MCHENRY WESTERN LAKE COUNTY EMS SYSTEM

Transcription

McHenry Western Lake County EMS
Policy Manual
2010
TABLE OF CONTENTS - POLICIES
OPERATIONS NARRATIVE
ABANDONED INFANT
ABUSE OF CONTROLLED SUBSTANCES
ADVANCED PROCEDURES
AIRWAY MANAGEMENT/ENDOTRACHEAL INTUBATION
APPARATUS STANDARDS INVENTORY
•
APPARATUS STANDARDS INVENTORY FORM
•
APPARATUS STANDARDS INVENTORY NONTRANSPORT FORM
•
APPARATUS STANDARDS INVENTORY ALS INTERCEPT FORM
BYPASS/HOSPITAL DIVERSION
CHANGE IN EMT LICENSURE STATUS
CLINICAL EXPERIENCE FOR EMS SYSTEM PROVIDERS
CLINICAL EXPERIENCE FOR OUT OF SYSTEM EMS PROVIDERS
COMMUNICABLE DISEASE/INFECTION CONTROL
• BLOOD/BODY SUBSTANCE EXPOSURE FORM
COMMUNICATION OF PROCEDURAL UPDATES
CONFIDENTIALITY/RELEASE OF INFORMATION
CONSENT FOR TREATMENT
CONTINUING EDUCATION-EMT/PHRN
CORONER NOTIFICATION
DATA COLLECTION AND EVALUATION
DIRECT ADMISSION OF BEHAVIORAL PATIENT
DISTRIBUTION OF PHARMACY PROPHYLAXIS
DUAL SYSTEM PARTICIPATION-EMT-P/PHRN/ECRN
ECRN RECIPROCITY
ECRN RECOGNITION
ECRN AND ED PHYSICIAN EMS DUTIES AND RESPONSIBILITIES
EDUCATIONAL CURRICULUMS
EMD AGENCY AFFILIATION
EMD RECOGNITION/RENEWAL
EMS PROVIDER RECOGNITION
EMS PROVIDERS CONVICTED OF A FELONY CRIME
EMS UNIT STAFFING REQUIREMENTS
EMT LICENSURE TESTING
EMT-B RERECOGNITION OF LICENSURE REQUIREMENTS
EMT-P/PHRN RERECOGNITION OF LICENSURE REQUIREMENTS
ENTRANCE REQUIREMENTS FOR EMT-PARAMEDIC TRAINING
ETHICS
EXTENDED ETA
EXTENSION-EMT LICENSE
INACTIVE STATUS
INDEPENDENT RENEWAL
INFIELD SERVICE UPGRADE
LEAD INSTRUCTOR
LICENSURE NON TESTING
MANAGING DISRUPTIVE BEHAVIOR
MEDICATION ADMINISTRATION & REPLACEMENT OR EXCHANGE
MODIFICATION OF AMBULANCE SERVICE
MUTUAL AID
PATIENT ABANDONMENT BY SYSTEM PERSONNEL
PATIENT’S RIGHT TO REFUSAL
• RELEASE OF LIABILITY FORM
PEAK CENSUS
PHRN TRAINING/RECOGNITION
• PHRN APPLICATION FORM
PHYSICAL RESTRAINTS
PHYSICIAN/NURSE AT THE SCENE
POSITION DESCRIPTION: EMS ADMINSTRATIVE DIRECTOR
EMS SYSTEM COORDINATOR
ASSOCIATE EMS COORDINATOR
EMS EDUCATOR
EMS AGENCY LIAISON
EMS MEDICAL DIRECTOR/ASSOCIATE
EMS PRECEPTOR
PROVIDER AGENCY SYSTEM ENTRY
QUALITY ASSURANCE IMPROVEMENT
• OPPORTUNITY TO IMPROVE FORM
RADIO REPORT
REPORTING ABUSE AND/OR NEGLECT
REPORTING SUSPECTED CRIMES
RESERVE AMBULANCE NOTIFICATION POLICY
• RESERVE AMBULANCE NOTIFICATION FORM
RESOURCE HOSPITAL OVERRIDE
SPINAL IMMOBILIZATION
SYSTEM IMMEDIATE SUSPENSION
SYSTEM SUSPENSION
SYSTEM REVIEW BOARD
SYSTEM WIDE CRISIS MANAGEMENT
• SYSTEM WIDE CRISIS FORM
• SYSTEM WIDE CRISIS WORKSHEET
WITHHOLDING OR WITHDRAWING RESUSCITATIVE EFFORTS
• DNR FORM
REGION IX
BYPASS/DIVERSION
CONTINUING EDUCATION
DO NOT RESUSCITATE
DURABLE POWER OF ATTORNEY
INTERSYSTEM REGION CONFLICT
PARAMEDIC EDUCATION
PEAK CENSUS
OPERATIONS NARRATIVE
The McHenry Western Lake County EMS System was organized in 1973 and
approved by the Illinois Department of Public Health in 1975 to provide Advanced
Life Support emergency services to the population of the western Lake County
and McHenry County area. At that time all EMS service was provided by
volunteer provider agencies, with the city of Crystal Lake being the largest
population to be served. The general culture of McHenry County was rural, with
an emphasis on agriculture and recreational industry. The past 35 years have
brought a great evolution in the culture as agriculture slowly gives way to a
suburban environment, where residential and industrial growth have abounded.
Today each ALS provider agency within the McHenry Western Lake County EMS
System provides their service through a combination of both full-time and parttime staffing. The concept of the volunteer has evolved to the “paid on call” and
“paid on premise” responder. The following Advanced Life Support Agency
providers are participants within the McHenry Western Lake County EMS
System:
A-Tec Ambulance (private transport service)
Cary Fire Protection District
Crystal Lake Fire Department
Elgin Medi Transport
Flight for Life-McHenry (SEMSV-Helicopter)
Fox Lake Fire Department
Fox River Grove Fire Protection District
Lakewood Fire Department
McHenry Township Fire Protection District
Nunda Rural Fire Protection District
Rescue Eight (private transport service)
Richmond Township Fire Protection District
Spring Grove Fire Protection District
Wonder Lake Fire Protection District
Woodstock Fire/Rescue Department
The continued growth of our service area has demonstrated a direct impact in the
volume of the EMS patient contacts experienced by the provider agencies. It is
estimated that we interact with approximately 35,000 patients each year. This
continued growth presents an ongoing challenge in response and staffing needs
for System provider agencies, as we continue to focus on “best practice” and
quality service in meeting the EMS needs of our community. In addition our
participation in IDPH EMS Region IX affords the opportunity to work
cooperatively with other EMS Systems in developing regional quality indicators,
standards of care and disaster response plans.
RESOURCE HOSPITAL
Centegra Hospital McHenry (CHM) serves as the resource hospital for the
McHenry Western Lake County EMS System. Located at 4201 Medical Center
Drive in McHenry, CHM is a designated Level II Trauma Center/EDAP, which
provides comprehensive emergency department services for the prehospital
patients in our community. John Pacini, DO serves as the EMS System Medical
Director and Cindy Amore, RN, BSN is the EMS System Coordinator.
CHM maintains accountability for the following Resource Hospital operations:
1. TRAINING
A contractual agreement has been in place for the past 30 years with McHenry
County College (MCC), which serves as the primary educational program site for
all levels of EMS training: First Responder (EMR), Emergency Medical Dispatch
(EMD), EMT-Basic and EMT-Paramedic. MCC is credentialed by the Illinois
Community College Board and NCA. The programs offered for credit at MCC
provide students the opportunity for an Occupational Certificate or Associate
Degree completion. The EMS program enjoys access to a “state of the art”
classroom/lab facility in presenting program content. The lab setting provides for
a simulated classroom learning experience in both the Emergency Department
(ED) clinical and the ambulance environment.
Emergency Communications RN (ECRN) and PreHospital RN (PHRN) training is
provided through the EMS Department located at CHM. We continue to be
recognized by the American Heart Association as a Training Center for ACLS,
PALS and BCLS; and an ACEP provider for ITLS-Basic and Advanced. In 2004,
NIMC became an approved IDPH site for the Trauma Nurse Specialist program.
2. LICENSURE/RELICENSURE
The EMS Department at CHM maintains records for all EMS System providers.
Continuing education requirements for system EMT-B/EMD providers are
maintained by each provider agency and validated with the resource hospital at
time of relicensure. Continuing education records for System EMTP, PHRN and
ECRN providers are maintained by the resource hospital, and validated by the
EMS System Coordinator annually.
3. POLICIES/PROCEDURES
System policies and procedures are developed in cooperation with the IDPH
Region IX EMS Advisory Committee and system provider representatives, in
accordance with the practice needs of our System as afforded by the IDPH EMS
Rules and Regulations. Any changes to EMS System policies or procedures are
communicated to our system providers directly by the resource hospital.
Communication strategies may include written notification, educational training
sessions, or website postings. The Associate Hospitals: Centegra Hospital–
Woodstock (CHW) and Good Shepherd Hospital assist in the needs assessment
for policy/procedure revisions and support the implementation process when
changes occur.
4. COMMUNICATIONS
CHM provides the center of communications for the EMS System. Administrative
follow up and quality improvement programming is coordinated by the EMS
Medical Director and EMS System Coordinator. On-line medical direction is
provided by ECRN licensed emergency department personnel for all prehospital
communications. Providers may elect to contact any of the three system
hospitals with report during treatment and transport. A policy is in place to
address conflict resolution regarding medical direction, which affords the
Resource hospital the ability to override other medical orders from another
System hospital. A digital record of radio transmission is maintained by each
system hospital, and utilized by the System for quality improvement review.
Hospital to hospital communications can be achieved using MERCI 280 , or
StarComm radios in addition to more traditional communication methods.
5. DATA COLLECTION
All system prehospital care reports are archived by the CHM. The system
currently utilizes an electronic records system. Computer work stations are
present in each provider agency and system hospital ED for documentation of
patient assessment/treatment data. Records are stored on a web-based server,
with all system files accessible to the EMS System Coordinator. Unusual
occurrences or requests for call review are documented on the system
“Opportunity to Improve” form, and managed by the EMS System Coordinator.
Follow-up summaries are also maintained by the resource hospital.
6. QUALITY IMPROVEMENT
The Quality Improvement program is developed with input from the EMS Region
IX Advisory Board, with the inclusion of recommendations from the Region IX
Trauma Advisory Board and Region IX EDAP committee. Additional quality
indicators are determined based on educational focus/need, patient assessment
patterns, or issues identified by system oversight. Monitoring is accomplished
primarily from a retrospective chart review. Ongoing monitoring includes invasive
airway management, cardiac arrest and trauma arrest management. QI review
information is communicated quarterly to System providers via the System EMS
Council. Results are shared in a collective system format, as well as by individual
providers. The current electronic records program affords the opportunity for
each EMS agency to monitor specific trends and practices through their
department database. Specific call events are reviewed as needed with
prehospital care providers for the benefit of learning and process improvement.
The EMS Medical Director is involved in the education review of all patient care
situations in which a concern for quality arises.
ASSOCIATE HOSPITAL
Centegra Hospital Woodstock (CHW) is located at 3701 Doty Road in
Woodstock, IL. CHW is a designated Level II Trauma Center/EDAP, which
provides comprehensive emergency services. Cindy Tabert, EMT-P fulfills the
role as the Associate EMS Coordinator in monitoring daily EMS operations.
CHW supports EMS system operations through providing on-line medical
direction, QI monitoring, EMS supply inventories, and serves as an EMS clinical
site.
Advocate Good Shepherd Hospital is located on Rt. 22 in Barrington, IL. Good
Shepherd Hospital is a designated Level II Trauma Center/EDAP, which provides
comprehensive emergency services. Good Shepherd Hospital supports EMS
system operations through providing on-line medical direction, QI monitoring,
EMS supply inventories and serves as an EMS clinical site.
The Trauma Coordinators and EDAP liaisons at each Associate Hospital work
closely with the EMS System in monitoring the prehospital trauma care and
pediatric management being provided to patients transported within the system.
Participating Hospital
There are no “participating hospitals” within the McHenry Western Lake County
EMS System.
Intersystem Agreements
The McHenry Western Lake County EMS System maintains an agreement for
on-line medical direction between CHM and Condell Medical Center, which is the
resource hospital for the Condell EMS System. There is also a separate
agreement in place for both CHM and CHW with Provena St. Joseph Hospital in
Elgin, the resource hospital for Provena St. Joseph EMS System. The purpose of
this agreement is to facilitate communication of patient care when patients are
being transported between those two specific system hospitals by ALS provider
agencies. This agreement has improved the communication/delivery of patient
care directly for the ALS agencies affected: A-Tec Ambulance, Fox Lake Fire
Department, The Greater Round Lake Fire Protection District, Wauconda Fire
Protection District, Huntley FPD and Marengo Rescue Squad. ECRNs and ED
Physicians are oriented to the policy/procedures and standards of care for each
EMS System, in an effort to provide appropriate on-line medical direction when
accepting the transfer of a patient from one of the agencies listed above.
MWLCEMS OPNAR
IMPL: 1980; REV: 2/10
ABANDONED NEWBORN INFANT PROTECTION ACT
POLICY
It shall be the policy of the McHenry Western Lake County EMS System to comply with
the state of Illinois legislations which allows a parent to relinquish a newborn infant,
believed to be 30 days old or less to a hospital, fire station or emergency medical facility.
The parent may remain anonymous and is immune from liability, as long as the newborn
infant does not demonstrate signs of abuse or neglect.
PROCEDURES
1. Every fire station/EMS facility must accept and provide all necessary emergency
care to a relinquished newborn infant as defined in the Abandoned Newborn Infant
Protection Act.
2. The action of relinquishing the newborn infant serves as implied consent for EMS
to provide emergency care and transport of the infant to the nearest Emergency
Department.
3. The receiving EMS personnel must transport the relinquished child to the nearest
Emergency Department. A patient assessment must be performed and an EMS
run record completed, which will include date, time and circumstances of
relinquishment.
4. EMS personnel must make every attempt to verbally inform the parent, that by
relinquishing the infant anonymously, he or she will have to petition the court in
order to prevent the termination of parental rights and regain custody of the child.
5. If the mother or father is present, the EMS personnel will provide a “parent
information packet”. The parent is requested to complete the forms within the
packet. EMS personnel must clearly inform the parent that:
a. acceptance of the packet of information is completely voluntary;
b. completion of the Illinois Adoption Registration Form and Medical Information
Form is completely voluntary;
c. a Denial of Information Exchange form may be completed, which allows the
relinquishing parent to remain anonymous to the infant and other parties
involved in subsequent adoption;
d. the parent may provide medical information only and still remain anonymous.
6. If assessment of the relinquished child reveals suspected abuse or neglect, the
EMS personnel are mandated to report the suspected abuse/neglect as outlined by
system policy.
7. A Department of Children and Family Services (DCFS) report is made to the hotline
(1-800-252-2873) within 12 hours of relinquishment. EMS personnel indicate the
newborn has been relinquished under the “Abandoned Newborn Infant Protection
Act”.
8. The relinquished infant will be transferred to the care of the Emergency
Department, awaiting a care plan to be developed by DCFS.
9. If the parent of the relinquished infant returns to the fire station/emergency facility
within 72 hours of relinquishing the infant, EMS personnel must provide the parent
with information regarding the hospital name and location to which the infant was
transported.
ABANDONED INFANT
IMPL: 10/01; REV: 2/10
ABUSE OF CONTROLLED SUBSTANCES BY SYSTEM PERSONNEL
POLICY STATEMENT
It shall be the policy of the McHenry Western Lake County EMS System that providers
must not engage in patient care while under the influence of alcohol or other substances,
as their judgment and/or performance could be affected.
PROCEDURE
1. Should a provider be suspected of being "under the influence" of a behavior-altering
chemical while providing EMS prehospital care, an appropriate Incident
report must be completed and sent to the CHM EMS Office. Where a fellow
provider from the same agency suspects or has knowledge of substance abuse,
he/she must report that to his/her supervisor immediately.
2. The EMS MD or EMS System Coordinator will contact the provider's employer
agency. Disciplinary action should be generated by that agency. However, the
EMS Department reserves the right to issue disciplinary action under IDPH
Rules, Section 535.260. The action may include immediate suspension, if the
provider's actions demonstrate a concern for public safety.
3. Drug testing may be required as a condition of a System Review Board Hearing or
employer policy. In order to return to active practice, the EMT cannot be required
to submit to drug testing which conflicts or duplicates an already established
provision established within the collective bargaining agreement.
