Download chfbb2firstresponder..

BOOK: Blue Book II
SECTION: First Responder Protocols (CHF)
Pg. 1 of 12
FIRST RESPONDER PROTOCOLS - MEDICAL CONTROL BOARD (TULSA, OKLAHOMA CITY)
TABLE OF CONTENTS
SECTION I: ADMINISTRATIVE PROTOCOLS
PROTOCOL I.1:
PROTOCOL I.2:
PROTOCOL I.3:
PROTOCOL I.4:
PROTOCOL I.5:
PROTOCOL I.6:
PROTOCOL I.7:
PROTOCOL I.8:
PROTOCOL I.9:
PROTOCOL I.10:
COMMUNICATION REPORTS
CODE I TRAUMA REPORTS:
MULTI-PATIENT SCENE/MASS CASUALTY INCIDENT/TRIAGE
NO CODE ORDERS AND DISCONTINUANCE OF CPR
PATIENT REFUSAL OR NON-TRANSPORT
PHYSICIAN ON SCENE
STAGING
CRIME SCENE MANAGEMENT POLICY
CARE OF MINORS PROTOCOL
USE OF HELICOPTER WITHIN THE REGULATED SERVICE AREA
Format Property of FireNotes, Inc® (OCFD.com)
T.O.C.
Last Revised: 5/4/2017 2:03:00 AM
2
2
3
7
8
9
9
10
11
11
BOOK: Blue Book II
SECTION: First Responder Protocols (CHF)
PROTOCOL I.1: COMMUNICATION REPORTS
Pg. 2 of 12
REVISED 5/8/02
NOTE: Upon arrival of EMSA personnel a patient report should be given to the lead paramedic.
A. HISTORY
1. Patient description: number, age, sex.
2. Chief complaint.
3. Pertinent additional symptoms.
4. Pertinent past history, medications.
B. OBJECTIVE FINDINGS
1. Current condition.
2. Level of consciousness
3. Vital signs.
4. Pertinent localized findings.
C. TREATMENT
1. In progress and response to treatment.
SPECIAL NOTES
A. Communications must be brief, orderly, precise.
B. Outstanding objective findings may need to take precedence over a detailed history.
C. First Responders should not clear the scene until an orderly transfer of care has been made and it has
been determined that no further medical assistance is required.
D. Scene management is the responsibility of the First Responder Agency. Patient care decisions are the
responsibility of the highest medically trained personnel within the First Responder Agency until the
arrival of the Advanced Life Support. Patient care decisions will then become the responsibility of the
Advanced Life Support personnel.
PROTOCOL I.2: CODE I TRAUMA REPORTS:
REVISED 5/8/02
CODE 1 TRAUMA REPORTS
I. ON SCENE PROCEDURES:
A. Upon arrival on scene, personnel should conduct a scene size up, to include the Trauma Alert Criteria
as outlined below.
B. Multiple patients should be immediately triaged. Primary receiving hospital(s) will be notified as
soon as possible of the impending arrivals of “Code 1 Trauma Patients”.
II. TRAUMA ALERT CRITERIA
(Absolute indications for rapid transport and early notification of Code 1 Trauma Patient).
The following procedure is to be used to define a “Code 1 Trauma Patient”, to determine which patient(s)
will be transported to a Comprehensive Emergency Hospital, and provide direction for early notification of
impending arrivals at the emergency departments.
Code – 1 Trauma Patients meeting any of the following criteria will be considered to be a “Trauma Alert”
patient and will be transported to the appropriate CEH.
A. MULTISYSTEM BLUNT OR PENETRATING TRAUMA WITH UNSTABLE VITAL SIGNS
1. Hemodynamic Compromise (Systolic B/P of less than < 90 mm/Hg or heart rate greater than > 110
bpm with cool/pale skin,
2.
Respiratory Compromise (Respiratory rate less than < 10 b/m or greater than > 29 b/m, however
tachypnea, hyperventilation, alone will not necessarily initiate this level of response)
3.
Altered Mental Status (Glasgow Coma score less than or equal to </= 12 (excluding patients whose
normal Glasgow Coma score 12 or less, as established by the patient’s medical history or preexisting medical condition when known
Format Property of FireNotes, Inc® (OCFD.com)
T.O.C.
