngeal Nausea 1 Vomiting 1 Diarrhea Negative

PAGE 5 OF 9

MVA

1

'

Neonatal Intensive Care Unit Newborn

NICU

1 NB

Nitroglycerine No Apparent Distress

Non-breathing,Unconscious, Pulseless, Unresponsive

Normal Saline Normal Sinus Rhythm Normal Spontaneous Vaginal Delivery

Nupu

I

N

1 NS 1 NSR

Partial Pressure of Oxygen

PO2

Past Medical History

PMH

Pedal Edema

PED ED

Pediatric

PED

Pediatric Medical Center

PMC

Pediatric Trauma Center

PTC

Pelvic Inflammatory Disease

PID

NIA

1 NPO

Notice of Privacy Practices

1

Object IObjective

1 OBJ

Obstetrical IGynecological

Partial Pressure of Carbon Dioxide

Penicillin

I

Not Applicable INot Available Nothing by Mouth

PSVT

Patient 1 Physical Therapy

No Known Allergies

Normal

Paroxysmal Supraventricular Tachycardia

1

-

PCN

Percussion

PERC

Per Rectal

PR

Personal Protective Equipment

PPE

Possible

POSS

Posterior

POST

Postoperative

POST OP

NPP

OBIGYN

Occasional

OCC

Organic Brain Syndrome

OBS

Oropharyngeal

OP

Ounce

OZ

Overdose

Postpartum Prehospital Care Coordinator

PCC

OD

Premature Atrial Contraction

PAC

Oxygen

02

Premature Junctional Contraction

PJC

Pacemaker Rhythm

PMR

Premature Ventricular Contraction

PVC

PALP

Prenatal Care

PNC

Para IPulse

P

Prior To Arrival

PTA

Paramedic IAfternoon 1 Evening

PM

Private

PVT

Paroxysmal Nocturnal Dyspnea

PND

Private Medical Doctor

PMD

Palpation

Revised: 512005

1

[


ABBREVIATIONS

Protocol

PRO

Sacral Spine

S-S P

Proximal

PROX

Saline Lock I Sublingual

SL -

Public Access Defibrillator

PAD

-ffD

seizure

--

----.....--

Pulmonary Edema

PUL ED

Pulmonary Embolus

Sexually Transmitted Disease Short Backboard

Pulseless Electrical Activity

PEA

Pulses 1 Movement 1 Sensation

PMS

Pupils Equal and Reactive to Light

PERL

Sinus Arrhythmia

Radial

RAD

Sinus Bradycardia

Range of Motion

ROM

Sinus Tachycardia

Red Blood Cell

RBC

small

Refused Medical Assistance

RMA

Small Bowel Obstruction

SBB

1

Shortness of Breath

SA

-+

solution

ed Nurse

SOB

Resident Of 1 Rule Out

wo

Specialty Center

Respiration

RESP

Standing Field Treatment Protocol

SB

1

1

SBO SOL

Stab Wound

Respiration Rate Returned by Radio

RxR

Subcutaneous

SQ

Revised Trauma Score

RTS

Subjective

SUBJ

Rheumatic Heart Disease

RHD

Substernal Chest Pain

SS

Sudden Infant Death Syndrome

SIDS

Suppository

SUPP

Right Right Bundle Branch Block

RBBB

Right Lower Extremity

RLE

Right Lower Quadrant

RLQ

Right Upper Extremity

RUE

Right Upper Quadrant

RUQ

Revised: 512005

PAGE 7 OF

9

Section 4: Records IDocumentation

-Supraventricular Tachycardia

SVT

UNC

Unconscious Unifocal

Symptom Syrup

SYR

Upon Our Arrival

UOA

Tablet

TAB

Upper Gastrointestinal

UGI

Tachycardia

TACH

Upper Respiratory Infection

URI

Temperature

T

Urinary Tract Infection

UTI

Tender Loving Care

TLC

Venereal Disease Ventricular Fibrillation

Tetanus Toxoid Thoracic Spine

T-SP

Ventricular Tachycardia

Thoracic Vertebrae

T-1. T-2. etc.