CONTSUBS
IMPL: 10/95; REV: 2/10
ADVANCED PROCEDURES
POLICY
It shall be the policy of the McHenry Western Lake County EMS System that EMTParamedics and PHRN’s may become recognized to perform certain skills beyond those
required of the "System" providers. The list of skills includes those listed below. Training
and retraining are required by individual policy.
PROCEDURES
EMT-PARAMEDIC and PHRN
•
•
•
•
•
Portable Ventilator Transport
Infusion Pump and PCA Pump Transport
Heparin Infusion Interfacility Transport
Nitroglycerin Infusion Interfacility Transport
SEMSV-Expanded Scope of Practice
(Flight For Life)
ADVANCED PROCEDURES
IMPL: 8/95; REV: 2/10
McHENRY WESTERN LAKE COUNTY EMS SYSTEM
AIRWAY MANAGEMENT/ENDOTRACHEAL INTUBATION
POLICY
It shall be the policy of the McHenry Western Lake County EMS System that licensed
EMT-Ps, and PHRNs, approved to intubate within the "System", may intubate ADULT
patients provided they have been "Recognized" to do so according to the procedures
outlined below. (Definition – Adult – demonstrating physical changes of puberty).
GUIDELINES AND PROCEDURES
1. A paramedic or PHRN will be "Recognized" to intubate ADULT patients when
he/she:
a.
Successfully completes the EMS sponsored Airway Management Seminar
demonstrating proficiency by written exam and practical evaluation by the
EMS Medical Director/designee.
b.
Upon passing the airway management competencies, intubation privileges
are awarded.
NOTE: Paramedics or PHRNs who do not become "Recognized" will not be
allowed to intubate.
2. A paramedic or PHRN will continue to be "Recognized" when he/she annually
successfully completes the annual advanced skill update (written and skill
evaluation) with a score of 80% or better. The annual advanced skill update will be
offered each Spring as part of the system continuing education programming.
NOTE: Paramedics or PHRN's who fail to recognize misplaced advanced airway
will not be allowed to intubate until they attend remediation training and
demonstrate proficiency.
3. Paramedics or PHRN's functioning secondary within the system, who are allowed
to intubate within their primary system must:
a.
Submit a letter from their primary EMS System specifying the intubation
training they have received.
b.
Demonstrate airway management proficiency (written exam and skill
testing) evaluated by the EMS Medical Director/designee.
NOTE: In the interim, EMT-P's/PHRN's who have previously been performing
intubation in the field, but have not yet completed the skill validation due to
scheduling, must request permission to intubate from medical control prior to
attempting intubation. Permission will be granted on an individual case basis at the
discretion of the ER physician in charge.
4. A paramedic or PHRN "Recognized" to intubate within the system, may intubate
appropriate ADULT patients. PEDIATRIC PATIENT INTUBATIONS MAY BE
PERMITTED ON AN INDIVIDUAL CASE BASIS AT THE DISCRETION OF THE
ER PHYSICIAN IN CHARGE OF THE CALL. REQUESTS FOR PERMISSION
TO ATTEMPT A PEDIATRIC INTUBATION MUST BE MADE PRIOR TO
PERFORMING THE INTUBATION VIA TELEMETRY RADIO/CELL PHONE TO
MEDICAL CONTROL.
5. An EMT-P/PHRN who places an ET tube at the scene is expected to continue
responsibility for the management of the airway during transport, through arrival in
the Emergency Department.
6. All intubations with either King Tube or ET MUST be verified at the receiving
Facility and documented on the run report.
7. The procedure for intubation shall be that as outlined in the AHA-ACLS course for
non-trauma patients and as outlined in the ACEP-ITLS course (in-line intubation
and manual c-spine stabilization by second rescuer) for trauma patients.
INTUBATE
IMPL: 7/88; REV: 2/10
POLICY
It shall be the policy of the McHenry Western Lake County EMS System that EMS vehicles
(ambulances/non-transport response vehicles) are properly equipped so that all patients
may be appropriately treated. In order to be assured that adequate supplies are in stock,
the items listed below will assist EMS agencies in supplying their vehicles.
PROCEDURES
1. All Basic Life Support (BLS) equipment, required by IDPH shall be carried on all
ambulances (see attached list).
2. The purchase and stocking of such BLS equipment is the responsibility of the
individual EMS agency.
3. The BLS equipment specifications (type, manufacturer, supplier) are left to the
discretion of the service with the following exceptions:
a. Bag Valve Masks should be disposable with oxygen inlet and inline
capnography. Color metric detector.
b. Cervical collars must be a one piece rigid-type, i.e., Stif-Neck.
c. CID devices – disposable or reusable
d. Sheets and pillow cases must be changed after each patient transport.
4. The required ALS equipment listed below must be provided by the EMS agencies
who have chosen to provide ALS. The model and manufacturer of supplies are left
to the discretion.
a. Cardiac Monitor-Defibrillator with 12 Lead ECG capability
b. Telemetry Radio and/or cellular phone w/telemetry capability
c. MAST Suits
d. Laryngoscopes and Blades
5. The operation of an ALS non-transport response vehicle as a second line
responder in the absence of an ALS ambulance to provide initial patient care, is
recognized by the system. The ALS response vehicle must meet the minimum
staffing requirements for an ALS service as identified by IDPH Rules
and Regulations: Chapter I section 535.830 f and maintain the Apparatus
Standards Inventory for ALS Response Vehicle-Non Transport (See attachment).
6. All ALS supplies, including initial drug kit, as identified on the Apparatus Standards
Inventory (attached) will initially be provided by the Resource Hospital. These items
should be replaced as in #7 below.
7. All supplies used during patient care should be replaced at the receiving facility
following transfer of the patient. Documentation of supplies used in providing
patient care are monitored electronically via the Pyxis or Omnicell System.
8. It is the responsibility of the EMS agency to maintain complete inventories of
BLS/ALS supplies on all system vehicle (transport and non-transport). Outdated
medications and supplies are to be replaced through the established system (Pyxis
or Omnicell) and noted in the inventory management as replacement/restock.
Replacement of BLS supplies not used in patient care is the responsibility of the
EMS Agency.
9. The EMS System and IDPH will inspect each EMS response vehicle (transport and
non-transport) annually. An updated ALS inventory form will be completed to insure
appropriate access to required equipment and supplies for providing patient care.
APPARATUS POLICY
IMPL: 1/80; REV: 2/10
____________________________ _____________ ____________ ______________________________
DEPARTMENT
UNIT
STATE #
DATE OF INSPECTION
__________________________________________ _______________________ ____________________
TYPE OF VEHICLE
MAKE
YEAR
MEDICATIONS
Required
MEDICATIONS
Required
Stock
Stock
Adenosine
3
Sodium Bicarbonate (preload)
2
6mg/2ml vials
50mEq/50ml
Amiodarone
3
Tetracaine Opthalmic
1
150mg/9ml vials
1 ml
Aspirin
8
Vasopressin
2
81mg tablets
20 units/1 cc vial
Atrovent
1
Verapamil
1
0.02%/2.5ml
10mg/4ml
Atropine (preload)
3
Versed
4
1mg/10ml
5mg/1ml
Benadryl/Dipenhydramine
1
Zofran 4mg ODT &
2
50mg/2ml
4mg/2ml vials
2
Benzocaine Spray w/straws
1
IV SOLUTIONS
Dextrose (preload)
25gm/50ml
Dopamine (premix)
400mg/250ml
Epinephrine (ampules)
1:1,000 1mg/1ml
Epinephrine (preload)
1:10,000 1mg/1ml
Etomidate (preload)
2mg/2ml 40mg
Glugagon
1mg/1ml vial
Glucose Gel
40% - 37.5gm
Lidocaine (preload)
100mg/5ml
Magnesium Sulfate
1gm/2ml
Morphine Sulfate OR Fentanyl
10mg/1ml
100mcg/2ml
Narcan
2mg/2ml
Nitroglycerine (bottle)
0.4mg/tablet
Proventil
0.083%/3cc
2
0.9 NaCl 1000cc
8
1
0.9 NaCl 50cc
1
4
1
2
6
Pressure Bag Infuser
Saline Flush
IV TUBING
1
Mini Drip Tubing
1
3
Macro Drip Tubing
4
1
Blood Tubing
2
3
Piggyback Tubing
1
4
Hep Locks
2
2
IV CATHETERS
2
14 gauge Angio Cath
16 gauge Angio Cath
18 gauge Angio Cath
20 gauge Quick Cath
22 gauge Quick Cath
24 gauge Quick Cath
1
6
1
4
4
4
2
2
2
PRODUCT DESCRIPTION
NEEDLES
21 or 22 gauge X 1-1½ inches
23 gauge X 1 inch
EZ IO – 2 Adult needles/1 Peds needle
SYRINGES
Plastic Carpo-Jet syringe
1cc X 27 gauge Turberculin w/needle
3 cc w/needle
10 cc no needle
20 cc no needle
Mad Device
LAB DRAW
Short Draw-Orange Top
Required
Stock
2
EQUIPMENT
Cardiac Monitor w/defib
w/synchronized cardioversion & Pacer
Debrillator gel(tube) or Defib Pads
EKG Paper (rolls)
12 Lead (optional)
2
1
2
2
2
1
1
1
Protocols
1
2
2
MAST- Adult & Peds
Pulse Oximeter
King Tubes 2,3,4 1 each size
C-PAP
2
Glucometer
Required
Stock
1
ENDOTRACHEAL TUBES
Size 5.5
Size 7.0
Size 7.5
Size 8.0
Stylet (1 Adult/1 Peds)
Laryngoscope/Magils Forceps
Telemetry Radio and/or Cell Phone
(circle one or both)
Batteries/ET Holders
LARYNGOSCOPE BLADES
Pediatric
Straight
Curved
Smart Triage Tags
1
1
2
2
2
2
1
2
2
BLS Equipment according to Illinois Department of Public Health (IDPH) standards.
I hereby certify that this EMS vehicle contains the above required stock.
___________________________________________
Department Representative
____________________________________________
EMS Representative
Ct-revised 9.09
2
ALS RESPONSE VEHICLE NON-TRANSPORT
____________________________ _____________ ____________ ______________________________
DEPARTMENT
UNIT
STATE #
DATE OF INSPECTION
__________________________________________ _______________________ ____________________
TYPE OF VEHICLE
MAKE
YEAR
MEDICATIONS
Required
MEDICATIONS
Required
Stock
Stock
*Adenosine
1
*Vasopressin
2
6mg/2ml vials
20 units/1cc vial
Aspirin
4
*Verapamil
1
81mg tablets
10mg/4ml
Atrovent
1
*Versed
2
0.02%/2.5ml
5mg/1ml
*Atropine (preload)
1
Zofran 4 mg ODT &
2
1mg/10ml
4mg/2ml vial
2
1
IV SOLUTIONS
50mg/2ml
*Benzocaine Spray w/straws
1
0.9 NaCl 1000cc
2
Dextrose (preload)
25gm/50ml
Epinephrine (ampules)
1:1,000 1mg/1ml
*Epinephrine (preload)
1:10,000 1mg/1ml
*Etomidate (preload)
2mg/2ml 40mg
Glucagon
1mg/1ml vial
Glucose Gel
40% - 37.5gm
*Lidocaine (preload)
100mg/5ml
10mg/1ml
100mcg/2ml
Narcan
2mg/2ml
Nitroglycerine (bottle)
0.4mg/tablet
Proventil
0.083%/3cc
Tetracaine Opthalmic
1 ml
*with Cardiac Monitor only
1
MAD DEVICE
1
1
IV TUBING
1
Macro Drip Tubing
2
1
Blood Tubing
1
1
Blood Draw Setup
1
1
IV CATHETERS
1
1
14 gauge Angio Cath
16 gauge Angio Cath
18 gauge Angio Cath
20 gauge Quick Cath
22 gauge Quick Cath
2
NEEDLES
1
21 or 22 gauge X 1/1½ inches
23 gauge X 1 inch
1
1
1
2
2
2
2
2
1
1
PRODUCT DESCRIPTION
SYRINGES
1cc X 27 gauge tuberculin w/needle
3cc with needle
10cc no needle
Plastic Carpo-jet
Required
Stock
1
EQUIPMENT
Cardiac Monitor w/defib
w/synchronized cardioversion & Pacer
Debrillator gel(tube) or Defib Pads
OR
AED
1
1
1
Glucometer
Pulse Oximeter
Protocols
OPTIONAL
King Tube Sizes 2,3,4 1 each
ENDOTRACHEAL TUBES
Telemetry Radio and/or Cell Phone
(circle one or both)
Size 5.5
Size 7.0
Size 7.5
Size 8.0
Stylet (1 Adult/1 Peds)
Laryngoscope/ Magils Forceps
ET Holder & batteries
LARYNGOSCOPE BLADES
Pediatric
Straight
Curved
EMS Incident Report Forms
Required
Stock
1
1
2
2
2
2
1
2
2
BLS Equipment according to Illinois Department of Public Health (IDPH) standards.
I hereby certify that this EMS vehicle contains the above required stock.
___________________________________________
____________________________________________
EMS Representative
Ct-revised 9.09
2
ALS Intercept
_________________________________________
DEPARTMENT
Product Despcription
MEDICATIONS
Adenosine
6mg/2ml vials
Amiodarone
150mg/9ml vials
Atrovent
0.02%/2.5ml
Atropine (preload)
1mg/10ml
50mg/2ml
Benzocaine Spray w/straws
Dopamine (premix)
400mg /250cc
Epinephrine (preload)
1:10,000 1mg/1ml
Etomidate (preload) 40 mg
2mg/2ml
Glucagon
1mg/1ml vial
Lidocaine (preload)
100mg/5ml
Magnesium Sulfate
1gm/2ml
10mg/1ml
100mcg/2ml
________________________________________
DATE OF INSPECTION
Required
Stock
3
3
1
3
1
1
MEDICATIONS
Sodium Bicarbonate (preload)
50mEq/50ml
Vasopressin
20 units/1cc vial
Verapamil
10mg/4ml
Versed
5mg/1ml
Zofran
4mg ODT &
4mg/2 ml vial
IV SOLUTIONS
Required
Stock
2
2
1
4
2
2
1
0.9 NaCl 1000 c
2
6
0.9 NaCl 50 cc
1
1
IV TUBING
3
Mini Drip Tubing
1
3
Macro Drip Tubing
2
4
Piggyback Tubing
1
2
SYRINGES
Plastic Carpo-Jet
1
I hereby certify that the EMS Intercept box contains the above required stock.
__________________________________________
__________________________________________
EMS Representative
Revised 9.09 CT
1
BYPASS/HOSPITAL DIVERSION
POLICY
It shall be the policy of the McHenry Western Lake County EMS System to
provide prehospital care to patients and to transport them to the closest hospital
facility. Bypass of the closest hospital facility may be appropriate when special
circumstances exist. In this situation, the following guidelines and procedures
MUST be followed:
GUIDELINES AND PROCEDURE
1. Ambulances may bypass the closest facility when the patient would
significantly benefit transport to another facility farther away and when the
patient’s condition is such that transport to the farther facility will not
significantly increase his/her morbidity or mortality or where the guidelines
of the Regional Trauma Plan are in effect. The decision to bypass the
closest facility must be made through communication with the base
hospital at the discretion of the ED physician in charge of the EMS run.
2. During capacity census at an EMS System Hospital, the EMS
Coordinator/Designee may alert area EMS providers to the lack of
available critical care monitored beds or capacity census. (No bed
space available for inpatient admissions including flex holding areas and
the ED). The ED will continue to accept reports from EMS providers, but
may divert the transport to a more distant hospital, in an effort to provide
appropriate medical management of the patient.
3. The decision to initiate Bypass/Ambulance Diversion will be made by the
EMS Medical Director, ED Medical Director, Chief Nursing Officer, and ED
Manager. Bypass will be initiated only under the following conditions:
a. General Bypass:
1) No monitored beds available for inpatients within the facility
and ED
2) All potential staff to provide care for holding areas has been
exhausted.
3) An internal disaster exists, but not limited to a power failure,
fire or flood.
b. Trauma Bypass:
1) No available OR suites exist, all suites are staffed with “on
call” teams and one team is treating a trauma.
2) CT scan not available
4. The EMS System Coordinator will be notified of a decision to initiate
Bypass/Ambulance Diversion. In turn, the EMS Coordinator will notify
area EMS agencies and area hospitals of the need for ambulance
diversion.
a. In accordance with IDPH regulations, Bypass may NOT be honored
if three or more hospitals in geographic area are also under Bypass
conditions and EMS transport time to the nearest facility exceeds
15 minutes.
b. EMS agencies will be asked to establish early radio contact with
medical control to determine the most appropriate transport
destination for the patient.