Last Revised: 5/4/2017 2:03:00 AM
BOOK: Blue Book II
SECTION: First Responder Protocols (CHF)
Pg. 3 of 12
PROTOCOL I.2: CODE I TRAUMA REPORTS: - continued
B. ANATOMICAL INJURY CRITERIA FOR DETERMINING CODE – 1 TRAUMA PATIENTS
1. Penetrating Injury to the head, neck, or torso (excluding superficial wounds in which the depth of
the wound can be easily determined
2. Second or third degree burns involving greater than > 20% or involving face, airway, hands, feet,
or genitalia
3. Amputation above wrist or ankle
4. Paralysis
5. Flail chest
6. Two or more long bone fractures (upper arm or thigh)
7. Unstable pelvis or suspected pelvic fracture
8. Open or suspected depressed skull fracture
PROTOCOL I.3: MULTI-PATIENT SCENE/MASS CASUALTY INCIDENT/TRIAGE
REVISED 5/8/02
DEFINITIONS
A. MULTI-PATIENT SCENE (MPS):
1. Less than < 5 critical patients.
2. Less than < 10 non-critical patients.
B. MASS CASUALTY INCIDENT (MCI):
1. Five or more critical patients.
2. Ten or more non-critical patients.
C. TRIAGE: The sorting and allocation of treatment to patients.
D. TRIAGE TAG: A tag developed to label injured victims, identify severity of injury, identify the place the
victim was found, and identify where the victim was sent and is approved by the Medical Control Board.
TRIAGE CATEGORIES:
A.
B.
C.
D.
RED - I: Critical; requiring care within 0-30 minutes.
YELLOW - II: Urgent; requiring care within 30-120 minutes.
GREEN - III: Delayed; requiring care within 12 hours.
BLACK - V: Dead or near dead.
N OT E
Overall incident command at all multiple patient scenes (MPS) or mass casualty incidents (MCI) is the
responsibility of the responding public safety agency (Police or Fire). The EMT directing all patient care will
generally be the paramedic from the first arriving unit.
Format Property of FireNotes, Inc® (OCFD.com)
T.O.C.
Last Revised: 5/4/2017 2:03:00 AM
BOOK: Blue Book II
SECTION: First Responder Protocols (CHF)
Pg. 4 of 12
PROTOCOL I.3: MULTI-PATIENT SCENE/MASS CASUALTY INCIDENT/TRIAGE - continued
A. MULTIPLE PATIENT SCENE
1.
UPON ARRIVAL AT A SCENE INVOLVING MULTIPLE PATIENTS:
a) Park vehicle in safe location
b) Advise dispatch of:
1) Approximate number of patients.
2) Number of additional units needed.
3) Any hazardous conditions.
4) Best access to scene (if appropriate).
5) Staging area location (if appropriate).
c)
Establish the following roles:
1) MEDICAL SECTOR COORDINATOR:
i.
MANAGE PATIENT CARE, refrain from "hands-on" treatment.
ii.
Establish appropriate communications.
iii.
Assign ambulances to specific patients. (Incoming ambulances should report their
arrival in person.)
iv.
Maintain multiple patient worksheets.
2) TRIAGE OFFICER:
i.
Perform rapid triage and "tag" patients with numbered triage tags.
ii.
Fill out patient log, indicate triage tag color, age/sex.
iii.
Relay initial triage information to the Medical Sector Coordinator and continue to
update patient status as needed.
iv.
After triage is completed, assist treatment and transportation teams as needed.
2.
TRANSITION FROM MPS TO MCI.
a) Requests other ALS units to assist with MCI Sectors.
b) Confer with Incident Command to assure appropriate designation of MCI Officers, as outlined in
the MCI Protocol.
B. THE MASS CASUALTY INCIDENT PROTOCOL
1.
FIRST ALS UNIT ON THE SCENE:
a) Identify your unit and advise dispatch of the following:
1) The exact location of the incident.
2) The type of incident (transportation accident, fire, explosion, etc.).
3) Environmental conditions (hazardous materials, extreme weather, etc.).
4) Number of ALS ambulances needed.
5) Immediate danger zone.
6) Staging area.
7) Recommended routes to and from the scene.
