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Potential Procedures for Response to EMS Agency Request for Paramedic

Potential Procedures for Response to EMS Agency Request for Paramedic. Vermont EMS District 3 October 2009. Overview . Providing paramedic care requires a significant commitment of resources by an EMS agency

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Potential Procedures for Response to EMS Agency Request for Paramedic

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  1. Potential Procedures for Response to EMS Agency Request for Paramedic Vermont EMS District 3October 2009

  2. Overview • Providing paramedic care requires a significant commitment of resources by an EMS agency • Need to clarify expectations and procedures between agencies receiving and providing paramedic care

  3. Overview • Goal of system: provide timely paramedic care to patients in District 3 who would benefit from it • by building on existing foundation of cooperation and assistance • through education of EMS providers and community leaders on which pts are most likely to benefit from paramedic care

  4. Overview • Most important principle: Do what is best for the patient

  5. Assumptions • The “radio room” has evolved into a true Communications Center • EMS agencies and Comm Ctr will have list of conditions and situations that may merit immediate call for paramedic response

  6. Assumptions • EMS crew chief can request paramedic when may be helpful (first responders go through crew chief) • EMS crew chief can cancel paramedic after suitable evaluation of scene or pt • On-line medical direction is a resource for determining whether to cancel

  7. Assumptions • INITIALLY, these services are planning to provide paramedic care: • Essex Rescue • Colchester Rescue • South Burlington Fire Dept • Coverage will increase as more agencies come on line

  8. What would happen when an EMS agency requests paramedic service in District 3? • Assume the non-paramedic service and a neighboring paramedic service have signed an agreement for paramedic intercepts

  9. Comm Center Role: • coordinate and communicate with paramedic services • NOT command and control – full authority remains with the services • take daily roll call to determine which paramedic services available

  10. Scenario • High speed MVC with pt ejected in town without paramedic service • Crew chief requests paramedic dispatch • Comm Ctr coordinates dispatching of first available paramedic

  11. Scenario • If paramedic available, responds in response vehicle • Crew treats and packages pt for transport • If paramedic arrives before ambulance leaves scene, gets in ambulance • If ambulance has left, crew chief and paramedic coordinate rendezvous if feasible

  12. Scenario • If ambulance and paramedic rendezvous, paramedic gets in ambulance and works with crew treating pt during transport • If no rendezvous, paramedic cancels response and ambulance continues transport

  13. Scenario • If paramedic not initially available, Comm Ctr coordinates dispatch of closest paramedic

  14. Scenario • Result • the only time transport may be delayed is in unusual circumstance when the ambulance and paramedic agree (with medical direction consult, when appropriate) that paramedic interventions justify delay

  15. Scenario • Results • If no ambulance crew member able to drive paramedic vehicle to hospital, ambulance returns paramedic to vehicle after call • Ambulance bills for treatment and transport • Cost of paramedic response determined beforehand

  16. Algorithm for Dispatch of Paramedic Crew chief requests dispatch of paramedic Closest paramedic available? YES NO Paramedic responds Arrive before ambulance leaves scene? Dispatcher consults back-up list If no other paramedic available, ambulance treats & transports alone NO YES Ambulance & paramedic confer Is rendezvous feasible? Ambulance transports with paramedic on board NO YES Paramedic cancels and ambulance transports without paramedic Ambulance & paramedic meet

  17. Determination of Criteria • Adopted criteria based on nationwide priority dispatch as well as models currently being used in the state of VT and New England • Regional Ambulance (Rutland) • CALEX Ambulance • Rescue Inc • Southern Maine

  18. Criteria for Paramedic Dispatch Cardiac: chest pain, chest pressure, dysrhythmias, cardiac arrest Respiratory: dyspnea, apnea, asthma, COPD exacerbation Unconscious/unresponsive CVA/Stroke Overdose/poisoning Gunshot wound/stabbing

  19. Criteria Allergic reaction/symptomatic insect stings/anaphylaxis MVC with: multiple patients, car vs. pedestrian/bicycle/motorcycle Obvious major mechanisms of trauma: fall >15 feet, crush injuries, injury involving machinery/power tools Pain management as required

  20. Criteria • Pediatric patients meeting any of previous criteria • Future criterion: • Request by trained personnel on scene

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