5. In the event of a system-wide crisis, i.e., mass casualty situation or other
disaster event; the Resource Hospital will evaluate the scope of service
required to effectively manage the patient care needs, as identified by the
responding agency. The Medical section of the McHenry County Disaster
Plan will be implemented as indicated.
a. If the nature of the crisis event is such that system resources
cannot effectively provide the services required, the Resource
Hospital will notify the Region IX RHCC Hospital for support as
defined by the Region IX Disaster Plan.
6. Bypass will be canceled when the following conditions exist:
a. General Bypass:
1) Monitored inpatient beds are available for patient admission
2) Additional staffing has been obtained to staff holding areas,
creating admitting bed space.
3) An internal disaster has been resolved.
b. Trauma Bypass:
1) OR suites are available.
2) CT has been restored for patient use.
c. The EMS Coordinator will notify area EMS agencies and area
hospitals of the cancellation of Bypass/Ambulance Diversion status.
BYPASS
IMPL: 8/95; REV: 2/10
CHANGE IN EMT LICENSURE STATUS
POLICY
The McHenry Western Lake County EMS System recognizes the potential for a system
participant to request a reduction or reactivation of their EMT licensure status, based on
changes in personal circumstances. In accordance with IDPH Rules and Regulations, the
EMS Medical Director and EMS System Coordinator will make an effort to accommodate
the system participants request, within the structure of System Policy and Procedure.
PROCEDURE
1. An EMT-B may request voluntary reduction of licensure to First Responder status
for the remainder of their licensure period.
a. The request is to be made in writing to the EMS System.
b. The provider’s EMT-B license is to be attached to the written request.
c. The EMS Medical Director will review the request, and a transaction card will be
submitted to IDPH indicating change of licensure status, accompanied by an
updated Child Support statement.
d. In order to re-register as a First Responder, the individual must demonstrate
he/she has met the requirements for re-registration as defined by IDPH-EMS
Rules section 515.720(b).
2. An EMT-B who has reverted to First Responder status may be reinstated to
EMT-B status after:
a. making a written request to the EMS Medical Director.
b. demonstrating skill proficiencies and current knowledge of basic life support
patient care standards to the EMS Medical Director/EMS System Coordinator.
(The evaluation of basic life support skill proficiency may utilize both
written and practical testing).
c. remediation of any skill deficiency must be completed to the satisfaction of the
EMS Medical Director and may include both classroom and clinical educational
experience.
d. upon successful completion of proficiency testing, the EMS Medical Director
will request reinstatement of the individual’s EMT-B license, in writing to IDPH.
e. a transaction card will be submitted to IDPH indicating a change in licensure
status, accompanied by an updated Child Support statement.
3. An EMT-P may request voluntary reduction of licensure level to EMT-B, if personal
circumstances warrant.
a. The request is to be made to the EMS System in writing.
b. The provider's EMT-P license is to be attached to written request.
c. The EMS Medical Director will review the request, for current CE requirements.
d. A Transaction card will be submitted to IDPH indicating the change of licensure
4. An EMT-P who has reverted to EMT-B status may be reinstated to their previous
advanced practice after:
a. Making a written request to the EMS Medical Director
b. Demonstrating skill proficiencies and current knowledge of advance practice
patient care standards to the EMS Medical Director/EMS System Coordinator.
(The evaluation of advanced level skill proficiency and patient care standards
may utilize both written and practical testing)
c. Remediation of any skill deficiencies must be completed to the satisfaction of
the EMS Medical Director and may include both classroom and clinical
educational experience.
d. Upon completion of Advance Practice proficiency testing, the EMS Medical
Director will request reinstatement of the provider's advanced practice
licensure, with written request to IDPH.
e. A transaction card will be submitted to IDPH indicating the change in licensure
5. Any EMT, PHRN or ECRN whose license has expired may, within 60 days after
licensure expiration, submit all relicensure material as required, with a fee of $50
payable to IDPH, for licensure renewal. If all requirements are in order and the
EMT has no disciplinary action pending, licensure application will be submitted
to IDPH.
6. Any EMT, PHRN or ECRN whose license has lapsed for a period of more than 60
days, shall be required to reapply for IDPH licensure by completing all required
training and licensure testing.
STATUSCHANGE
IMPL: 1/98; REV: 2/10
CLINICAL EXPERIENCE FOR EMS SYSTEM PROVIDERS
POLICY
Emergency Medical Technicians functioning within the McHenry Western Lake County
EMS System are allowed to practice in the Emergency Department (ED) clinical areas.
They may provide patient care under the direct supervision of an ED Registered Nurse or
Physician for the purpose of education and skill training.
DEFINITION
Emergency Medical Technician-Basic (EMT-B) - a prehospital provider recognized by
IDPH to deliver basic life support emergency care.
Emergency Medical Technician-Paramedic (EMT-P) - a prehospital provider recognized by
IDPH to deliver advanced life support emergency care.
EMS Student - an individual enrolled in an IDPH approved EMS training program
conducted by the McHenry Western Lake County EMS System for the purpose of gaining
the knowledge and skill of an EMT-Basic or EMT-Paramedic.
ACTION STEPS
1. EMT's are required to sign up for clinical time in the Emergency Departments at
CHM and CHW. Clinical time scheduled at Good Shepherd Hospital (GSH) needs
to be confirmed in advance with the GSH EMS Coordinator.
2. EMT-B's and EMT-B students will be allowed to perform the following in the clinical
area:
a. assess and report vital signs
b. assist with oxygen delivery and airway management
c. assist with bleeding control and bandaging
d. assist with immobilization and splinting, including application of MAST
e. CPR
f. observe assessments and treatments provided by ED associates
3. EMT-P and EMT-P students will be allowed to perform the following in the clinical
area:
a. basic life support skills as identified for the EMT-B
b. patient assessment
c. initiating vascular access (IV and IO)
d. medication administration including drug dosage calculation, preparation and
administration via oral, IN, IM, Sub-q, IO, IV and Hand Held Nebulizer.
e. apply EKG electrodes and interpret EKG rhythm; 12 lead EKG acquisition
and review
f. CPR, cardioversion (synchronized/unsynchronized) and external
transcutaneous pacing
g. airway management including oral endotracheal intubation, supraglottic
airway device, suctioning and needle chest decompression
h. apply and inflate MAST trousers
4. All clinical experience must be documented on a Clinical Documentation Form to
include: recorded times of the clinical experience, an outline of the types of
patients cared for and the treatment provided or observed by the EMT. The form
also needs to include the evaluation/signature of the precepting ED RN, MD, or
EMT-P (Patient Care Technician).
5. Conduct in the clinical area should be professional at all times. Dress code
includes: departmental uniform shirt or shirt with a collar, dark slacks and dark
shoes. T-shirts, jeans and white athletic shoes are not acceptable. Each EMT
must come prepared with a watch with a second hand, stethoscope, and EMS ID.
Gum chewing is not allowed in the clinical area, while providing patient care.
Each EMT must present a professional appearance at all times, as they
are perceived as a member of the hospital healthcare team. Use of electronic
communications devices (i.e., cell phone, texting devices) is not allowed in the
clinical area.
6. Upon arrival to the clinical area, the EMT should notify the Charge Nurse, who will
be responsible for introducing a clinical preceptor and making patient assignments.
It is the EMT's responsibility to make the preceptor aware of his present skill
proficiency. The Clinical Preceptor will allow the EMT to provide patient care at
his/her discretion, based on the best interest of providing quality patient care.
7. All advanced skills performed in the clinical area by EMS students, must first be
completed in the classroom setting, where individual proficiency has been
evaluated and recorded. This information will be communicated to the
clinical areas by the EMS Coordinator. All advanced skills performed during the
clinical experience must be performed under the direct supervision of a RN, MD or
EMT-P (Patient Care Technician) involved in the patient's care.
8. Patient confidentiality is a critical consideration. All information related to the
patient's cared for by the EMT during the clinical experience must be maintained
confidential. Breech of confidentiality is grounds for immediate dismissal from the
program.
9. In the event of exposure to a communicable disease, the EMT must notify the
Charge Nurse in the clinical area, and proceed in accordance with the McHenry
Western Lake County EMS System Policy regarding Infection Control-Body
Substance Exposure.
CLINICAL
IMPL: 1/98; REVISED: 2/10
CLINICAL EXPERIENCE FOR OUT OF SYSTEM EMS PROVIDERS
POLICY
In an effort to build upon the working relationships with EMS agencies outside the McHenry
Western Lake County EMS System, who interact with system hospitals for patient transports, it
shall be the policy of the McHenry Western Lake County EMS System to allow licensed EMS
providers (EMT-B, EMT-P and Prehospital RN) to participate in a scheduled clinical experience
within a system hospital, including EMS ride along or FFL.
GUIDELINES AND PROCEDURE
1) The EMS Provider must be an active member of a municipal or private EMS agency.
Appropriate clinical attire includes department uniform shirt, name tag, dark slacks
(no jeans) and dark shoes. Clinical participants should arrive prepared with a watch and
stethoscope, to assist with patient care.
2) Prior to participating in a clinical experience the EMS provider must submit the following to
the EMS System Coordinator:
a. copy of current EMS licensure & CPR certification
b. validation of primary EMS system affiliation
c. validation of municipal or private EMS agency affiliation
3) The EMS Provider participating in a clinical experience within the McHenry Western Lake
County EMS System is not considered to be an employee of a system hospital or ride
along agency.
4) Clinical experience must be scheduled in accordance with current system procedure.
Orientation to the clinical facility will be provided upon arrival to the clinical area. The
triage nurse will be responsible for providing an orientation to the emergency
department and the EMS ride along agency will provide an orientation to their operations
for the ride along experiences.
5) Clinical skills performance will be limited to the level of practice designated by licensure.
All clinical skills must be performed under the direct supervision of an emergency
department physician, RN or EMT-P (Patient Care Technician). The emergency
department staff reserves the right to limit involvement in patient care by the EMS
provider.
6) The EMS providers involvement in patient care during the clinical experience must be
documented on the clinical evaluation form and evaluated by the supervising emergency
department physician, RN or EMT-P (Patient Care Technician). It is the expectation that
the EMS providers participating in a clinical experience will maintain confidentiality
regarding all information related to patient treatment and transport situations during this
experience.
CLIN-OOS
IMPL: 3/93; REV: 2/10
COMMUNICABLE DISEASE/INFECTION CONTROL POLICY
POLICY
It is the policy of the McHenry Western Lake County EMS System to prevent and
control communicable diseases. Each EMS system provider should make every
effort to prevent disease transmission to themselves and to our patients. In the
event of a possible exposure to a communicable disease, the McHenry Western
Lake County EMS System will ensure that our EMS system providers are
properly evaluated and treated, or referred for appropriate medical care. This
policy is in concert with the policy set by Centegra Health System in managing
Communicable disease and exposure (IPC 7.1)
DEFINITION
A communicable disease is a disease that may be transmitted either directly or
indirectly from one individual to another. Communicable disease guidelines for
restriction from work are established by the Centers for Disease Control (CDC)
and IDPH. Each EMS agency will maintain a policy regarding illness work
restrictions in accordance with CDC and IDPH guidelines.
PROCEDURE
1. Each EMS agency is to maintain a record of medical illness history and
immunization status for each EMS system provider.
2. EMS system providers must be able demonstrate immunization status or
acquired immunity for the following contagious diseases:
• Measles/Mumps/Rubella – MMR
• Hepatitis B
• Rubeolla
• Tetanus
3. Documentation of annual TB screening is to be maintained by each EMS
agency.
4. Each ambulance must have waterless hand washing products and EPA
approved surface cleaning agents available at all times. A 10% chlorine
bleach solution is an acceptable surface cleaning agent.
5. Hand washing is the most important practice in the control of contagious
disease. All EMS providers are to wash their hands BEFORE and AFTER
providing patient care. A waterless hand sanitizer is an acceptable option
when soap and running water is not immediately available.
6. Appropriate personal protective equipment (PPE) is to be stocked in all
ambulances and EMS response vehicles to include but not be limited to:
non-latex gloves, face masks including N-95 masks, goggles or face
shields and gowns.
7. Each EMS agency is responsible to insure all EMS system participants
are appropriately fitted with respiratory protection in accordance with
OSHA and IDOL guidelines.
8. PPE is to be worn as appropriately indicated in providing patient care.
Gloves should always be worn when there is a risk of contact with blood or
other body fluids. Procedures which risk the aerosolization of respiratory
secretions (suction; CPAP, HHN; invasive airway management) may
indicate the use of protective eyewear and masks. Gowns are to be worn
in situations in which there is risk of exposure by splattering or spraying of
infectious material.
9. When appropriate PPE is to be disposed of in accordance with
appropriate hazardous waste regulations. Re-usable PPE (i.e., SCBA,
protective eyewear) must be cleaned with an appropriate cleaning agent.
Soiled patient clothing and linen should be contained in a Bio Hazard
labeled bag; and transported to the ED with the patient for disposition.
10. N-95 masks are indicated in the treatment and transport of patients with
suspected TB or Acute Febrile Respiratory Illness (influenza). N-95
respiratory protection is sized appropriately for each EMS system
participant through an annual fit-testing process coordinated by each EMS
agency.
11. Use of sharps (needles, glass ampules, lancets) requires extreme caution.
In all cases, needless access systems are to be used when available. In
the situation where a needless access system is not an option, sharps are
to be used with extreme caution and disposed of in an appropriate
puncture proof Bio Hazard container.
12. Disposable equipment is to be used in providing patient care when
possible. Re-usable equipment (laryngoscope handles/blades, ECG
monitors, BP cuffs, etc) must be cleaned in accordance with manufacturer
and CDC/OSHA guidelines, utilizing an appropriate disinfecting agent.
13. CPR should be performed utilizing appropriate PPE in providing airway
support. Unprotected mouth-to-mouth ventilation is to be avoided.
14. All communicable disease exposures which occur in the delivery of patient
care are to be reported upon arrival to the ED to the ED physician/charge
RN.
15. The involved EMS provider(s) are to complete a Blood/Body Substance
Exposure form describing the nature of the exposure.
16. The ED physician will evaluate the EMS provider and the significance of
the exposure. If indicated the ED Physician will consult with the Infection
Control Preventionist (ICP) to determine if an actual communicable
disease exposure has occurred. The need for treatment will be
coordinated with Pharmacy to determine the appropriate treatment
protocol.
17. In the event that a communicable disease exposure is determined to have
occurred following the admission of the patient to the hospital. The ICP
will contact the EMS System Coordinator to identify the EMS responders
involved and the treatment protocol required. The EMS System
Coordinator will then notify the EMS agency of the communicable disease
exposure to determine specific individuals involved in the treatment and
transport of the patient and provide direction for the individuals involved in
acquiring follow up treatment.
18. The EMS System Coordinator will provide the names of the individuals
involved to the ICP for follow up in access to treatment.
19. Any exposure of blood or body fluids to the mucus membranes of the eyes
or mouth would indicate immediate irrigation with normal saline or water
and then follow up evaluation by the ED physician.
20. The use of manikins during the instruction of CPR to either EMS providers
or the general public necessitates the follow up cleaning of all equipment
in accordance with manufacturer guidance and AHA policy.
INFECTION CONTROL
IMPL: 2/78; REV: 2/10
BLOOD/BODY SUBSTANCE EXPOSURE FORM
This form is to be completed by a prehospital provider when he/she comes into direct contact with
blood or body fluids (including but not limited to emesis, urine, stool, sputum). The forms are four
part, no carbon, color coded to match the run sheets. The fourth copy (gold) is to be sent to the
Infection Control Department at the receiving facility. When it has been determined by the
receiving facility that a patient is infected with a disease reportable to squad members as identified
by the Illinois Department of Public Health, the receiving facility must notify the squad either directly
or indirectly thru the EMS Office.
DATE_____________________________________________________________
INCIDENT #________________________________________________________
PATIENT NAME_____________________________________________________
DEPARTMENT_____________________________________________________
CONTACT PERSON________________________________________________
PHONE #(S)_______________________________________________________
SQUAD MEMBERS-Exposed
NAME (PRINT)
ID#
_________________________
_________________________
_________________________
_________________________
_________________________
TYPE OF CONTACT
___________ _____________________
___________ _____________________
___________ _____________________
___________ _____________________
___________ _____________________
Describe how exposure occurred:_________________________________________________
____________________________________________________________________________
____________________________________________________________________________
Were protective barriers in place:
Gloves ___
Gown ___
Mask ___
Eyewear ___
EMERGENCY DEPARTMENT
PHYSICIAN NOTIFIED: __________________________________________________________
M.D. Signature
Date Time
____________________________________________________________________________
Laboratory Test Ordered
BLOOD EXPOSURE FORM
IMPL: 11/87; REV: 2/10
Distribution of copies: White: Medical Records, Yellow:Ambulance,
Pink: EMS Department, Gold: Infection Control
COMMUNICATION OF PROCEDURAL UPDATES
POLICY
It shall be the policy of the McHenry Western Lake County EMS System, to maintain an
open channel of communications between the EMS Office and the System providers.