8) Approximate number of patients.
b) Get identification vests and task cards.
Format Property of FireNotes, Inc® (OCFD.com)
T.O.C.
Last Revised: 5/4/2017 2:03:00 AM
BOOK: Blue Book II
SECTION: First Responder Protocols (CHF)
Pg. 5 of 12
PROTOCOL I.3: MULTI-PATIENT SCENE/MASS CASUALTY INCIDENT/TRIAGE - continued
2.
Upon arrival at the scene of a MCI, the Medical Director shall assume responsibility of Medical
Command. Medical Command will coordinate the activities of the following sectors:
a) TRIAGE SECTOR.
b) TREATMENT SECTOR.
c) TRANSPORT SECTOR.
d) COMMUNICATIONS SECTOR.
All sector officers report only to Medical Command. Medical Command in turn reports to Incident
Command of the lead agency.
3.
TRIAGE SECTOR:
a) If initial triage is done at the rescue site and not in the triage area, use colored tape corresponding
to triage categories. Colored tape can then be replaced in the triage area by triage tags.
b) Take triage tags from the unit. It may be convenient to put the tags in bundles of a standard
number of tags (i.e., 25 tags per bundle).
c) Perform first pass (initial) triage. Do not perform any treatment in first pass triage other than
very quick, simple and extremely urgent measures (i.e., open the airway by positioning). Too
much time with any single patient at this point may ultimately result in loss of life by delaying
other steps in the process of mobilizing and preparing other resources or attending to other
patients with similar or even more urgent needs.
d) Attach tag to patient using the string loop on their body, not their clothing. The clothing may
have to be removed later on. Over the head or on the upper arm works well.
e) Tear off the appropriate strips on the bottom of the tag to indicate triage category. Use some
method to count the number of patients in each category. This information will need to be
relayed to command or the appropriate sector officer.
f) Guide ambulatory patients to the GREEN treatment area, if established. Use discretion in
allowing GREEN patients to assist in caring for the YELLOW and RED patients while awaiting
transfer to the treatment areas. ALL victims should be tagged - those without apparent injuries
should be tagged GREEN.
g) Report number of patients in each category and in total to the triage sector officer. The total
number of patients you triaged may be determined by counting the number of tags left over from
your original pre-packaged bundle.
h) Repeat triage sequence to monitor changes in condition. Time and circumstances allowing,
perform more detailed assessment, treatment, and write-in information on the tag while the
treatment sector continues to move patients out of the triage area.
4.
TREATMENT SECTOR:
a) Establish patient treatment areas after conferring with Medical Command regarding location.
b) Personnel from the treatment sector should be assembled into crews and then sent by the
treatment sector to perform BASIC packaging in the triage area and then move patients to the
GREEN, YELLOW or RED treatment areas. The treatment sector officer may choose to have
separate personnel continue treatment once inside the treatment area, depending on the logistics
of the particular call. All uninjured victims should be kept in the GREEN treatment area until
evaluated and released at the appropriate time by the transport sector or taken in a controlled
manner away from the incident by the transport sector.
c) Treatment sector personnel should fill out the information called for on the tags. On the clinical
side of the tag, circle injuries on the body diagram, note the BP, pulse, respirations. Note any IM
or IV medication given and the time it was given. On the administrative side of the tag, note the
time, date, patient name, address, city, state, and past medical history and prescriptions. On the
last line, which is only half way across the tag, record the name of the person in the treatment
sector who primarily managed their care. Before the patient leaves the treatment sector, detach
and keep the perforated corner of the tag with the Red Cross symbol. It will have a tracking
number on it, which should be noted on the EMSA run report. This same number is on the other
perforated corner, on the main portion of the tag, and on each of the colored tear-off strips at the
bottom of the tag.
d) If a patient changes condition (RED, YELLOW, GREEN, BLACK) inside the treatment sector,
move them to the appropriate area.
Format Property of FireNotes, Inc® (OCFD.com)
T.O.C.
Last Revised: 5/4/2017 2:03:00 AM
BOOK: Blue Book II
SECTION: First Responder Protocols (CHF)
Pg. 6 of 12
PROTOCOL I.3: MULTI-PATIENT SCENE/MASS CASUALTY INCIDENT/TRIAGE - continued
5.