Verbal Order

Three Times a Day

TID

Vital Signs / Versus

Times / By

x

Volume

VOL

To Keep Open

TKO

Water

H20

(Total) Body Surface Area

(T) BSA

Watt-Second

Traffic Accident

Weak

Traffic Collision

Weight

---

---

Transient Ischemic Attack

TIA

Well Developed / Well Nourished

WDIWN

Transport

TRANS

White Blood Cell

WBC

Treatment

Wide Open

Tuberculosis

With

Twice a Day

BID

Within Normal Limits

Tylenol

TYL

Without

Unable to Locate

UTL

YearIOld Female YearIOld Male

Revised: 512005

WNL

. Section 4: Records 1 Documentation

0 Year I Old Male

Decrease I Negative 1 Minus

1 -

Equals

Female

Greater Than

Increase I Positive I Plus

Less Than

c No Change Number Percent

1

%

Secondary To

Revised: 512005

PAGE

9 OF 9

Section 4: Records & Documentation

BIBLIOGRAPHY

1

M-S Unit Inventory 'advance Health Care Directives (AHCD) UTE (Apparent Life Threatening Event) 'aMA/Patient Refusal of Treatment or Transport 'application of Patient Restraints 'aspirin istration to Chest Pain Patients 'assessment of Altered Level of Consciousness Glasqow Coma Scale (GCS) Revised Trauma Score (RTS) ksessment Unit Inventow apparatus Maintenance

1

I

1 1

'automated External Defibrillators Base Hospital lTransportation Criteria Body Armor Vests Bomb Scene Incidents Burn Patient Destination CAUOSHA and FEDIOSHA Notifications

1

Cellular Telephone Procedures Communicable Disease Decontamination Communicable Disease Exposure and Notification (F-420) Source Patient HIV Status Source Patient HIV Status Flowchart Petition for Order to Test Blood (Accused) Infectious Disease Protocols Communication Failure Protocol Conditionally Available (CAV) & Non-Available (NAV) Decompression EmergenciesIPatientDestination

I

DeterminationIPronouncement of Death in the Field

1

Disposing of Medical Waste EMS Report Short Form for Multi Casualty Incidents (MCI) EMS UPDATES 1996-1997,1999,2000,2001,2002,2003 EMS Safety Eye Shield and Face Masks EMT-1 Scope of Practice

Revised: 512005

PAGE 1 OF

I

3

LAFD Book 33 1 EMS UPDATE LAFD Book 33 LAFD Book 33 Dept. Bulletin LAFD Book 33 Dept. Bulletin LAFD Book 33 LAFD Book 33 EMS UPDATE LAFD Book 33 LAFD Book 8 1 Training Bulletin Dept. Bulletin LAFD Book 33 Training Bulletin Training Bulletin LAFD Book 33 Dept. Bulletin MOP, Vol. 1 Dept. Bulletin

Ref. No. 702

2003 Ref. No. 808.1 Ref. No. 834 No. 01-10 Ref. No. 838 No. 99-20 Ref. No. 809 Ref. No. 809

1999

1 Ref. No. 703 I

I

Module 4 No. 64

No.98-14,99-11, 99-14 Ref. No. 808 No. 81 No. 75 Ref. No. 512 No. 99-09 2/1-4234& 2/1-56.01 No. 96.29

Dept. Bulletin 1 LAFD Book 75 LAFD Book 33 LAFD Book 33 LAFD Book 33 LAFD Book 33 Training Bulletin LAFD Book 33 Dept. Bulletin LAFD Book 33 LAFD Book 33 Training Bulletin MOP, Vol. 1 1 Dept. Bulletin

No. 98-17

Dept. Bulletin LAFD Book 33

No. 92-7 Ref. No. 802

I

I

Ref. No. 836.2 Ref. No. 836 Ref. No. 836.1 Ref. No. 836.3 No. 82 Ref. No. 810 No. 98-20 Ref. No. 518 Ref. No. 814 No. 100

211-84.60 No. 03-19


BIBLIOGRAPHY

Eaui~mentRetrieval Procedure Firelighter Burn Injuries Health Insurance Portability and ability Act (HIPAA) Honoring Prehospital Do-Not-Resuscitate (DNR) Orders Hospital Directory Hospitals Requesting Diversion of ALS Units (Guidelines) Hospital Status Information via Mobile Data Terminals (MDTs) Infectious Disease Protocols LAFD EMT Re-certification Training Course Lifepak 12 Cardiac MonitorIDelibrillatorUse Management of Multiple Victim Incidents Medical Guidelines (DHS) Medical Supplies and Pharmaceuticals Minimum Equipment Used on Incidents Multi-Casualty Incident Procedures