PROCEDURE
1. An EMS Council has been established for the purpose of regular meetings between
EMS Agency representatives, known as EMS Coordinator and the EMS
System Staff. The council is chaired by a member elected from the representing
EMS Coordinators. All Provider Agencies affiliated with the system must identify
a EMS Coordinator representative to participate on the EMS Council.
2. EMS Council meetings are schedule bimonthly. Minutes are recorded and
maintained by the EMS Secretary at the Resource Hospital. Meeting minutes are
archived electronically on the system website. Meeting notices and agendas are
distributed from the Resource Hospital in electronic format.
3. The EMS Council provides a format for open discussion of EMS issues related to
policy and procedural changes, QI activity and results, educational needs,
Regional EMS communications, and issues related to System Emergency
Department operations.
4. Proposed changes to the System equipment inventory, policies and procedures are
first communicated to the EMS Council. The EMS Coordinators are expected
to communicate this information to their providers.
5. Any change in System policy or procedure which directly impacts patient care
practices is provided to each EMS provider through mandatory inservices, which
may include: lecture, demonstration lab, newsletter with post-test, or direct mail of
policy/procedure updates, with an attached return sign-off.
6. System manual amendments are distributed to the EMS Coordinators via electronic
distribution and file reference hosted on the EMS System website. EMS providers
applying for System Entry received System manuals upon providing required
credentials to the EMS Office.
COMMUNICATION UPDATES
IMPL: 12/97; REV: 2/10
CONFIDENTIALITY/RELEASE OF INFORMATION
POLICY
It shall be the policy of the McHenry Western Lake County EMS System to comply with
State and Federal laws regarding patient privacy and release of confidential medical
information.
1.
The run report is a part of the patient's medical record. A copy must be left with
the receiving facility.
2.
The medical record is the property of the hospital/clinic/facility agency providing
the treatment to the patient. The information contained within the medical record
is the property of the patient and cannot be released to individuals, not otherwise
authorized, without the written authorization of the patient, a subpoena, court
order or statute. Disclosure logs will be maintained in accordance with state and
federal law for each record release.
3.
Protected health information (PHI) is defined as any information that identifies an
individual patient and is maintained or transmitted in any form (electronic,
telephonic, oral, and written). PHI is commonly communicated during treatment,
examination, observation, and conversations during a transport. PHI may only
be disclosed for the purpose of providing patient medical care in the course of
treatment, payment or healthcare operations.
a)
Confirmation of receipt to the appropriate recipient for a transmission
of EMS patient information via fax or email is required to insure
protection. Use of the fax transmission creates a higher risk of
breach.
b)
Portable electronic devices containing electronic patient information
(laptops, flash drives) must be maintained in a secure environment.
c)
Email transmissions of PHI are to be encrypted to insure
confidentiality during the transmission process.
4.
Patient privacy shall not be violated by any system participant. Under
appropriate circumstances, general information may be released to public
inquiry from the media or law enforcement officials, in compliance with federal
and state laws. A statement may be made to identify the general condition of
the patient and confirm transport to a hospital emergency department for
treatment. (Sample: “Two adult patients were transported to a local hospital in
fair condition”). Condition reports are limited to the following definitions:
Undetermined – Patient is awaiting further evaluation by physician/ED
team in order to determine extent of illness/injury.
5.
Good – Vital signs are stable and within normal limits. Patient is conscious
and comfortable. Indicators are excellent.
Fair – Vital signs are stable and within normal limits. Patient is conscious,
but may be uncomfortable. Indicators are favorable.
Serious – Vital signs are unstable and not within normal limits. Patient is
acutely ill/injured. Indicators are questionable.
Critical – Vital signs are unstable and not within normal limits. Patient is
acutely ill/injured and may be unconscious. Indicators are unfavorable.
Communications between EMS providers and hospital staff must not violate
patient’s privacy in any manner. In order to assure this, the patient's name is
NOT to be used in MERCI radio transmissions. With patient permission, it may
be used during telemetry or cellular phone transmission for the purpose of
obtaining hospital records.
6.
Discussion of EMS patient care amongst EMS providers, EMS students,
instructors, and other members of the EMS System must not violate patient’s
right to privacy. To ensure that the patient's rights are not violated, no
discussion should occur that is beyond the purpose of treatment, operations,
quality improvement, performance, and education. Any discussion must be
conducted in such a manner as to provide a secure environment, which
eliminates the risk of inadvertent disclosure to those parties not involved in the
purpose of the information sharing.
7.
EMS providers may make requests for information regarding patient’s follow-up
condition for the purpose of operations, performance, quality improvement and
education. All requests must be made by the EMS provider involved in
providing the patient’s prehospital treatment. Follow-up condition requests are
to be directed to the EMS System Coordinator or Associate EMS
Coordinator. Under no circumstances should the EMS provider make direct
contact with the receiving ED staff for information regarding patient condition
reports after transport.
8.
All requests for copies of the EMS Run record are to be routed to the EMS
Office at CHM or to the responding EMS agency and disseminated in
accordance with system policy on release of patient information. (see #2).
9.
All subpoena requests should be communicated between the EMS Office at
CHM and the responding EMS Agency, to include the date of the incident, the
assigned electronic record number, and the party requesting the records copy.
10.
A subpoena request for EMS patient records required by an attorney is not
sufficient to release the medical record/PHI, without signed authorization from
the patient or a court order requiring production of the document, which includes
the following language:
•
•
11.
The parties will not use or disclose the medical record for any purpose other
than the litigation or proceeding for which the information was requested
The parties will return or destroy all copies of the medical record at the end
of the litigation or proceeding.
Violations of the patient’s privacy are to be reported on the OPPORTUNITY TO
IMPROVE form. Violations of patient’s privacy may be subject to disciplinary
actions and litigation.
CONFIDRELEASE
IMPL: 2/80; REV: 2/10
CONSENT FOR TREATMENT
POLICY
It shall be the policy of the McHenry Western Lake County EMS System that System
Providers respond 24 hours per day, without unlawful discrimination. They will provide
emergency service without regard to the patient's ability to pay and they must treat and/or
transport patients as appropriate to the situation, the EMS ACT, IDPH Rules and
Regulations, the EMS System Policies and Procedures and the local provider bylaws,
policies or ordinances. To accomplish this policy, the following guidelines and procedures
MUST be followed.
1. All patients must consent to treatment. The consent must be informed. In order to
comply, the patient may verbally agree to treatment, may by gesture indicate
his/her desire for treatment or upon the provider informing the patient of the
desired treatment, the patient's lack of refusal may be taken as consent.
2. A minor patient may consent/refuse treatment if he/she is:
a. emancipated by legal decree
b. pregnant at the time treatment is rendered
c. 12 years of age or older, requesting treatment for sexual assault/abuse, a
sexually transmitted disease, alcohol or drug abuse or limited outpatient mental
health counseling
d. a member of the U.S. Armed Forces
e. 16 years of age or older presenting with a psychiatric emergency
3. Patients who are unconscious or otherwise so incapacitated that they cannot
comply with the above provisions, will be treated under the doctrine of implied
consent.
4. Patients who are minors, other than defined in #2, should have the consent of the
parent or guardian obtained prior to treatment/transport. However, time should not
be wasted obtaining consent where the parent or guardian is not immediately
available and the minor is obviously in need of medical treatment. Minor's may not
refuse treatment, and therefore must be transported to the hospital. Should the
child appear uninjured, and with the consent of the Physician in charge of the run,
and as long as other patients are not jeopardized, the responding EMS provider
may wait until a parent or guardian arrives at the scene for formal refusal of
treatment.
5. Patients who are obviously intoxicated, suffering from obvious mental illness,
suicidal or potentially so, homicidal or potentially so, under the influence of
drugs, or otherwise incapacitated such that they do not exhibit the ability to make
sound judgements, are to be treated as though they implied consent. They are
not allowed to refuse treatment.
6. In all cases where question arises regarding the patient's consent for medical
treatment, it is imperative that the EMS providers contact medical control and
provide treatment according to system medical direction.
CONSENT
IMPL: 8/95; REV: 2/10
CONTINUING EDUCATION – EMT/PHRN
POLICY
A.
The Illinois Department of Public Health (IDPH), Division of EMS, published
Rules and Regulations stipulating that an EMT (A/B, I/D or P) and/or
Prehospital RN (PHRN) must complete 120 hours (h) of continuing
education (CE), addressing both adult and pediatric care in each fouryear licensure cycle, earned in accordance with Region IX and their EMS
System's policies.
B.
EMTs/PHRNs are ultimately responsible to complete state and systemrequired CE.
C.
EMTs and PHRNs within the MWLCEMS System are required to
complete all mandatory CE offerings as identified.
D.
Although CE records are kept at system hospitals, each EMT/PHRN is
responsible for keeping their own records and maintaining a copy of time
accrued to compare with any record kept by the System or by their
employer.
E.
Any CE approved by another System's EMS Medical Director will be
accepted as long as the content is based on topics or materials from the
National EMS Education Standards. Approval of other continuing education
will be determined on an individual content or site code approval.
F.
Clinical CE may be awarded as per System policies- must demonstrate
evaluation by preceptor in hospital or pre-hospital setting.
G.
No more than 25% of the hours accrued by one individual towards
relicensure may be in the same subject or delivery format- ie; self study; online; clinical, etc.
OPTIONS FOR OBTAINING CE HOURS
DIDACTIC
HOURS
DOCUMENTATION
ACLS, PALS, APLS, ITLS, PHTLS,
ATLS, PEARS
Initial certification and re-recognition
Hour-for-hour, up to 16 hours.
Copy of course certificate/card
indicating successful completion,
hours of attendance, date and sponsor
of course.
ACLS, PALS, APLS, ITLS, PHTLS,
ATLS, PEARS
Instructor
Hour-for-hour, up to 16.
Copy of course certificate/card,
indicating hours of attendance, date
and sponsor of course.
DIDACTIC
HOURS
DOCUMENTATION
CPR completion card that covers adult
one-rescuer, adult foreign body airway
obstruction management, pediatric
one- rescuer CPR, pediatric foreign
body airway obstruction management,
and adult two- rescuer CPR.
Up to 2 hours per year.
Copy of American Heart Association
Healthcare Provider CPR Card or
American Red Cross Professional
Rescuer Card.
CPR
Instructor
Hour-for-hour, up to a maximum of 5
hours per year.
Course roster or other equivalent proof
of teaching experience
1.
2.
3.
Hour-for-hour, up to 5 hours in a 2
year period.
Copy of Course and attendance
certificate indicating date, course,
hours and sponsor or instructor of
course.
Hazardous Materials Course
An 8 hour/one time credit.
Verification of attendance and dates.
Hazardous Materials Refresher
Course
4 hours.
Helicopter Safety Class
2 hours per year.
Dive/Trench/Rope Rescue Class
2 hours. per year
Mass Casualty Drill
4 hours per year
Auto Extrication Class
4 hours per year
Outside Seminars
Subject to system approval.
Attach copy of certificate.
Advanced Education
Nursing classes
PA classes
Other, per system
Subject to system approval. Content
may or may not qualify. College credit
earned may = x 2 hours for CE credit
Verification of attendance and dates,
i.e., copy of report card or grade
transcript.
Paramedic Instruction (EMTP)
Hour-for-hour for each subject area.
Verification from Course Coordinator
EMTB Instruction (EMTB
Hour for hour for each subject area
EMT/B/First Responder Instruction
5 hours annually (EMTP or EMTB)
CPR Instructor Certification
CPR Instructor Trainer
CPR Instructor Update
Reference: EMS Rules Sections 515.560, 515.570 and 515.580
CONT.EDUC.
IMPL: 3/80; REV: 2/10
CORONER NOTIFICATION
POLICY
It shall be the policy of the McHenry Western Lake County EMS System to work
cooperatively with the Medical Examiner/Coroner Office in response to a fatality due to
trauma or medical illness, indicating a need for further evaluation – i.e., homicide, suicide,
physical abuse/neglect, or other crime scene, accidental death, sudden death without
medical history, poisoning or overdose by drugs or alcohol.
PROCEDURE
1. In cases where EMS providers arrive upon the scene of a pulseless, nonbreathing
patient who demonstrates obvious death:
a. rigor without profound hypothermia;
b. post mortem lividity;
c. decapitation or other severe trauma in which performance of CPR is not
possible;
d. evidence of a valid DNR order.
The responding EMS Agency or law enforcement agency must contact the
appropriate Medical Examiner/Coroner Office.
2. The patient assessment is to be communicated to the base hospital via telemetry
radio/cell phone and documented on the EMS run report. An ECG strip validating
asystole should be obtained as confirmation of death.
3. Once the Medical Examiner/Coroner has been notified, it is necessary to follow
his/her instructions regarding the disposition of the deceased. The EMS providers
may be cleared from the scene, leaving the law enforcement officer present in
charge of the body. However, when no such official is present, the responsibility
for the body remains with the EMS agency present.
CORONER
IMPL: 8/95; REV: 2/10
DATA COLLECTION AND EVALUATION
POLICY
It shall be the Policy of the McHenry Western Lake County EMS System that data
shall be collected for all responses by System Agencies and that such data shall be
analyzed by the Resource Hospital for the purposes of Quality Assurance, research
and required reporting to IDPH.
1. The patient care report, approved by the Resource Hospital, shall be
completed for all patient contacts within the EMS System. The report shall
include all pertinent patient information, assessment findings and treatment.
It must be completed immediately following the run, according to the
"System" guidelines. Refusals shall be completed at the scene with radio
transmission completed prior to the EMS Service or the patient leaving the
scene. Appropriate abbreviations may be utilized by those completing
the reports. The report must be signed and must include all providers who
transported the patient.
2. A copy of the patient care report shall be left with the receiving facility as it
becomes a part of the patient's medical records. In the event the patient
has refused treatment, the EMS Agency shall retain the original and send a
copy to the EMS Office.
3. All patient care reports will be stored electronically with access by the EMS
System, EMS Agency and receiving hospital.
4. Data reports provided to the EMS System by IDPH will be shared with the
system, as well as individual provider agencies within the system.
DATACOLLECT
IMPL: 8/95; REV: 2/10
DIRECT ADMISSION OF BEHAVIORAL HEALTH PATIENTS
WITHIN THE CENTEGRA BEHAVIORAL HEALTH PROGRAM
POLICY
in cooperation with area crisis counselors and psychiatrists to provide for the
disposition of the patient who presents with a behavioral emergency without the
complication of medical illness or injury, to be admitted directly for inpatient
behavioral health services, without evaluation in the Emergency Department.
The decision regarding direct admit to an inpatient unit will rest between the
treating psychiatrist and the emergency medical physician providing medical
control.
PROCEDURE
Upon identification of the patient in need of behavioral health admission via EMS
transport the following communications must occur:
1. The psychiatrist will make contact with the inpatient behavioral health unit
to arrange direct admission.
2. The psychiatrist will consult with the ED physician providing EMS medical
direction regarding the decision for direct admission, without evaluation in
the Emergency Department.
3. The referring behavioral health service will provide appropriate
documentation of need for admission to EMS providers, to accompany the
patient for transfer. The Behavioral Health clinician caring for the patient
will provide EMS with a report on the patient’s condition prior to transfer.
4. The transporting EMS unit will validate the authorization for direct admit
with the Emergency Department, and provide a patient report of EMS
assessment findings.
5. The ED will communicate to the admitting unit or Centegra Specialty
Hospital South Street-Central Intake (M-F 9am-5pm) updated report
findings and the anticipated time of arrival of the patient.
6. The EMS unit staff will complete documentation of the transfer in
accordance with System procedure for documentation.
7. The admitting behavioral health unit will anticipate the arrival of the
patient, to facilitate transfer of care from EMS upon arrival at the inpatient
unit.
DIRECT ADMIT-BEHAV.
IMPL: 6/05; REV: 2/10
EMS DISTRIBUTION OF PHARMACY PROPHYLAXIS
(SNS SUPPORT IN DISASTER SITUATIONS)
POLICY
participate in support of disaster relief efforts when called upon by the local
health department. It is recognized that in certain situations, distribution of mass
prophylaxis for contagious disease will be necessary to first responder
populations, in addition to the general population. In accordance with the plan
developed by the local health department, the MWLCEMS System will support
the role of the EMT-P/PHRN as a facilitator in distributing prophylaxis agents to
fellow responders in Fire, EMS and Law Enforcement and their immediate family
members.