TRANSPORTATION SECTOR:
a) Establish patient loading zone. Consider proximity to treatment area and ambulance approach
AND exit routes.
b) Assign patients from treatment areas to ambulances.
NO MORE THAN ONE CATEGORY RED PATIENT PER AMBULANCE.
c) Supervise the actual loading of patients.
d) While patients are loaded, tell the Communications Officer the ambulance unit and number/type
of patients on board (head, peds, OB, chest, burns, radiation, haz/mat).
e) If extra medical equipment is needed, request from the Medical Command.
f) Do not allow patients to "stack up" in the loading zone.
g) If necessary, delegate the loading of ambulatory patients into buses.
h) Always keep a unit ready for loading in the Loading Zone.
i) Just before a patient leaves the scene, by ANY means, the transport sector officer should detach
the remaining perforated corner of the tag (ambulance symbol) and retain it with notation of the
patient name, age, condition at transport, and destination. The last two items - condition and
destination - are mandatory for notation regarding all victims, including those without apparent
injuries.
j) Late Arriving Ambulances:
1) Go to the ambulance staging area.
2) STAY WITH YOUR UNIT! Wait for instructions.
It is understood that during an officially proclaimed disaster, each hospital will activate their
disaster plan to mobilize additional resources.
6.
COMMUNICATIONS SECTOR:
a) Start MCI log, using information from the Transportation Officer.
b) If necessary, designate a communications assistant to assure an organized flow of information
from scene to hospital.
c) Request additional ambulances through Medical Command.
d) As soon as a unit is ready to transport, tell EMSA dispatch the number and type of patients on
board (head, peds, OB, chest, burns, radiation, haz/mat). EMSA dispatch will determine unit
destination.
e) Inform loaded ambulance of its destination, ensure its safe departure, and immediately request
another ambulance to move in from the staging area to the loading zone.
f) Establish communications with receiving hospital and inform hospital of the identification of the
transporting unit and the total number of patients in each category being transported.
g) Transporting units should not communicate directly with the receiving hospital unless the
condition of the patient deteriorates and Medical Control contact is necessary for the management
of the patient.
NOTE:
Command at the scene of limited MPS/MCIs must be straightforward. The first paramedic that
arrives on scene is in charge of overall patient care, until the EMS field supervisor arrives. The
purpose of the “first in / last out practice” obligates the paramedic, who arrives on scene first, to take
charge of the scene, evaluate the magnitude of the situation and convey that evaluation and summon
additional resources required. The “first in” paramedic must refrain from “hands-on” treatment and
the loading of patients into his/her ambulance and focus their initial efforts on command and
communication. When additional resources arrive, the initial assessment can begin while others
(police/fire) establish a formal command center and initiate further communication.
Format Property of FireNotes, Inc® (OCFD.com)
T.O.C.
Last Revised: 5/4/2017 2:03:00 AM
BOOK: Blue Book II
SECTION: First Responder Protocols (CHF)
PROTOCOL I.4: NO CODE ORDERS AND DISCONTINUANCE OF CPR
Pg. 7 of 12
REVISED 5/8/02
A situation may arise at the scene where other persons may identify themselves as next-of-kin, family or
friends, stating that no resuscitative measures should be taken to revive the victim. First Responder personnel
are legally obligated to provide the level of care commensurate with the situation, based on their knowledge
that the patient is in need of such care. The First Responder shall accept a physician's written DNR order, an
Oklahoma Do-Not-Resuscitate (DNR) Consent Form, or an Advanced Health Care Directive accompanied by
a written statement from two physicians that the patient is a "qualified" patient.
Situations may arise where CPR has been initiated on an obviously deceased patient prior to arrival of the ALS
unit. If the following criteria are met, the FIRST RESPONDER may discontinue CPR or may choose not to
initiate CPR.
A. No pulse AND
No spontaneous respirations AND
Pupils fixed and dilated AND
ONE OR MORE OF THE FOLLOWING:
1. Rigor mortis.
2. Decomposition.
3. Dependent lividity.
4. Advanced Health Care Directive (see above).
5. Under physician's written DNR order.
B. Victim of blunt traumatic arrest without signs of life (i.e., pulse, spontaneous respirations, pupilliary
reactivity) or shockable rhythm (the AED should be utilized to determine a shockable rhythm). If injuries
are incompatible with life, determination of the patient's rhythm is unnecessary.