1

1 1

Multi-Casualty Medical Supply Cache

1

Notice of Privacy Practices (NPP) Paramedic Emergency Care, Third Edition, Brady, 1997 Paramedic Training Institute, January 1997

LAFD Book 33 Dept. Bulletin Dept. Bulletin LAFD Book 33 LAFD Book 33 LAFD Book 33 Dept. Bulletin Training Bulletin Dept. Bulletin LAFD Book 33 LAFD Book 32 Dept. Bulletin LAFD Book 63 LAFD Book 70 Dept. Bulletin Dept. Bulletin Dept. Bulletin

I Ref. No. 708

I No. 99-09 1 No. 03-1 1

Ref. No. 815 Ref. No. 501 Ref. No. 503

No. 98-21 No. 82 No. 0506 Ref. No. 519 No. 04-08 Pg. 54-55

I

Syllabus 1

Prehospital Emergency Care, 6th Edition, Brady, 2000 Patient Destination Guidelines Decompression Emergencies Sexual Assault Patient Destination Pediatric Patient Destination Perinatal Patient Destination Patient Resolution Guide (PRG) Patient Transportation Policy Police Custody (Patient Care Policy for Patients in Custody)

Syllabus 6

LAFD Book 33 Ref. No. 502 LAFD Book 33 Ref. No. 518 Ref. No. 508 LAFD Book 33 Ref. No. 510 LAFD Book 33 LAFD Book 33 Ref. No. 51 1 Training Bulletin No. 18 1 Dept. Bulletin 1, No. 04-22 1 Dept. Bulletin 1, No. 04-17 No. 92-5 Dept. Bulletin LAFD Book 33 No. 822,829 MOP, Vol. 5 , 917-00.00 (1-89) MOP, Vol. 5 Dept. Bulletin No. 96-1 1 1 Dept. Bulletin 1 No. 94-21 1 Dept. Bulletin 1 No. 01-06 Training Bulletin No. 87 LAFD Book 70 Ref. No. 822 LAFD Book 33 Ref. No. 829 LAFD Book 33 I

I

Reporting of AbuseINeglect-Child, Elder, Dependent Adult

1

Rescue Ambulance Preventative Maintenance Rescue Equipment Loan Slip (F-215M) Safety Precautions While Using RA Gurneys Service Areas Situation Report (F-904) Spinal Immobilization START (Simple Triage and Rapid Treatment) Suspected Child Abuse Reporting Guidelines Suspected Elder and Dependent Adult Abuse Reportinq

!

'

Revised: 512005 PAGE

No. 89-8 No. 04-03 No. 03-1 1

2 OF 3

I

I

I

I


BIBLIOGRAPHY

Towing Apparatus Procedures

1

MOP, Vol. 4 p ~ / 3 - 4 4 . 0 1

Trauma Catchment Areas

1

LAFD Book 33

1 I

Trauma Hospital Temp. ClosureIDiversion of Trauma Patients Trauma Triage Transporting Patients in Custody Trans. Pre-paid Health Plan to Kaiser Facilities Treatment 1 Transport of Minors

1 I

I Ref. No. 504 I

LAFD Book 33

Ref. No. 505

LAFD Book 33

Ref. No. 506

LAFD Book 33 Dept. Bulletin Dept. Bulletin LAFD Book 33

Ref. No. 838

1 I

No. 93-12 No. 03-12 Ref. No. 832

Trial Program-Emergency Medical Service Areas for California & Good Samaritan Hospitals

Dept,

No. 92-3

Trial Program, Hospital Transportation Service Areas

Dept. Bulletin

No. 90-17

1 1

V-Vac Hand Powered Suction Unit Variable Staffed BLS Ambulance Program

I

Revised: 512005 PAGE 3 OF 3

Training Bulletin Dept. Bulletin

1 1 I

No. 72 No. 04-22

Los Angeles Fire Department

EMS FIELD MANUAL Book 35

Record of Revisions Keep your manual current. After receiving and filing additional or revised pages, initial and date the appropriate columns following the change number. No blanks should appear between initialed blocks. If you have failed to record a revision notice or have not received one, notify the Quality Improvement Section at (213) 485-71 53.

CHANGE NOTICE #

INITIAL

DATE

CHANGE NOTICE #

INITIAL

DATE

I

*** Revisions incorporated into manual

PAGE I OF 2

Revised: 512005

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