PROCEDURE
1. The Governor of the State of Illinois declares a disaster state, and the
Strategic National Stockpile for specific prophylaxis has been requested
by the IDPH Medical Director for delivery to the local health department.
2. The local health department will make contact to the MWLCEMS System
Medical Director/Coordinator regarding the implementation of the mass
prophylaxis plan including distribution to first responders via EMS
providers.
3. The local health department will make contact to the MWLCEMS System
Fire/EMS agencies in requesting an EMTP/PHRN representative to report
to a predetermined distribution site to acquire a prophylaxis supply to
support first responders in their community.
4. The EMS System will recognize the “just in time” training provided by the
local health department to the EMTP/PHRN representative to include
• indications/contraindications, actions, dosing instructions and
potential side effects of the prophylaxis medication;
• documentation requirements of distribution to the first responder;
• resources for first responder follow up.
5. It will be the responsibility of the local health department to provide
support materials for the EMTP/PHRN representatives. (dosing
algorithms, documentation forms, etc).
6. The EMS providers may utilize the medical resources for physician
consultation provided either by the local health department or the System
medical control hospital when screening questions arise during the
dispensing process.
7. The local health department will make notification to the MWLCEMS
System Medical Director/Coordinator when the prophylaxis distribution
has been completed or if there are any concerns related to the EMS
provider distribution involvement.
FIRST RESP.PROPHYL
IMPL: 10/05; REV: 2/10
DUAL SYSTEM PARTICIPATION - EMT/PHRN/ECRN
POLICY
It shall be the policy of the McHenry Western Lake County EMS System to allow state
licensed EMT/PHRN/ECRN who function primarily within another system, to maintain dual
system recognition within the McHenry "System" provided they have met the requirements
listed below for system entry. They must also be a member of a "System" provider agency
and provide documentation to that effect.
It shall also be policy that EMT-Paramedic/PHRN/ECRN function with primary status where
they work full-time and secondary status where they work part-time or paid-on-call.
However, an EMT-Paramedic/PHRN/ECRN who was originally trained, licensed and
functions within the McHenry System, may under exceptional circumstances maintain
primary status within the McHenry System.
1. EMT/PHRN/ECRN who are primary with the McHenry "System" and choose to
maintain secondary status outside the McHenry System, must designate
their choice for primary status in writing to the EMS Office.
2. Paramedics/PHRN who maintain a secondary system outside the McHenry System,
and are recognized to perform advanced procedures within that
secondary system, must submit documentation of the training and testing verifying
their skill proficiency, which meets or exceeds the training requirements as
identified by the McHenry System. (See Advanced Procedure Policy)
3. Paramedic/PHRN/ECRN who were trained by the McHenry "System" will remain
eligible for entrance or re-entrance at all times provided they submit documentation:
a.
b.
c.
d.
e.
Validation of good standing from their primary EMS system
Current IDPH licensure
Current CPR for Healthcare Providers
Affiliation with system provider agency
Successful completion of "Protocol Review" with a minimal score of 80%
4. Paramedic/PHRN utilizing the McHenry "System" as secondary must annually
submit a form to the EMS Office indicating that they are current within their primary
system. This form will be mailed to the paramedic/PHRN and must be completed
by the primary system EMS Coordinator and/or EMS Medical Director. Following
state licensure, the paramedic/PHRN must also submit a copy of his/her current
licensure.
5. All EMT/PHRN/ECRN utilizing the McHenry "System" as secondary may be
required to complete mandatory system continuing education which involves policy
or protocol changes. They may also be required to participate in an annual skill
update to maintain System practice privileges.
DUAL SYSTEM PARTICIPATION
IMPL: 1/98; REV: 2/10
ECRN RECIPROCITY
POLICY
It shall be the policy of the McHenry Western Lake County EMS System to recognize the
credentialing process of ECRN's approved by another EMS System.
1. ECRN’s recognized in another EMS System may be approved within the McHenry
Western Lake County EMS System provided they submit:
a. copy of current IDPH ECRN License and Illinois RN license;
b. documentation/certificates or evidence of good standing as an ECRN
from their primary EMS System;
c. evidence of current ACLS, PALS, CPR for Healthcare Provider and
TNS/TNCC or ITLS Advanced;
d. complete the System Protocol Update Exam with a minimum score of
80%;
e. precepted evaluations of 9 EMS radio calls (minimum) following a radio
operation orientation;
f. documentation of 8 hours of EMS ride along/prehospital field experience
with a system ALS provider/agency, as approved by the EMS System
Coordinator/Associate EMS Coordinator.
ECRNRECI
IMPL: 3/97; REV: 2/10
ECRN RECOGNITION
POLICY
It shall be the policy of the McHenry Western Lake County EMS System that
voice medical control will be provided by Emergency Department RN’s who
achieve IDPH recognition as an Emergency Communications Registered Nurse
(ECRN).
REQUIREMENTS
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
Successful completion of IDPH approved ECRN Course
Demonstrate current training of BLS healthcare provider CPR
Demonstrate current Illinois RN licensure
Demonstrate current recognition as an ACLS and PALS provider
Demonstrate current recognition in the prehospital management of
trauma patient i.e., ITLS-Advanced, PHTLS, TNCC or TNS;
Complete an 8-hour ride along experience with a system ALS
provider agency as approved by the EMS System coordinator/Associate
Coordinator;
Complete a precepted radio operations orientation, documenting a
minimum of 9 evaluated radio reports;
Complete an IDPH Child Support Statement;
Upon completion of the above, application will be made to IDPH for
ECRN licensure;
Once ECRN licensure is completed, the individual ECRN is
responsible for notifying the EMS System of all address or name
changes within 30 days of such change
ANNUAL RERECOGNITION REQUIREMENTS
1.
2.
Evidence of current BLS healthcare provider CPR
Documentation of 8 hours EMS ride along experience with a system
ALS agency with initial System entry and then during the first 2 years
of System recognition. (total 3 ride along experiences)
3. Participate in EMS System continuing education updates offered with
successful completion of the written quizzes. (Minimum passing score
of 80%).
4. Maintain current documentation of ACLS, PALS and TNS or ITLSAdvanced/PHTLS training
5. Participate in EMS System protocol updates as required
ECRNRECOG
IMPL: 3/97; REV: 2/10
ECRN – EMERGENCY COMMUNICATION REGISTERED NURSE
AND ED PHYSICIAN
EMS DUTIES & RESPONSIBILITIES
POLICY
It shall be the policy of the McHenry Western Lake County Emergency Medical Services
(EMS) System that voice orders to prehospital and interhospital emergency care
personnel must be given by the EMS Medical Director (MD) or his/her designee who must
be either a licensed physician or a Emergency Communications RN (ECRN).
Approval and review of the Emergency Department (ED) Physicians and ECRN’s shall be
the responsibility of the EMS MD as outlined below. ECRN’s may give orders for ALS
patient care according to System Standard Operating Protocols (SOP), however, such
orders should have concurrent ED physician approval.
DEFINITION
To establish guidelines for ECRN’s and physician’s in providing voice order to
prehospital and interhospital providers.
SCOPE
ED ECRN
ED Physicians
ACTION STEPS
A. ECRN
1. An ECRN is a Registered Professional Nurse, licensed under the “Illinois Nursing
Act” who has successfully met the requirements listed below:
a. Attends an ECRN course approved by the Illinois Department of Public Health
(IDPH);
b. Completes a course in advanced cardiac life support (ACLS) and pediatric
advanced life support (PALS) as approved by the EMS MD and in
accordance with the American Heart Association (AHA) Standards.
c. Completes a trauma support course as approved by the EMS MD:
• Trauma Nurse Specialist (TNS)
• International Trauma Life Support (ITLS)
• Prehospital Trauma Life Support (PHTLS) or
• Trauma Nurse Core Curriculum (TNCC);
d. Participates in an orientation session including hands-on operation of the ED
telemetry system;
• Passes a written system protocol exam with an 80% or better;
• Acquires eight (8) hours of ride time yearly for the first three (3), with an area
prehospital ALS provider.
2. Upon completion, the ECRN will be eligible for IDPH licensure.
3. A list of current ECRN’s shall be maintained in the CHM EMS Office. The EMS MD
shall submit these names of approved ECRN’s to the Illinois Dept. of Public Health
and shall inform the Department of any changes in the status of approved ECRN’s.
4. ECRN’s who have been approved in another EMS System may be granted
reciprocity provided they submit documentation of their approval and complete
requirements for orientation to telemetry units and pass written examination with
80% or better.
5. ECRN licensure renewal will be facilitated by the EMS Medical Director in
accordance with IDPH requirements.
6. ECRN Duties:
a. Be thoroughly familiar with the SOPs established and procedures to be
followed when monitoring telemetry transmission. This includes competence
in cardiac dysrhythmia recognition and treatment, cardiopulmonary
resuscitation (CPR) procedures and use of radio telemetry equipment.
b. Provide voice medical control to EMS System prehospital providers in
accordance with approved EMS System Policy and Procedures. This includes
intravenous (IV) fluid administration, EMS medications, cardiac electrical
therapies and advanced airway management as indicated by patient
assessment findings. Patient treatment decisions are to be made with
concurrent communication to the ED Physician on duty.
c. Operation of EMS Communication Equipment (included in each facilities
orientation).
1. To communicate patient report findings and obtain medical control for
prehospital treatment, EMS Agencies may contact the ED via:
• MERCI radio on either MERCI 400 or MERCI 340
MERCI communication is limited to BLS reports or request for a (radio
telemetry) MED channel.
• Phone Line
815/385-9080 at CHM (alternate contact 815/385-9081)
815/338-6521at CHW (alternate contact 815/338-2025)
• Telemetry MED channels
MED 7/8 has been assigned to CHM - MED 7 is primary
MED 5/6 has been assigned to CHW - MED 5 is primary
2. ALS reports should be communicated via radio telemetry or phone line.
3. Report should include:
• EMS Agency unit responding
• Patient-age, gender and chief complaint
Blood pressure (BP)
Pulse rate
Respiratory rate
Pulse Oximetry
ECG findings if applicable (including 12 Lead findings when
appropriate
• Physical Assessment findings including pertinent negative findings
• Pertinent Medical History including current medications and allergies
• Treatments initiated; i.e., IV fluids, medications, airway interventions
• Estimated Time of Arrival (ETA) to destination
4. The ECRN should be in communication with the ED Physician regarding
reported assessment findings, treatments initiated and additional
treatments ordered.
5. The radio report/medical control orders are recorded in voice record by
the radio equipment and documented on the Radio Report form. This
provides a permanent record. The voice recordings are maintained by
the EMS System Coordinator at the Resource Hospital. The Radio
Report form is attached to the ED record when the patient is admitted to
the ED at CHM or CHW. All other Radio Reports are stored by the EMS
System Coordinator at the Resource Hospital or Associate Hospital.
6. The Radio Report form includes documentation:
• Date of run/time report initiated/EMS Unit responding
• Type of contact – MERCI/ Phone/ MED Channel
• ED Physician providing medical direction
• ECRN providing voice medical orders
• Patient assessment findings reported
• Medical history, patient medications, allergies
• Treatment initiated
• Physician orders
• Destination facility and ETA
B. Physicians
1. ED physicians who will be giving voice orders must be approved by the EMS MD.
The EMS MD may use his/her discretion in choosing the means by which he/she
determines physician’s knowledge of the EMS system protocol.
2. ED Physician performance should be reviewed at least annually.
3. A list of approved ED physicians will be maintained in the CHM EMS office and
updated as needed.
4. Attending ED Physician’s Duties:
a. Familiarize themselves with the recognition and appropriate treatment of cardiac
arrhythmias per EMS System Protocol.
b. Familiarize themselves with the operation of the radio telemetry equipment and
simple voice communication procedure.
c. Be familiar with the scope and depth of training of the personnel operating in the
prehospital setting.
d. Insure they are completely competent in CPR procedures and capable of
directing field personnel in the performance of CPR and ACLS interventions.
ECRNMD RESP
IMPL: 1/98; REV: 2/10
EDUCATIONAL CURRICULUMS
The McHenry Western Lake County EMS System, in agreement with MCC, offers EMS
Training accredited by the Illinois Community College Board for academic recognition as
an Occupational Certificate in EMT-Basic or EMT-Paramedic; or an Associate Degree in
Applied Science-EMS.
The McHenry Western Lake County EMS System, provides EMS training in accordance
with the National Education Standards and IDPH for the following levels of EMS
recognition:
-
First Responder (Emergency Medical Responder-EMR)
Emergency Medical Dispatcher (EMD) – (non-credit)
EMT-Basic (EMT-B)
EMT-Paramedic (EMT-P)
Emergency Communications RN (ECRN) – (non-credit)
Prehospital RN (PHRN) – (non-credit)
EDUCCURR
IMPL: 5/98; REV: 2/10
EMERGENCY MEDICAL DISPATCH AGENCY AFFILIATION
POLICY
recognize and provide medical oversight for Dispatch Agencies within the
geographic boundaries of the System who provide 911 access/dispatch for
System EMS response agencies.
PROCEDURE
1. The Emergency Medical Dispatch Agency must associate through
submission of an EMD Agency plan to participate in the McHenry Western
Lake County EMS System.
2. The EMD Agency Plan must include:
•
•
•
•
•
Name and Address of the agency (PSAP locations)
Agreement to provide EMS pre-arrival Instruction to all 911 EMS
callers using a format approved by the EMS System Medical
Director
Current information for all EMD personnel affiliated with the agency
to include-name, address, IDPH certification number; phone
contact and e-mail (if available)
Quality Improvement plan to address EMD compliance with PreArrival Instruction protocol, performance review of EMD personnel;
and accessibility to CQI reports upon request of the EMS System or
IDPH
Education Plan approved by the EMS System to insure access to
appropriate continuing education for all EMD’s to meet the
educational requirements for IDPH certification renewal.
3. The McHenry Western Lake County EMS System will provide medical
direction and oversight in approving EMD Pre-arrival Instructions; CQI
program development, Emergency Medical Dispatch Training and EMD
continuing education.
4. The Agency EMD Plan will be incorporated into the EMS System Plan
recorded with the Illinois Department of Public Health – Division of EMS.
It shall be subject to all rules and regulations as outlined within the EMS
Administrative Code 515.000
EMDAFFILIATION
IMPL: 5/09; REV: 2/10
EMERGENCY MEDICAL DISPATCH RECOGNITION/RENEWAL
POLICY
recognize personnel affiliated with area 911 Dispatch Agencies identified in the
System Plan as participants in the role of Emergency Medical Dispatcher (EMD)
with proof of IDPH certification or equivalent training approved by IDPH for
certification eligibility.
ACTION STEPS
1. The McHenry Western Lake County EMS System will provide oversight
and coordination in the offering of IDPH approved EMD training and
continuing education programming.
2. Eligibility for certification renewal beyond the initial certification period will
require the EMD to provide documentation of 48 hours of approved CE
acquired within the 4 year certification period.
3. The renewal process will involve submission of the following to the EMS
System Coordinator within 30 days of the identified certification lapse date
issued by IDPH:
• Documentation of 48 hours of approved EMD CE ( accrued 12
hours annually)
• Completion of the IDPH renewal form including the Child Support
Statement signed and dated.
4. It shall be the responsibility of the EMD to maintain current information
with the EMS System regarding contact data (name, address, phone, and
email, if available). The EMS System Coordinator will update IDPH of any
changes to the data currently noted in the state licensure data base.
EMD RECOGNITION
IMPL: 5/09; REV: 2/10
EMS PROVIDER RECOGNITION
POLICY
It shall be the policy of the McHenry Western Lake County EMS System to recognize
Paramedic/PHRN/EMT-Basic candidates licensed in the State of Illinois for affiliation
with a system provider, upon completion of the requirements listed below.
1. Demonstrate proof of Illinois EMS licensure and current BLS Healthcare Provider
CPR.
2. Provide validation of good standing from former or primary EMS system. (If newly
licensed, provide validation of evaluation from EMS training center.)
3. If affiliated with a system agency, provide documentation of such which indicates
membership; or approval for "ride-along" privileges or educational sponsorship.
PARAMEDIC/PREHOSPITAL RN
4. Successful completion of System Protocol Review with a minimum score of 80%,
and interview with the EMS Medical Director.
5. The Paramedic/PHRN will be considered probationary within the system for a
minimum of 3 months. The probationary Paramedic/PHRN must function with
another Paramedic/PHRN, of the same licensure status, who has been
recognized by the system for a minimum of 1 year.