NOTE:
Termination of treatment can be done based on an attending physician’s order, whether verbal, by direct voice
communication, or in writing. The order is based upon the physician’s decision that the patient did not want
resuscitation, the patient’s condition is terminal, death appears imminent, or that cardiovascular unresponsiveness has
been established. The First Responder, EMT or EMT-P decision to stop the resuscitation shall be based on a clear
physician’s order or on-line medical control. Withholding resuscitative efforts in the aforementioned situations is
considered consistent with the standard of care.
If the patient's personal physician is in attendance and requests that the patient be given limited or no resuscitative effort,
then the First Responder, EMT or EMT-P shall carry out the order.
Only in cases of obvious prolonged death should CPR be discontinued on infants, children, young adults, or cases in
which an unexpected death has occurred. Those patients where hypothermia may be a significant component of their
arrested state should receive aggressive resuscitative efforts as outlined in Protocol II.18 – Hypothermia and Frostbite.
Format Property of FireNotes, Inc® (OCFD.com)
T.O.C.
Last Revised: 5/4/2017 2:03:00 AM
BOOK: Blue Book II
SECTION: First Responder Protocols (CHF)
PROTOCOL I.5: PATIENT REFUSAL OR NON-TRANSPORT
Pg. 8 of 12
REVISED 5/8/02
A. The transport paramedic shall evaluate every patient refusing treatment/transport sufficiently to determine
the urgency of their condition. DO NOT insult or embarrass a patient for using emergency medical
services or refusing to accept transport.
B. All personnel shall be courteous with any patient who refuses an offer of transport or treatment.
C. All incidents not resulting in the transport of the patient require the completion of a Non-Transport Form.
D. The on duty EMSA Field Operation Supervisor (FOS) must be contacted for all incidents where:
1. Service has been requested; AND
2. Contact with the patient has been established, the patient has an acute medical condition, but transport
has been refused; AND
3. ANY ONE OF THE FOLLOWING:
a) Age < 2 or > 55; OR
b) Chief complaint;
1) Chest pain; OR
2) Shortness of breath; OR
3) Altered mental status or post altered mental status regardless of how transient or, regardless
of etiology (e.g., trauma, diabetes, seizures); OR
c) All non-emancipated minors, as defined by Protocol 1.15 Care of Minors that are NOT
accompanied by a parent or guardian.
d) All patients in whom a refusal of care and transport would, in the paramedic's judgment, place the
patient, the provider, and/or the EMS system at risk.
E. After the FOS has been informed of the situation, the FOS shall communicate directly with the patient, on
a recorded line, to establish the patient's intent. To validate the refusal, the FOS shall inform the patient or
surrogate of:
1. Their condition.
2. The potential risks of refusal.
3. Alternate forms of treatment or transport.
4. Their assumption of all risks by refusal.
F. The non-transport form of those patients where contact has been established must include the patient's
chief complaint, vital signs and paramedic assessment.
G. Leave patient instruction sheet for appropriate situations.
H. Additional written documentation shall include:
1. The patient’s stated reasons for rejecting treatment or transport.
2. Summary of the options communicated as available to the patient (e.g., transport by ambulance,
private car or other means, or inform the patient that emergency medical services can be recalled at
any time if the patient later wants medical assistance).
3. The paramedic’s observations or statements of the patient that indicated the patient is able to
understand the risks and consequences of refusing treatment and/or transport.
4. The patient’s signature, if possible, acknowledging information communicated to the patient by the
paramedic. Solicit a witness at the scene to countersign the non-transport to verify the information
communicated to the patient by the paramedic.
SPECIAL NOTES
1. DO NOT ignore clues to potentially serious injuries or illnesses, such as abnormal vital signs,
unconsciousness which may be followed by a transient lucid stage (head injury with epidural
hematoma), concern of family members or witnesses, or inconsistencies in information obtained from
different sources.
2.
DO NOT assume a patient who is intoxicated has no other injuries or medical needs.
3.
DO NOT disregard established protocols or input from Medical Control.
