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Quality Improvement

ALS Protocols

The EMS Agenda for the future is a strategic plan and needs assessment to guide the development of Emergency Medical Services (EMS) into the twenty-first century.

Policies & Procedures Policies & Procedures

The purpose of the Nor-Cal EMS protocols is threefold. First, to keep the regional protocols updated to the most recent ACLS interventions, undefined /optional scopes of practice for EMT-II/Paradmedics and national standards and trends. Second, to standardize interventions and treatments each level of care gives to similar patients by ALS prividers in our region. Annual competiencies have been included to evaluate the skills of each provider. Finally, to create a working document that optimizes a "user friendly" approach by using verbatim familiar ACLS language and not combining directions to do a procedure with directions on how to do a procedure. Personnel are expected to already know how to execute their individual scope of practice if they are practicing in the field.

It is the intent of the Nor-Cal EMS Medical Director, CEO and staff to make available to all ALS providers of the region their full, legal scope of practice and any limitation be placed at the local ALS program medical oversight level. In this manner, the local base hospital medical director, understanding local resources and needs, using their medical judgment has the ability to direct prehospital care.


Protocols How to use these protocols

Basically, these new protocols are straight forward, they operate much as the previous release. Below is an overview of the protocols to clarify their intent:

Adult Protocols

  1. General Information
    • Formulary, not intended as a complete drug reference but a guide to typical field use per AHA or other field care guides in patient care situations other than ACLS. This is based on Title 22, (individual) scope of practice defined and undefined (approved for this region) drugs. Drug concentrations listed are the most common or popular used, and are not intended to limit a provider agency to that particular concentration as long as the base hospital medical director approves an alternate.
    • Abbreviations, a collection of frequently used abbreviations in this region.
    • Scope/Prior to Contact (PTC) summary, to give a quick understanding of what is contained the individual ALS levels scope in this region. It may be worthy to note that regulation specifically limits much of the EMT-II scope of practice to after base contact. In instances where a procedure or medication is included in ALL scopes but regulation demands EMT-II base contact first, an X will be noted in the "prior to contact" column, and EMT-II appears in the "contact before" column.
  2. Specific patient care situation protocols. All cardiac category protocols were taken, as written, from the AHA textbook (1994) to include drugs listed in the protocol formulary.
  3. A "Skills Competency" section has been added to the ALS protocols. These competencies are to be completed on an annual basis and are a requirement for re-authorization with Nor-Cal as an ALS provider.

Pediatric Protocols

1. General information

a) Pediatric formulary, as in the adult section, is not intended as a complete drug reference but a guide to typical field use per AHA or other field care guides in patient care situations other than ACLS. This is based on Title 22, (individual) scope of practice defined and undefined (approved for this region) drugs.

b) Weights, age adjusted vital signs, et tube sizes, a useful "at a glance" field guide, as is the Braslow Tape which we highly recommend but is not mandatory.

c) Communication failure, due to the particularly sensitive nature of pediatric patients, more structure is necessary for care when the benefit of base consultation is unavailable.

2. Specific patient care situation protocols. All cardiac category protocols were taken, as written, from the AHA textbook (1994) to include drugs listed in the protocol formulary. All of these pediatric protocols were patterned after the State EMS Authority Pediatric Guidelines, developed by the Emergency Medical Directors Association of California.


Appendix Appendix

  1. Determination of Death Policy
  2. Do Not Resuscitate Policy
  3. Patient Destination Policy
  4. Undefined Scope of Practice Packets
  5. Protocol Development Policy

The Determination of Death Policy, Do Not Resuscitate Policy, and Patient Destination Policy are direct patient care policies. These are not new revisions, but do work in conjunction with some of the protocols, and the revision date can be found within the policy number located in the upper right hand corner of each page.

The Undefined Scope of Practice Packets are placed here for the convenience of the local ALS programs. As procedures or medications are added to each scope of practice, each local program must demonstrate that its providers have received the required training as specified by the State EMS Authority prior to implementation of the new item. In this manner the local program medical director performs a three step procedure to add a regionally approved procedure or medication:

  • Train the staff in the procedure or medication using the EMSA approved training guideline, provided in the packet.
  • Orient the staff to the EMSA approved protocol, provided in the packet.
  • Complete, sign and send to the medical director of Nor-Cal EMS the training verification form letter, included in the packet.

The ALS program may institute the new procedure or medication immediately upon completion of the above three items.

The Protocol Development Policy was created to ensure timely protocol development and to demonstrate our commitment to that end.


Acknowledgments Acknowledgments

We at Nor-Cal EMS extend our heartfelt thanks to all of the individuals who participated in the creation of the policies and procedures manual. We especially want to thank the following who demonstrated commitment to excellence by spending many hours reviewing the drafts and submitting comments:

Colusa Community Hospital staff

Mercy medical Center ALS staff

N.T. Enloe Hospital ALS and Trauma staff

Redding Medical Center

Regional Medical Directors Advisory Committee

Seneca District Hospital staff

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