6. The Paramedic/PHRN provider may be requested to document clinical
proficiencies via precepted evaluations of the management of ALS patients,
during the 3 month probationary period. Advanced EMS skills may be practiced
following completion of # 1, 2, 3, & 4.
7. Performance progress will be communicated from the EMS Agency
administration to the EMS System Coordinator/Associate Coordinator. When
remediation is indicated, a specific plan for improvement and re-evaluation will
be developed. An extension of the 3 month probation may be indicated based
on individual performance.
8. Upon completion of all requirements listed above, the Paramedic/PHRN will be
recognized as a "System" provider.
PROVIDER RECOGNITION
IMPL: 3/80; REV: 2/10
EMS PROVIDERS CONVICTED OF A FELONY CRIME
POLICY
The McHenry Western Lake County EMS System recognizes its responsibility to promote
professionalism in the delivery of EMS prehospital patient care in a manner which
demonstrates competency and a commitment to maintaining public safety. Therefore, in
conjunction with IDPH, the EMS System will not tolerate conduct unbecoming an EMS
provider, specifically a conviction of a felony crime.
GUIDELINES
1. A system provider accused of involvement in a felony crime may be suspended
from EMS practice within the McHenry Western Lake County, in accordance with
IDPH Rules and Regulations and System Policy.
2. The involved EMS provider will be afforded due process through local or state
review board as indicated by System Policy.
3. Upon notification of the EMS providers' conviction of a felony crime, the EMS
Medical Director/EMS System Coordinator will notify IDPH. Licensure status will
be determined in accordance with IDPH Rules and Regulations.
4. EMS System provider agencies are encouraged to complete meaningful
background checks on new applicants. In the event the background check
discloses a previous felony conviction, the EMS Provider agency is encouraged to
disclose this information to the EMS System as a component to system entry.
The EMS Medical Director will evaluate the situation as it relates to competency
and the delivery of safe patient care, in an effort to determine system recognition.
5. Felony convictions which may prohibit EMS System recognition and practice
including:
a. Rape, child abuse or crimes against a patient
b. Crimes of violence, drug trafficking or use, sexual misconduct or serious
Crimes against property.
6. In all cases, system recognition will take consideration of such factors as:
seriousness of the crime, nature of the crime, length of time since the crime
occurred and the applicant's conduct since the conviction.
FELONY
IMPL: 1/98; REV: 2/10
EMS UNIT STAFFING REQUIREMENTS
POLICY
It shall be the policy of the McHenry Western Lake County EMS System, that all EMS units
responding for the purpose of providing prehospital patient care must be staffed with
the minimum of two (2) Illinois licensed EMT/PHRN/MD system providers, as defined by
the Illinois EMS Act and the Rules and Regulations, in order to provide the patient with
optimal patient care.
1. All recognized ALS response units must be staffed with a minimum of one (1)
licensed EMT-P/PHRN and one (1) EMT-B. It
is the system preference that all
ALS agencies respond with two (2) EMT-P/PHRN providers, available to provide
patient care, whenever possible.
2. All BLS response units must be staffed with a minimum of two (2) EMT-B providers,
available to provide patient care.
Alternative Response Vehicles
1. Ambulance Assist vehicles – supplementary assist vehicle dispatched
simultaneously with an ambulance to provide patient care prior to the arrival of the
ambulance (i.e., fire truck, engine or officer car).
• ALS assist vehicle – requires staffing with a minimum of one (1)
EMT-P/PHRN
• BLS assist vehicle – requires staffing with a minimum of one (1) EMT-B
2. Non-transport vehicles – assist vehicle dispatched prior to dispatch of a transport
ambulance. Must be staffed 24/7.
• ALS Nontransport vehicle – requires 24/7 staffing with a minimum of one (1)
EMT-P/PHRN
• BLS Nontransport vehicle – requires 24/7 staffing with a minimum of one (1)
EMT-B.
EMS UNIT STAFFING
IMPL: 5/98; REV: 2/10
EMT LICENSURE TESTING
POLICY
As the Resource Hospital for the McHenry Western Lake County EMS System,
Centegra Hospital McHenry, will communicate with IDPH to confirm eligibility for
all EMT licensure candidates.
ACTION STEPS
1. Upon completion of all requirements associated with a System sponsored
EMT training program, the candidate will make application for licensure
testing through Continental Testing Services (IDPH selected vendor) or
National Registry of EMT.
2. Applications will be completed electronically, and all associated testing
fees will be paid to the testing service at the time of application.
3. Upon completion of the application, the candidate will notify the EMS
System Coordinator of the testing site and date and social security
number as required for exam roster.
4. The EMS System Coordinator will provide a roster of approved candidates
to IDPH via Continental Testing Services, for validation of the competency
of the applicants
5. When NREMT is selected, the EMS System Coordinator will provide
validation of the candidate’s competency via electronic submission
through the NREMT website.
6. Candidates are allowed a maximum of 3 testing attempts within a 12
month period from the initial testing date to achieve licensure.
7. Licensure will be granted through IDPH for students who achieve a test
score minimum of 70% as defined by EMS Rules/Regulations.
8. The EMS System Coordinator will monitor test results. Retesting must be
scheduled in the same procedural manner, involving the EMS System
validation
9. Testing fees are determined at the discretion of IDPH or NREMT.
EMTTESTING
IMPL: 2/10
EMT-BASIC RERECOGNITION OF LICENSURE REQUIREMENTS
POLICY
recommend relicensure for EMT-B providers who submit documentation of 120
hours of continuing education including current Healthcare Provider CPR training
prior to completion of the 4 year licensure period.
ANNUAL REQUIREMENTS
1.
2.
3.
Evidence of current BLS healthcare provider CPR submitted to
the EMS Office.
30 hours of continuing education each year for 4 years.
No more than 25% of the above hours can be in any single subject
area.
Continuing education credit will be awarded for didactic and clinical
education as approved by the EMS System. This includes
department inservices, seminars, hospital clinical and prehospital
patient contact time.
PROCEDURE
1.
2.
3.
4.
120 hours of continuing education training documentation with
approved IDPH education site code, verification of current BLS
healthcare provider CPR and completed child support statement is to
be submitted to the EMS Office at least 15 days prior to lapse of
EMT-B license.
The EMS System Coordinator will review the EMT-B training
documentation for adherence to the annual requirements. If the
requirements are complete, the EMS System Coordinator will
electronically notify IDPH of the completed renewal requirements via
the IDPH web portal.
The EMT-B is responsible for notifying the EMS System within 30 days
of any name or address change.
EMT’s who are not affiliated with a system provider agency or who are
no longer recognized in “good standing” within the McHenry Western
Lake County EMS System, may seek licensure renewal through direct
contact with the Regional EMS Coordinator. The EMS Department
will provide the EMT with the information necessary for this method of
renewal, upon request.
EMT-B RELICENSURE
IMPL: 10/97; REV: 2/10
EMT-P/PHRN RERECOGNITION OF LICENSURE REQUIREMENTS
POLICY
It shall be the policy of the McHenry Western Lake County EMS System that the EMTParamedics/ PHRN's utilizing the McHenry Western Lake County EMS System as their
Primary System MUST, in order to maintain recognition of their licensure status,
ANNUALLY complete and submit documentation of 30 hours of continuing education and
CPR certification, in accordance with the Illinois Department of Public Health, EMS Rules
and Regulations. The EMS office will maintain records of CE credit for all System EMT-P's
and PHRN's.
ANNUAL REQUIREMENTS
1.
Show evidence of current BLS Healthcare Provider CPR.
2.
The 30 hours of continuing education (CE) documentation and current BLS
healthcare provider CPR certification will be due in the EMS office by June
1st each year. EMT-P's/PHRN’s with a licensure renewal date other than June
will be required to submit a prorated amount of CE, calculated at the rate of 2.5
hours monthly by the June 1st deadline.
This requirement includes the hours accumulated from the Mandatory
Update/Testing Modules. Those modules may include written, (minimum
passing score 80%) practical or both. Current certification (within 2 years) of
ACLS, ITLS, PHTLS or PALS may be substituted for testing in some sections.
Failure to complete mandatory system continuing education within the
established time frame may result in a system suspension from practice. The
system may impose a fee for practical exam make-up testing or lecture
participation.
a.
CE credit will be awarded for didactic and clinical education as
outlined in the EMS System CE Policy. Any other trainings or seminars
not listed may be awarded CE credit at the discretion of the EMS Medical
Director.
3.
Paramedics utilizing the McHenry Western Lake County EMS System as a
secondary system must follow the guidelines of the Dual System Paramedic
Policy.
4.
The EMT-P/PHRN is responsible for notifying the EMS System within 30 days of
any name or address change.
5.
EMT-P/PHRN's who are not affiliated with a system provider agency or who are
no longer recognized in "good standing" with the McHenry Western Lake County
EMS System may seek licensure renewal through direct contact with the
Regional EMS Coordinator. The EMS Department will provide the EMT/PHRN
with the information necessary for this method of renewal application, upon
request.
6.
The EMS System Coordinator will validate the EMT-P/PHRN training
documentation for adherence the annual requirements. A completed child
support statement is to be submitted to the EMS System at least 15 days prior
to the lapse date of the EMT-P/PHRN license. If the requirements are complete,
the EMS System Coordinator will notify IDPH electronically via the IDPH
Hospital Web Portal of the completed renewal requirements.
EMTP.PHRN RELICENSURE
IMPL: 10/97; REV: 2/10
ENTRANCE REQUIREMENTS FOR EMT-PARAMEDIC TRAINING
It shall be the policy of the McHenry Western Lake County EMS System to promote
advanced level EMS training among the providers within our communities. In an effort to
maintain quality education and training, the following guidelines are provided for
application to the program.
1. The applicant to the Paramedic Program must demonstrate the following:
a. 18 years of age
b. Current Illinois State EMT-B license
c. Six months experience in the delivery of prehospital care at EMT-B level
d. Evidence of current Healthcare Provider CPR training
e. Successful completion of a pre-program entrance exam with a minimum
passing score of 75%/validation of BLS EMS Skills Proficiency.
f. Completion of program application with personal references and ALS agency
affiliation.
g. MCC-BIO 110 (Human Biology) or equivalent course.
2.
Upon successful completion of the pre-program entrance exam and submission of
a program application, the applicant will be asked to participate in an oral interview
involving the Lead Instructor of the program and/or EMS System Coordinator; other
EMS Educators may be included in the interview process. Following the interview,
the applicant will be notified in writing of his/her acceptance to the program.
3.
Registration for the Paramedic Program is coordinated through McHenry County
McHenry County College (MCC). The EMS Office will communicate a list of eligible
applicants to the MCC registration office prior to the registration deadline. Students
will be required to register at MCC.
EMTPENTR
IMPL: 1/79; REV: 2/10
ETHICS
POLICY
The McHenry Western Lake County EMS System supports the philosophy that concern
over the welfare of others should be the EMS provider’s highest priority, after confirmation
of their own safety. As a patient advocate, it is the responsibility of the EMS provider to
insure the quality of patient care is not compromised.
GUIDELINES
1. The fundamental responsibility of the EMS System is to conserve life, alleviate
suffering and promote health.
2. EMS providers are to provide patient care based on human need respecting patient
dignity without regard for nationality, age, sex, creed, race, financial status or
disability.
3. EMS providers will respect and hold private all information of a confidential nature
obtained in the course of providing patient care, unless required by law to divulge
such information.
4. EMS providers maintain professional competence and demonstrate a concern for
the competence of other members of the profession.
5. EMS providers assume responsibility for defining and upholding standards of
professional practice and education.
6. EMS providers assume responsibility for their individual professional actions and
judgements, and know and uphold the laws which define EMS practice.
7. EMS providers adhere to standards of personal ethics which reflect in a positive
manner on the profession.
8. Members of the EMS System may contribute to research relating to a commercial
product or service, but do not exercise professional influence in advertising,
promoting, or selling products wherein a conflict of interest may be alleged.
9. Members of the EMS System have an obligation to protect the public by not
delegating to a person less qualified, any service which requires the competence
of a system member.
10. EMS System members who advertise professional services do so in conformity with
system policies/procedures maintaining the dignity of the profession.
11. EMS System members work cooperatively with other team members; EMT's,
Nurses, Physicians and others, to provide the most appropriate care for the
patient.
12. The EMS System refuses to participate in unethical practices or procedures, and
assumes the responsibility for exposing incompetent or unethical conduct in
others, to the appropriate authorities.
ETHICS
IMPL: 7/80; REV: 2/10
DISPATCH GUIDELINES: EXTENDED ETA
POLICY
It shall be the policy of the McHenry Western Lake County EMS System to advise the
appropriate dispatching agency of any anticipated delay in responding to a call for EMS
transport, for the purpose of notifying the caller of the expected arrival of EMS on the
scene.
PROCEDURE
1. When an ambulance has been requested by telephone and the estimated response
time is foreseen to be delayed, the EMS provider will notify dispatch of the
approximate delay, to insure this information is available to the caller, if requested.
2. A foreseeable delay in response time may be anticipated if an ambulance is
responding from outside its normal response area. EMS agencies shall establish
internal policies to access mutual aid and to notify dispatch if they will be
responding from other than the usual and customary garage location.
3. Ambulance response may sometimes be delayed by unforeseen circumstances
beyond the control of the providers, i.e., traffic, weather conditions, railroad
crossings, etc. This policy has not been drafted to place unreasonable demands
on the dispatch agencies to continually monitor the status of the responding EMS
units, nor is it the intent of the EMS System to require the dispatchers to recontact
the caller if these delays are anticipated to be negligible.
EXTENDED ETA
IMPL: 12/97; REV: 2/10
EXTENSION OF EMS PROVIDER LICENSE LAPSE DATE
POLICY
provide access to an extension request for an EMS licensure period, in such
circumstances, where an EMS Provider is unable to meet the relicensure
requirements by the scheduled lapse date.
ACTION STEPS
1. The EMS provider (EMT/PHRN/EMD) must make a written request for an
extension of his licensure period to the EMS Medical Director. The
request should include detail as to why the extension is necessary to meet
the renewal requirements.
2. The EMS provider must also submit validation of current Healthcare
Provider CPR recognition, and a completed IDPH Child Support/Renewal
statement.
3. Only one extension request is allowed by IDPH rule. The extension period
can be requested to a maximum of 6 months.
4. The EMS System Coordinator will submit the request for final approval to
IDPH.
5. A new lapse date will be issued to the EMS provider when approved by
IDPH.
6. All outstanding renewal requirements must be met by the deadline of the
new lapse date. Failure to meet the outstanding requirements will result in
lapse of licensure.
7. It is the responsibility of the EMS Provider to provide the documentation of
completion of outstanding renewal requirements to the EMS System
Coordinator prior to the new lapse date. Upon receipt of all outstanding
requirements, the EMS System Coordinator will notify IDPH and a new
license will be issued.
EXTENSION
IMPL: 2/10
INACTIVE STATUS
POLICY
It shall be the policy of the McHenry Western Lake County EMS System to provide the
option for EMT’s, PHRN’s ECRN’s and EMD’s to make application for inactive status with
IDPH. The EMS Medical Director will request such inactive status from the Illinois
Department of Public Health, provided the EMT, PHRN, EMSD or ECRN has complied
with the guidelines below and with section 515.600 of the EMS Rules and Regulations as
outlined below.
1. The individual provider must make his/her request for inactive status in writing to the
EMS Medical Director. Such letter shall include a statement as to the reason
for the request. The provider must attach his/her Illinois EMT, PHRN, ECRN or
EMD license to the request for return to IDPH. A completed child support
statement must accompany the request.
2. Any individual requesting inactive status must be current with regards to relicensure
requirements, at the time of the request.
3. The EMS Medical Director shall submit a request for inactive status to the
Department of Public Health, per the Inactive Request Form. The providers Illinois
state license will be attached to the request form submitted to the state. The
following information will be included on the form:
a) Name of individual
b) Date of licensure
c) EMT Identification Number
d) A statement that the provider is current with regards to relicensure
requirements and Healthcare Provider CPR.
4. The Department shall review the request and notify the EMS Medical Director and
the provider of its decision.
5. Providers may NOT utilize inactive status in lieu of meeting relicensure
requirements. Requesting an extension is more appropriate.
6. Providers granted Inactive Status may not participate in EMS practice at ANY
licensure level.
7. Providers granted inactive status due to physical or mental impairment as defined
by IDPH Rules and Regulations section 535.430 may not have their EMT licensure
suspended or revoked while on inactive status.