Format Property of FireNotes, Inc® (OCFD.com)
T.O.C.
Last Revised: 5/4/2017 2:03:00 AM
BOOK: Blue Book II
SECTION: First Responder Protocols (CHF)
PROTOCOL I.6: PHYSICIAN ON SCENE
Pg. 9 of 12
REVISED 5/8/02
A. First Responders, EMTs and Paramedics must at all times act under (in increasing levels of authority):
1. The general guidelines of accepted practice by First Responders, EMTs and Paramedics, as defined by
MCB Prehospital Operational Standards and approved by the Medical Control Board.
2. Voice control from the appropriate Medical Control Physician (MCP).
B. PASSERBY PHYSICIAN'S RESPONSIBILITY:
1. If a physician (M.D. or D.O., the non-medical control physician, hereafter referred to as the NMCP)
requests, either verbally or in writing, that the medic carry out an order which does not fall under 1 or 2,
above, the MCP should be contacted for approval prior to carrying out the order. While in the process of
contacting the MCP, the first responder, EMT or paramedic should proceed to treat the patient per protocol.
2. If a disagreement arises as to patient management, the MCP and the NMCP should communicate directly
and attempt to resolve the problem.
3. If the physician at the scene is unwilling to accept the authority of the MCP, or has an irresolvable
disagreement with the MCP, he may assume control of, and responsibility for, patient care and must sign
the medical record. If the NMCP does not desire to ride to the hospital in the ambulance, it is expected that
he will contact the MCP by radio and make an orderly transfer of responsibility. It is further understood
that once the NMCP leaves the side of the patient, the patient is the sole responsibility of the MCP, and
decisions regarding patient care will be made by the MCP.
4. If there exists any doubt as to whether or not the physician at the scene is indeed a M.D. or D.O., the medic
should ask to see the physician's registration card from the Oklahoma State Board of Medical Licensure
and Supervision. If the physician cannot verify his status, the medic should proceed to manage the patient
according to established protocol.
5. The medics should make every effort to be courteous toward the NMCP and to carry out his orders if they
fall within the above protocol.
C. TREATING PHYSICIAN'S RESPONSIBILITY.
1. If the physician at the scene is the patient's personal physician, or if he/she has been summoned to the scene
by the patient or the patient's family, he/she will direct the patient’s care unless he/she relinquishes
responsibility to the paramedics. The personal physician should sign the ambulance run sheet and make an
orderly transfer of responsibility to the MCP when he physically leaves the side of the patient.
2. First Responders, EMTs and paramedics may accept telephone orders from personal physicians as long as
they are consistent with protocol including Non-Transport and Do Not Resuscitate. If there is a
disagreement, contact medical control.
PROTOCOL I.7: STAGING
REVISED 5/8/02
The goal of this policy is to assure protection of all emergency medical personnel responding to a violent incident.
After having been dispatched to the scene of an unsafe or violent occurrence, field personnel will stage themselves
an appropriate distance away (i.e., 2 city blocks for scenes of violence, designated perimeter for fires) and will not
proceed to approach the patient and render care until the scene is declared safe by the appropriate agency. In cases
involving remote staging, dispatch should be notified when the scene has been declared safe, and that information
transmitted to the field personnel. Specific details related to the communication procedure will be the responsibility
of Central Communications for each responding agency.
A. While you are enroute to a call where violence might be involved, check to see whether police are also enroute
to the scene. You may be advised by dispatch to stage when a known violent incident is in progress.
B. While you are still a few blocks away from the area, stop the siren and turn off the lightbar.
C. Routinely park out of sight of the house address to where you are responding, or safely outside the Danger Zone
(an area about 120 degrees in front of the house is at least partially exposed).
D. If you find a violent situation, advise dispatch of your staging address. Also, advise dispatch of safe approach to
the area for all other incoming emergency responders.
E. If you find a violent situation and police have not been called as yet, you may advise dispatch of your need for
police assistance.
F. It should be specifically noted that in those unusual cases of violence where field personnel are at or arrive on
scene prior to the arrival of police, AND there are known injuries, AND the assailant is known to have left the
scene, field personnel must use their best judgment and training experience to proceed cautiously to render care
to the patient.
Format Property of FireNotes, Inc® (OCFD.com)
T.O.C.
Last Revised: 5/4/2017 2:03:00 AM
BOOK: Blue Book II
SECTION: First Responder Protocols (CHF)
PROTOCOL I.8: CRIME SCENE MANAGEMENT POLICY
Pg. 10 of 12
REVISED 5/8/02
The following policy has been developed to ensure the protection of the patient's welfare as well as to ensure
the ability to conduct an effective and thorough investigation.
A. Only those units assigned will respond to the call. Over response tends to cause confusion at the crime
scene and destruction of evidence.
B. When approaching a potential crime scene which is being protected by law enforcement personnel, the
First Responder may request entry into the area to determine life status of the individual.
C. If law enforcement personnel refuse First Responder personnel access into the crime scene, the First
Responder should not become confrontational. The First Responder should complete and submit an
incident report form to the appropriate supervisor.
D. If First Responder personnel are allowed access into the scene, only ONE INDIVIDUAL should enter to
minimize disturbance of the crime scene.
E. If the patient is a victim of penetrating trauma, check for re-activity of the pupils, presence of carotid pulse
and spontaneous respirations.
1. If the injury is a HEAD, NECK or TRUNCAL WOUND, and the patient's pupils are fixed and
dilated, and carotid pulse and spontaneous respirations are absent, do not attempt to resuscitate.
2. If the injury is an ISOLATED EXTREMITY WOUND, and the patient's pupils are fixed and dilated,
and carotid pulse and spontaneous respirations are absent, continue basic life support measures until
cardiac rhythm can be verified by ALS personnel.
F. If the patient is a victim of blunt traumatic arrest without signs of life (i.e., pulse, spontaneous respirations,
and pupilliary reactivity) or shockable rhythm, (the AED should be utilized to determine a shockable
rhythm), do not initiate resuscitative measures. If injuries are incompatible with life, determination of the
patient's rhythm is unnecessary. (Protocol I.3 - No Code Orders and Discontinuance of CPR)
G. If there are no signs of trauma, do not attempt resuscitation if the patient has no pulse, no spontaneous
respirations, the pupils are fixed and dilated, AND has one or more of the following:
1. Rigor mortis
2. Decomposition
3. Dependent Lividity
H. If the patient has signs of life, aggressive resuscitative efforts should be initiated.
1. Keep your medical equipment close to the victim.
2. Stay close to the body.
3. Keep your hands out of any bodily fluids that have pooled.
4. Do not wander around the scene.
5. Minimize destruction of the patient's clothing. If the patient's clothing has a puncture, do not use the
hole in the clothing to start cutting. Begin cutting at another part of the garment.
SPECIAL NOTES
1. DO NOT go through the victim's personal effects (if the victim has expired).
2. DO NOT cover the body with a sheet or other material (if the victim has expired).
3. DO NOT move, take, or handle any object at the scene.
4. DO NOT clean the body of blood, etc.
5. DO NOT wander around the crime scene, return to your vehicle.
6. DO NOT litter the crime scene with medical equipment, dressings, bandages, etc.
I.
J.
If possible, transfer the victim from the scene to the ambulance expeditiously and stabilize the victim in the
ambulance.
If the patient relates any information relating to the crime while in transit to the medical facility, inform a
police officer at once.
Format Property of FireNotes, Inc® (OCFD.com)
T.O.C.
Last Revised: 5/4/2017 2:03:00 AM
BOOK: Blue Book II
SECTION: First Responder Protocols (CHF)
PROTOCOL I.9: CARE OF MINORS PROTOCOL
Pg. 11 of 12
REVISED 5/8/02
A. If field personnel arrive at the scene of an emergency and there is a minor in need of treatment, but no
parent or guardian, field personnel can treat the minor if the minor consents and if the parent or guardian
cannot be reached after a reasonable attempt has been made.
B. IF THE PARENT/GUARDIAN CANNOT BE REACHED AFTER A REASONABLE ATTEMPT HAS
BEEN MADE, AND THE MINOR REFUSES TREATMENT, field personnel must determine the need
for further emergency medical evaluation. The EMS service does not have the right to transport patients
(including minors) against their will. In this case, proceed with the following procedure:
1. If the minor requires further medical evaluation but refuses transport, contact the police and request
that the minor is taken into protective custody.