RETURN TO ACTIVE STATUS
1. In order to return to active status, the provider must complete the following
requirements:
a) Make the request for reactivation in writing to the EMS Medical Director;
b) Successfully pass a comprehensive written and/or practical examination
administered by the System, directed at the appropriate level of practice;
c) Submit documentation that the provider is physically and mentally capable of
functioning within the system (if these were included as circumstances for
the inactive status.) An interview with the EMS Medical Director may
be indicated in this situation.
2. Once the requirements for reinstatement have been met, the EMS Medical Director
shall apply to the Department of Public Health for reinstatement of the
individual’s license. Upon approval, a new licensure renewal date will commence.
INACTIVE
IMPL: 1/98; REV: 2/10
NON-RENEWAL/INDEPENDENT RENEWAL EMS LICENSURE
POLICY
provide validation of the completed requirements necessary for licensure renewal
to IDPH for all EMS licensed individuals actively participating within the EMS
System. In the event that an individual is unable to demonstrate appropriate
renewal requirements in accordance with System requirements or the individual
is no longer actively participating as a System EMS provider, the McHenry
Western Lake County EMS System will afford the opportunity for the individual to
make direct contact with the appropriate IDPH representative to seek licensure
renewal independent of the system.
SCOPE OF POLICY
Non-renewal or Independent renewal may be applicable to EMS licensed
providers:
• EMT-Basic
• EMT-Paramedic
• ECRN
• PHRN
• EMS Lead Instructor
• EMD
PROCEDURE
1. An individual who is maintaining licensure independent of the System
would need to provide appropriate documentation of meeting the specific
IDPH renewal requirements.
2. Contact the IDPH Regional EMS Coordinator to submit validation of IDPH
renewal requirements to include:
a. completed EMS Licensure renewal form/child support statement
b. documentation of approved continuing education/training to meet IDPH
rules for renewal specific to licensure level
3. The EMS System will provide information related to denial for renewal by
the System to IDPH if requested. Situations for non-renewal may include:
a. System suspension currently in place ; failure to follow action plan to
resolve suspension
b. No current system affiliation for validation of educational renewal
requirements or skill competency
INDEPENDENT RENEWAL
IMPL: 2/10
INFIELD SERVICE LEVEL UPGRADE
POLICY
In the event that a mutual aid request is made of a System ALS Provider to assist a BLS
Provider, the care of the patient becomes the responsibility of the ALS Provider Agency
responding.
PROCEDURE
1. Upon receiving a mutual aid request, the responding ALS Agency must establish
radio contact with medical control, advising of the nature of the request.
2. The responding ALS Provider may choose to continue the prehospital treatment of
the patient in the BLS/ILS licensed vehicle as long as they transfer the required
ALS equipment to the BLS vehicle for transport.
3. Upon gaining access to the patient, the ALS Provider must:
a. reassess the patient;
b. initiate patient care in accordance with the appropriate system protocols;
c. document patient care on the system approved run report;
d. maintain communication with medical control.
INFIELD UPGRADE
IMPL: 10/95; REV: 2/10
EMS LEAD INSTRUCTOR REQUIREMENTS
POLICY
The McHenry Western Lake County EMS System recognizes the importance of quality
instruction in the coordination of educational programming for EMS personnel. In
accordance with IDPH Rules and Regulations, we require a recognized EMS Lead
Instructor to coordinate EMS training offered within the System for continuing education.
ELIGIBILITY REQUIREMENTS FOR EMS LEAD INSTRUCTOR
1. Demonstrate current licensure within the State of Illinois as EMT, RN or MD.
2. Demonstrate a minimum of 4 years experience as an EMS provider.
3. Demonstrate a minimum of 2 years teaching experience in the adult classroom
setting. (i.e., CPR or First Aid Instructor, ITLS, PHTLS, ACLS, PALS, assistant
Instructor in EMT skill sessions, training officer, etc.)
4. Successfully complete the NAEMSE (National Association of EMS Educators)
Instructor Course. The EMS Office is responsible for notifying IDPH of EMS
Instructor candidates upon successful completion of all course requirements.
RERECOGNITION OF EMS LEAD INSTRUCTOR LICENSURE
1. The individual must demonstrate to IDPH a letter of support from the EMS Medical
Director indicating the successful coordination of EMS educational programming
during the 4 year licensure period.
2. The individual must document a minimum of 10 continuing education hours
annually. (Programs used to fulfill other professional continuing education
requirements, i.e., EMT, nursing, may also be used to meet this requirement).
3. The EMS System Coordinator will validate the rerecognition requirements prior to
submitting a renewal application to IDPH.
LEADINSTRUCTOR
IMPL: 1/98; REV: 2/10
LICENSURE APPLICATION: ECRN, PHRN, EMD, FIRST RESPONDER/EMR
POLICY
The McHenry Western Lake County EMS System will submit documentation in
accordance with IDPH Rules and Regulations for individuals who are eligible for
IDPH EMS licensure issued without testing through the submission of an
electronic application (transaction card).
PROCEDURE
1. Upon completion of an approved IDPH course for recognition as an
ECRN, PHRN, EMD or First Responder/EMR, the student will be asked to
provide information necessary for registration with IDPH recognition and
licensure/certification.
2. The student will be asked to provide the following information to the
resource hospital:
• Name
• Residential Address (City, State and Zip Code)
• Date of Birth
• Social Security Number
• Driver’s License Number
• Validation of child support status as indicated on the IDPH Child
Support Statement form
3. An electronic application will be completed with authorization from the
EMS Medical Director and then submitted to IDPH for approval and
processing by the EMS Department at the Resource Hospital.
LICENSURE NON TESTING
IMPL: 1/80; REV: 2/10
MANAGING DISRUPTIVE BEHAVIOR
POLICY
It shall be the policy of the McHenry Western Lake County EMS System that providers
must act in an appropriate professional manner, while functioning in ANY capacity
associated with the EMS System. Patients, students, staff members and other providers
should not be subjected to physical, verbal or the effects of substance abuse by a patient,
student, staff member or provider. Should any occur, the following guidelines shall apply:
PHYSICAL ABUSE
1. Patients and others who are or who become physically abusive and who in doing
so present danger either to themselves, or others including providers, may be
restrained without order of a physician or the police.
2. Soft restraints and other non locking devices must be utilized.
3. With physician or police order, locking restraints, including handcuffs, may be used.
4. Where the patient is handcuffed prior squad arrival, the patient may be transported
with the cuffs in place provided the police will be accompanying the patient or
follow behind.
5. In ALL cases where a patient is restrained, the run report must reflect
documentation of the incident. Providers must also document repeated distal
neuro and circulatory checks.
6. Providers must refrain from becoming physically abusive except in defense of an
attack.
7. The police and other appropriate agencies must be contacted as soon as possible.
8. Incident reports must be completed and sent to the Resource Hospital where
appropriate.
VERBAL ABUSE
1. Where patients or others become verbally abusive, providers should make every
attempt to defuse such volatile situations without resorting to restraint.
2. Where the verbal abuse lead to physical abuse, the physical abuse guidelines
should be followed.
3. Providers should not direct verbal abuse at a patient, bystander, student, staff
member, another provider, or a member of another agency.
4. Appropriate documentation of all verbal abuse must be included on the run report.
5. Incident reports must be completed and sent to the Resource Hospital where
appropriate.
In all cases of physical, verbal or substance abuse, individual rights of privacy shall not be
violated. Individuals should be afforded counseling as appropriate to the situation.
Providers must be afforded “Due Process” as outlined in the Suspension Policy.
DISRUPTIVE BEHAVIOR
IMPL: 5/98; REV: 2/10
MEDICATION ADMINISTRATION and REPLACEMENT OR EXCHANGE
POLICY
It shall be the policy of the McHenry Western Lake County EMS System to provide
medication management of specific prehospital emergencies administered by EMT-B’s,
EMT-P's and PHRN's.
SCOPE
Medications may be administered to the patient as indicated by the assessment findings in
accordance with appropriate scope of practice route in accordance with specific treatment
protocols identified.
PROCEDURE
1. Aseptic technique must be maintained.
2. Verify medication order:
a. repeat med order to ECRN during hospital communication
b. upon removal from drug box.
c. upon removal from package.
d. prior to patient administration.
3. Medications must be administered in dosaging allotments as specified by medical
control/patient care protocols.
4. Medication administration must be documented on the patient run report:
a. time medication administered.
b. dose of medication administered.
c. route of medication administered.
d. patient response to medication administered.
PATIENT ASSIST MEDICATIONS
EMT-B/EMT-P/PHRN: Oral (PO)
Sublingual
Inhaled-MDI
IM-Autoinjector
EMT-P/PHRN:
Subcutaneous/IM Injection
Intranasal
Intrarectal
IV/IO
HHN or ET
REPLACEMENT or EXCHANGE OF CONTROLLED SUBSTANCES
1. Controlled Substances- (Fentanyl, Versed, and Morphine Sulfate) are to be
exchanged or replaced in the Centegra Hospital Pharmacy (CHM or CHW).
All other medications can be replaced and/or exchanged within the Pharmacy
Pyxis system.
2. The EMS provider presenting to the Pharmacy must be able to provide identification
of his EMS agency affiliation
3. Documentation required for replacement of a controlled substance administered during
patient care must be presented to the Pharmacy. A green sheet or PCR is
acceptable. The patient information section of the report/green sheet must be
complete.
4. The pre-filled syringe, or vial / ampule with the administration syringe from which the
administered dose was given must also be presented to pharmacy.
Residual medication will be wasted by Pharmacy according to DEA procedure.
5. Out date exchanges must be presented with intact packaging by an EMS provider
with appropriate identification. Controlled substance inventory is to be checked daily
and logged in each agency. Any discrepancy in inventory requires the completion of
an incident report with notification of the EMS System Coordinator
MEDADM
IMPL: 8/95; REV: 6/10
MODIFICATION OF AMBULANCE PROVIDER AGENCY SERVICE
POLICY
System provider agencies shall maintain compliance with system standards as reflected in
their initial commitment to the system and the EMS System Plan. In the event there is a
change in the process by which the provider agency provides EMS within their service
area, the system must be notified.
PROCEDURE
1. In the event that an approved system EMS vehicle will be taken out of service, the
provider agency must notify the EMS System Coordinator at the Resource Hospital
within 24 hours of the change in status. The information requested includes:
a. IDPH license # of involved vehicle
b. Reason for being taken out of service (i.e., normal maintenance, repair)
c. Estimated time until the disabled vehicle is returned to service
d. Any alteration in delivery of service as a result (i.e., replacement vehicle
or non-transport response vehicle.
2. A “Request to Modify/Amend Previously Approved System Plan” form may be
indicated for submission to IDPH.
3. In accordance with IDPH Rules and Regulations, 515.830, section h., a
replacement vehicle may be used for 10 days without an IDPH inspection, provided
IDPH has been notified of the use of the replacement vehicle by the second
working day.
4. In the event a replacement vehicle is placed in service, it may be appropriate to
transfer both BLS and ALS equipment from the disabled system vehicle to the
replacement vehicle. However, this may still require inspection by the EMS System
and the Regional EMS Coordinator.
MODIFICATION
IMPL: 1/98; REV: 2/10
EMS MUTUAL AID AGREEMENTS
POLICY
The McHenry Western Lake County EMS System recognizes that occasions may occur,
in which the need for additional equipment or manpower may be beyond the resources
available to any one provider agency. Therefore, we support the use of mutual aid
agreements through MABAS (Mutual Aid Box Alarm System) or PPERS (Private Provider
Emergency Response System), to access additional manpower and equipment as
indicated by a patient care scenario.
GUIDELINES
1. Each EMS provider agency is to maintain a current MABAS or PPERS agreement,
or other mutual aid document, as a component to their provider plan, within the
EMS System.
2. In the situation in which mutual aid is provided by a non-system provider agency,
the medical direction for that patient’s care will be provided by the corresponding
EMS System Resource or Associate Hospital, in accordance with that system
standard of care.
3. Any concerns regarding the management of the incident or the delivery of patient
care, will be directed through the appropriate EMS System or EMS Agency.
MUTUAL AID
IMPL: 1/98; REV: 7/10
PATIENT ABANDONMENT BY SYSTEM PERSONNEL
POLICY
It shall be the policy of the McHenry Western Lake County EMS System that no patient
shall be abandoned by any EMS service or provider. Abandonment includes that of an
EMS Service or provider turning a patient over to a less qualified individual for the purpose
of delivering patient care.
PROCEDURE AND GUIDELINES
1.
In the event that a transfer of patient care from one EMS service/provider to
another is required, it is the responsibility of the initiating EMS service/provider to
maintain patient care until the second EMS service/provider arrives on the scene.
The receiving EMS service must be licensed to provide an equivalent or higher
level of patient care.
2.
The transfer of patient care must include a report of the patient's assessment
findings and medical treatments/response to the receiving EMS service/provider.
The patient's assessment and treatments must be documented on the EMS
patient care report.
3.
An ALS service may request approval for BLS transport on a case by case basis
from medical control, in situations where hardship may exist and the patient
condition deems appropriate for BLS level transport.
4.
Each EMS Agency involved in providing assessment and treatment for the patient,
must document their findings in a patient care report.
PATIENT ABANDONMENT
IMPL: 8/95; REV: 2/10
PATIENT'S RIGHT TO REFUSAL
POLICY
It shall be the policy of the McHenry Western Lake County EMS System to provide access
to prehospital assessment and treatment 24 hours a day. However, System EMS
providers shall recognize the patient's right to refuse prehospital care, in accordance with
the following guidelines.
PROCEDURES
1. In order to refuse prehospital assessment or treatment, the adult patient must be
determined to be decisional. Patients who are obviously intoxicated, suffering from
mental illness, suicidal or potentially so, homicidal or potentially so, under the
influence of mind altering chemicals, or otherwise incapacitated such that they do
not exhibit the ability to make sound judgement, are to be treated as though they
imply consent and are not allowed to refuse treatment.
2. Patients who are minors, may not refuse treatment, unless the parent or legal
guardian is immediately available to complete a refusal as outlined in #3.
3. Adult patients who are judged to be decisional, and who do not fall under the
guidelines listed in #1, have the right to refuse any and all of the
treatment/transport offered to them by the responding EMS agency. This includes
the right to refuse transport to the closest medical facility. The EMS Provider is to
follow the outline below, when a patient refuses care:
a. Assess the patient condition as completely as possible;
b. Discuss patient’s assessment findings with the patient;
c. Offer the patient a treatment and transport plan of care;
d. Recognize the potential risks to refusal of the treatment/transport plan of care;
e. Document the assessment findings and the patient’s refusal of care through
contact with medical control via recorded telemetry communication and in
writing in the patient run report. Contact with medical control must be made
while present with the patient at the scene;
f. Advise the patient of the potential risks of not seeking treatment and the
potential signs and symptoms to be alert to. Advise the patient and any witness
of the need to seek medical attention immediately should their condition
continue or become more pronounced;
g. Provide the appropriate Release of Liability form for signature by the patient
and a witness (form attached);
h. Provide a follow-up instruction sheet if appropriate. The original copy (white) to
be left with the patient upon being signed and witnessed; duplicate copy
(yellow) to be attached to the EMS copy of the Release of Liability and
forwarded to the EMS Resource Hospital (form attached);
i. Document actions taken in f,g, and h in the patient run record.
4. EMS providers dispatched to the scene of a potential trauma or medical
emergency must respond to assess the nature of the incident, the mechanism
involved and the number of patients present. If there is no evidence of contributing
mechanism and there are no complaints of illness/injury by the individuals involved
the call may be terminated. Law enforcement personnel may not make this
assessment on behalf of EMS. The response to the call should be documented
by the responding EMS agency. Any indication of patient injury or illness indicates
the need to complete a patient assessment on a System Run Report. If no
transport is indicated or patient refuses transport, document the refusal as outlined
in #3.
5. Patients should be transported to the closest full service facility, unless the patient
is transported in accordance to the Regional Trauma Plan or a SEMSV (helicopter)
is utilized. Should the patient refuse transport to the closest facility, a release of
liability should be signed and witnessed, as outlined in #3.
6. Patients may be transported to the hospital of their choice, bypassing the closest
facility, if based upon the information available to the physician in charge of the
call, the patient's medical condition is such that the benefit of transport to a more
distant hospital for appropriate medical treatment is not expected to increase the
risk to the patient from transport to a more distant hospital. The decision to
bypass the closest facility must be documented in writing and via telemetry
communication with the base hospital.