2. If this is unsuccessful, advise the minor thoroughly of the hazards and potential health risks attendant
to their refusal of transport. If the minor has significant injury or illness, or altered mental status or
post altered mental status regardless of how transient (i.e., trauma, diabetes, seizures), or impaired
decision-making capacity, do not leave the patient without a parent or guardian.
3. If the minor does not appear to require further medical evaluation, and refuses transport, advise the
minor thoroughly of the potential risks of not receiving further medical evaluation.
4. In all cases, fill out all documentation regarding the minor's refusal to be transported and have the
minor sign the refusal form. Leave patient instruction sheet in appropriate situations.
C. If the minor gives consent and field personnel, in good faith, rely on such consent - the minor cannot later
revoke consent.
NOTE:
A minor is defined as “any person under the age of eighteen years of age, except such person who is on active
duty with or has served in any branch of the Armed Services of the United States shall be considered an adult”.
An emancipated minor is defined as any minor who is married, has a dependent child or is emancipated,
separated from and not supported by his parents or guardian, or is pregnant.
PROTOCOL I.10: USE OF HELICOPTER WITHIN THE REGULATED SERVICE AREA
REVISED 5/8/02
A. PURPOSE
Since the medical literature demonstrates that helicopter utilization is not justified in an urban setting
unless there are extenuating circumstances and since there is a high cost involved, as well as potential
danger to the helicopter crew, other EMS providers and citizens, the following criteria apply to helicopter
utilization in the Regulated Service Area.
B. “NO FLY” PATIENT CONDITIONS
Helicopter utilization is seldom indicated for patients without a chance for survival or without serious
injury or illness. The following are incidents when a helicopter should NOT be used:
1. Cardiac Arrest without Return of Spontaneous Circulation in the field,
2. Trauma Patients with trauma scores of 4 or less,
3. Trauma Patients not meeting the criteria for Code One Trauma Alert,
4. Patients with stable vital signs and without signs of serious illness.
C. “NO FLY” ZONE
Helicopter utilization is seldom indicated within a ten mile radius of the hospital-based helicopter unless
there are extenuating circumstances. Indications are as follows:
1. Hazardous or impossible road conditions resulting in significant delays for ground transport of
seriously injured or ill patients with time sensitive conditions,
2. Multiple patients of serious nature requiring rapid transport, overwhelming available ground units,
3. At the paramedic’s discretion, if lengthy extrication is required and transport by ground would be
extended or delayed for other reasons.
Format Property of FireNotes, Inc® (OCFD.com)
T.O.C.
Last Revised: 5/4/2017 2:03:00 AM
BOOK: Blue Book II
SECTION: First Responder Protocols (CHF)
Pg. 12 of 12
PROTOCOL I.10: USE OF HELICOPTER WITHIN THE REGULATED SERVICE AREA - continued
D. HELICOPTER UTILIZATION
At the First Response or Transport medic’s discretion, helicopter utilization may be appropriate in the area
of ten miles or greater from the hospital-based helicopter.
1. If the EMSA or transport agency is on scene, the paramedic may elect to dispatch a helicopter if time
and distance would allow the patient with a time sensitive problem to be delivered significantly faster
by air than ground.
2.
If the EMSA or transport agency is not on scene, the First Response medic should request an ETA for
ground transport. If transport time by ground is believed to be detrimental to the patient, the First
Response medic may request helicopter dispatch. This decision should be communicated to the
EMSA Communications Center by the dispatched helicopter communications center.
E. CANCELLATION OF HELICOPTER
Either First Responder or transport medics may cancel helicopter dispatched by another agency if a
patient’s condition warrants it.
F. LANDING ZONE
Either Fire or the appropriate law enforcement agency will be responsible for a safe landing zone.
G. UTILIZATION REVIEW
All helicopter dispatches in the EMSA Regulated Service Area will undergo utilization review by the
Office of the Medical Director of the Medical Control Board.
WESTERN DIVISION
EASTERN DIVISION
Format Property of FireNotes, Inc® (OCFD.com)
T.O.C.
Last Revised: 5/4/2017 2:03:00 AM