7. In the event that a system provider is prohibited from transporting to a more distant
facility in accordance with patient preference, due to local ordinance, bylaw or
policy, the provider agency should establish contact with an ambulance service to
provide transport to such patients. The initial responding agency is obligated to
remain with the patient until the transporting ambulance arrives, providing medical
treatment as required. The request for transport and all medical treatment
administered must be documented on the run report. A Release of Liability should
be obtained and documented as in #5.
8. In all cases, where question arises regarding the patient's right to refusal of EMS
care, it is imperative that the EMS providers contact the base hospital, and provide
treatment according to system medical direction.
PTS RIGHT TO REFUSE
IMPL: 3/79; REV: 2/10
RELEASE OF LIABILITY
In consideration of the fact that I have:

Refused First Aid care offered to me or the patient

Refused transport to a medical facility which has been offered to me or the
patient

Refused transport to the nearest hospital after being advised that the
welfare of the patient required prompt emergency care
I do forever release and give up any claim, demand or action against
_______________________________________, and any and all persons
employed by or responding with any fire unit, rescue squad or ambulance unit,
and do hereby COVENANT AND AGREE to hold such persons and entities
harmless from any claim, demand, loss or action, by myself, the patient, or any
person claiming by or through myself or the patient for any alleged act or
omission in the care or treatment of the patient in compliance with this refusal.
This release is binding on my heirs, executors, and assigns.
I hereby acknowledge that I have been provided with a copy of the Notice of
Privacy Practices on this date.
Date ________________________________
Patient’s Name (print)___________________________________________________
Address ______________________________________________________________
City/State/Zip__________________________________________________________
DOB ________________________ Age _____________
Patient Signature______________________________________________________
Witness ______________________________ Relationship ____________________
RELEASE FORM
IMPL: 12/97; REV: 2/10
PEAK CENSUS DISTRIBUTION
POLICY
The purpose of the Peak Census - Ambulance Transport Policy is to provide
reasonable transport options for EMS agencies affected by high ED census in
multiple hospitals within a defined geographical area. The intent of a coordinated
transport distribution plan is to lessen the need for a specific hospital to
implement Ambulance Diversion/Bypass actions.
DEFINITION
“Peak Census” occurs when a specific hospital is experiencing near capacity
census with limited access to inpatient beds, critical care equipment, support
resources and staffing which impact the management of patient care. The
hospital surge capacity plan may have implemented patient admission to
overflow space, which in turn provides a strain on available support resources
and staffing.
ACTION PLAN
1. Stricken hospital implements their internal PEAK Census response plan
and updates the IDPH HHAN to reflect Peak Census Status
2. Assessment is made through review of the IDPH HHAN and direct contact
between the stricken hospital and the surrounding hospitals regarding
“Peak Census” status within the general geographic area; ED-to-ED
communication evaluates concern for pending “Bypass” situations.
3. ED’s of stricken hospitals notify the EMS Coordinator of the internal
hospital Peak Census response plan implementation. (Associate Hospital
EMS Coordinator notifies the Resource Hospital EMS Coordinator to
implement the plan).
4. EMS Agencies are notified of the activation of the EMS System Peak
Census Distribution Plan for transport of EMS patients by the EMS
System Coordinator from the Resource Hospital.
5. All hospitals will continue to accept EMS patients who are assessed to
have BLS managed assessment findings.
PREHOSPITAL REGISTERED NURSE (PHRN)
TRAINING/RECOGNITION
POLICY
It shall be the policy of the McHenry Western Lake County EMS System to approve a
Registered Professional Nurse as a "Pre-hospital RN", and to allow that R.N. to perform
ALS skills in the prehospital or interhospital phase of patient care within and according
to the "SYSTEM" guidelines provided that he/she has successfully completed and
documented the requirements listed below.
1. A course in extrication training which is based upon the National EMS Education
Guidelines for EMT’s.
2. A course in telemetry and communications training which is based upon the
National EMS Education Guidelines for EMT’s.
3. A course in dysrhythmia identification, therapeutic modalities, pharmacokinetics,
intubation, defibrillation and management of a cardiac resuscitation as approved
by the EMS Medical Director and which is in accordance with current American
Heart Association Advanced Cardiac Life Support Standards (ACLS Course).
4. A course in trauma management: Trauma Nurse Specialist (TNS), Trauma
Nurse Course Curriculum (TNCC), International Trauma Life Support (ITLS),
Prehospital Trauma Life Support (PHTLS) or other equivalent course, as
approved by the EMS MD.
5. A course in pediatric patient management: PALS, APLS or PEPP.
6. Current BLS Healthcare Provider CPR Training.
7. Successful completion of the "SYSTEM" Protocol Exam with a minimum score of
80%.
8. An interview with the EMS MD (may include megacode, oral exam, etc.).
9. Completion of a Field Internship (minimum 3 months) under the supervision of a
licensed EMT-P or PHRN documenting proficiency of ALS prehospital patient
care through a minimum of 25 hours patient contact time.
NOTE: Field Internship time may be prorated based on current clinical
experience.
6. Each EMS System will develop a distribution plan, which addresses preestablished transport destinations for the EMS agencies impacted by Peak
Census at System Hospitals.
7. The EMS System Peak Census Distribution plan will address:
•
•
•
•
•
All unstable patients will be accepted by the closest ED facility
regardless of Peak Census or Bypass statusOB patients who present in active labor or with complications will
be transported to the closest facility regardless of Peak Census or
Bypass status
Consideration for transport of pediatric patients, when stricken
facilities include a Pediatric ED center (EDAP Recognition).
Transport requests for delivery to a facility other than the
predetermined destination outlined in the plan, require medical
control contact prior to leaving the scene enroute to the requested
destination
A procedure for notification of area ED’s and EMS agencies in both
the implementation and the discontinuation of the Peak Census
Ambulance Distribution Plan
8. Peak Census Ambulance Distribution concerns shall be addressed in
accordance with the Region IX Intersystem/Inter-region Conflict Policy.
PEAKCENSUS
IMPL: 1/08; REV: 2/10
10. Upon successful completion of all educational requirements and the Field
Internship, the PHRN will be recommended to IDPH for licensure recognition.
11. PHRN re-recognition shall be approved by the EMS MD in accordance with
System Policy.
12. PHRN's may be suspended and will be afforded due process as outlined in
535.420 and 535.430 of the EMS Rules and Regulations.
13. PHRN's who choose not to seek re-recognition, may request Inactive Status or
may allow their status to lapse. They may reapply and be approved by the
following procedures outlined in System Policy Inactive Status.
14. PHRN's recognized in another system may be recognized within the McHenry
Western Lake County EMS System provided they submit documentation and
certificates from their primary system and complete the entrance exam as
defined in Dual System Participation Policy.
PHRN TRNG-RECOG.
IMPL: 1/98; REV: 2/10
PHRN APPLICATION
NAME: ___________________________________________________________
(LAST)
(FIRST)
(MI)
ADDRESS: ________________________________________________________
(STREET)
_________________________________________________________________
(CITY)
(STATE)
(ZIP)
PHONE: (
) _________
(HOME or CELL)
RN LICENSE #:
(
)_____________________
(WORK)
_______ _________ (ATTACH COPY)
NAME OF SYSTEM FIRE DISTRICT, DEPARTMENT, RESCUE SQUAD,
AMBULANCE SERVICE: ____________________________________________
REQUIREMENTS: (ATTACH DOCUMENTATION AS APPROPRIATE)
1. EXTRICATION COURSE
____ 2. TELEMETRY/COMMUNICATIONS COURSE
____3. ACLS OR EQUIVALENT
____ 4. PALS OR EQUIVALENT
5. TNS, TNCC, ITLS, PHTLS OR EQUIVALENT
6. CURRENT HEALTHCARE PROVIDER CPR CARD
7. PROTOCOL REVIEW
8. INTERVIEW WITH EMS MEDICAL DIRECTOR
9. INTERNSHIP OR PRIOR FIELD EXPERIENCE:
(May require actual internship or letter from squad)
PHRN APPLIC FORM
USE OF PHYSICAL RESTRAINTS
POLICY
Patients who become physically abusive and who in doing so present a danger either to
themselves or others, including the EMS providers, may be restrained to insure their safety
and a safe environment.
PROCEDURE
1. Soft restraints may be utilized prior to making contact with medical control.
2. With physician order or police order, locking restraints, including handcuffs applied
by the police, may be used.
3. In all situations where the patient is restrained with handcuffs, by a police officer,
the patient may be transported with the handcuffs in place, provided the law
enforcement officer accompanies the patient to the hospital during transport. The
law enforcement officer may accompany the patient in the ambulance or follow
behind the ambulance in his squad car. EMS must have the ability to release the
locking device in the event of an emergency.
4. In ALL cases where a patient is restrained, the run record must reflect
documentation of the incident, and repeated assessments of the distal
neuro/circulatory status of the restrained extremities.
5. Access to the patient’s airway must not be compromised when choosing to apply
physical restraints.
RESTRAINT
IMPL: 12/97; REV: 2/10
PHYSICIAN / NURSE AT THE SCENE
POLICY
It shall be the policy of the McHenry Western Lake County EMS System to recognize the
assistance of a Physician and/or Nurse who renders patient care at the scene of an EMS
incident. In dealing with this special situation the patient care must be provided according
to the procedure established by the System.
PROCEDURE
1. Physicians who are at the scene of a traumatic injury or medical emergency may
choose to offer their service and direct patient care. The physician may be allowed
to direct patient care, when the following are established.
a.
Evidence of proper identification;
b.
The physician must agree to accept responsibility for patient care and is
willing to accompany the patient on transport to the hospital as documented
on the EMS run record.
c.
Medical control is contacted and the physician on the scene confers with
the ED Physician regarding the plan for patient care.
2. A licensed registered nurse or practical nurse who arrives at the scene of a
traumatic injury or medical emergency may assist in the delivery of patient care,
when the following guidelines are met:
a.
Evidence of proper identification
b.
Obtain a release accepting responsibility for patient care delivered and the
willingness to accompany the patient on transport to the hospital if ALS
procedures are performed, as documented on the EMS run record.
c.
Practices patient care within the limitations of their scope of practice.
3. EMS providers must not exceed their scope of practice in providing patient care to
comply with the requests of a physician or nurse arriving at the scene.
PHYS.RN SCENE
IMPL: 8/95; REV: 2/10
McHenry Western Lake County EMS System
Request for Reinstatement of EMT Licensure
Policy Statement :
In accordance with Section 515.640 of the Illinois Administrative Code, it shall be the policy of
the McHenry Western Lake County EMS System to provide a means by which an EMS provider
will be eligible to reinstate his/her Illinois EMT license, in the situation where the EMS license
has been lapsed for less than 36 consecutive months.
Guidelines and Procedure
1.
The EMS provider must make a written request to the EMS System Medical Director
explaining the intent to reinstate a lapsed license. Included with the request will be
documentation proof of completion of continuing medical education and clinical
requirements in accordance with the following IDPH EMS Rules/Regulations: Continuing
education in accordance with Sections 515.560, 515.570 and 515.580 and EMT training in
accordance with Section 515.500, 515.510 or 515.520
2. The EMS System Coordinator will validate the lapse date of the former EMT license and
evaluate the education completed with the letter of request for reinstatement.
3. The EMT candidate will schedule an appointment with the EMS System Coordinator for
competency testing (written and practical) appropriate to the level of licensure reinstatement
being requested.
4. Upon completion of a comprehensive written and practical competency exam, the EMS
System Coordinator will determine the specific need for remediation and develop a training
plan to include both classroom and clinical education review.
5. At the completion of the remediation training plan the EMS System Coordinator will provide a
final evaluation of the candidate’s performance indicating competency in practice to the
appropriate level of licensure. The candidate will be recommended to the EMS System
Medical Director, for validation of readiness to write the Illinois Department of Public Health
approved exam for licensure.
6. The EMS System Medical Director will provide IDPH with a completed Reinstatement
Request Form including the following information:
- Proof of the candidates completion of continuing medical education and clinical
requirements
- Recommendation attesting to the applicant’s clinical qualification for retesting
7.
The EMT candidate/applicant will be responsible for the reinstatement fee, (amount
prescribed by IDPH ) and payable to the Illinois Department of Public Health.
8. The EMT candidate/applicant will then complete the testing process as directed by IDPH,
which may include additional fees for testing.
12/11 caa rev 4/12
POSITION DESCRIPTION
TITLE
EMS ADMINISTRATIVE DIRECTOR
DEPARTMENT
EMERGENCY MEDICAL SERVICES
NATURE AND SCOPE OF POSITION
The EMS Administrative Director coordinates the administrative responsibilities of the
McHenry Western Lake County EMS System, in coordination with the EMS Medical
Director and EMS System Coordinator. The EMS Administrative Director adheres to
system policies, procedures and standards of patient care in accordance with the Illinois
EMS Act and its’ Rules and Regulations.
PRINCIPAL RESPONSIBILITIES
1. Provides administrative representation to the EMS System on behalf of
CHMcHenry as the Resource Hospital.
2. Supports the activities of the EMS System in accordance with System Policy and
IDPH Rules and Regulations.
3. Maintains an awareness of current issues in EMS through ongoing communication
with the EMS System Coordinator regarding information presented at Regional
EMS committee meetings and State EMS Council.
4. Works with EMS Medical Director and EMS System Coordinator to facilitate the
delivery of prehospital patient care within the McHenry Western Lake County
System.
PD-EMS ADMINISTRATIVE DIRECTOR
IMPL: 5/98; REV: 2/10
TITLE
EMS SYSTEM COORDINATOR
DEPARTMENT
Coordinates the daily activities of McHenry Western Lake County EMS System,
including training for EMS prehospital providers: EMT-Basic, EMT-Paramedic,
Emergency Communication Registered Nurses (ECRN), Emergency Medical
Responder (EMR), Emergency Medical Dispatcher (EMD) and Prehospital RN's
(PHRN). Adheres to system policies, procedures, and standards of patient care in
accordance with the rules and regulations of the Illinois Department of Public Health,
Emergency Medical Services Act.
1. Coordinate Emergency Medical Services training in cooperation with McHenry
County College for EMR, EMT-Basic, EMD and EMT-Paramedic. Assists EMS
Faculty in curriculum updates, syllabus development, course instruction and
course evaluation.
2. Assists in the coordination of training for ED Physicians, ECRN's and System
Providers for continuing education, disaster drills and seminars.
3. Assists the EMS Medical Director with the maintenance of the EMS System
Policy/Procedure and Standard of Care Manual for the McHenry Western Lake
County EMS System. Maintains a working knowledge of these procedures and
the CHM/CHW EMS office (in accordance with the Emergency Medical Services
Act, Rules and Regulations established by the Illinois Department of Public
Health).
4. Work with Emergency Medical Service providers to facilitate the delivery of
prehospital patient care within the McHenry Western Lake County EMS System.
Communicate with EMS associates and EMS provider agencies regarding
provider performance and quality of care issues.
5. Coordinate System Entry procedures and field internship experience for EMTBasic and EMT-Paramedic, ECRN and PHRN candidates.
6. Maintains updated information related to EMS licensure through the IDPH
HHAN-EMS licensing database.
7. Serves as coordinator to the American Heart Association Community Training
Center.
8. Maintains knowledge and skill proficiencies necessary to direct prehospital care
relative to the patient's age specific needs.
9. Demonstrates knowledge of the principles of growth and development over the
life span, and posses the ability to assess data reflective of the patient's status.
Includes being able to interpret the appropriate information needed to identify
each patient's requirements for treatments relative to the patient's age specific
needs.
10. Participates in the EMS Quality Improvement Program. Provides direction for
EMS Staff in developing focus areas for review. Coordinates QI educational
reviews with system provider agencies as indicated based on data review, or
specific occurrence.
11. Participates in Emergency Management/Disaster Preparedness Planning for
organizationsl, regional and community preparedness response.
12. Participates in Associate performance appraisal process by evaluating specific
EMS clinical job related functions/skills.
13. Actively participates in organizational development programs and encourages
staff participation throughout the department.
14. Performs other duties as assigned.
QUALIFICATIONS AND GUIDELINES
Education Certification/ Registration:
- Illinois Licensed EMT-Paramedic or RN-Required
- IDPH EMS Instructor Certification-Required
- ACLS certification-Required; Instructor Preferred
- ITLS or TNS certification-Required; Instructor Preferred
- CPR for Healthcare Provider-Required; Instructor Preferred
- PALS certification-Required; Instructor Preferred
Experience:
- 3 to 5 years experience providing ALS patient care in the prehospital, ED or
Critical Care setting.
- 3 to 5 years experience as in EMS education or Quality improvement activitiesPreferred.
Other:
- Physical ability to perform functional requirements as detailed.
PD-SYSTEM COORD
IMPL: 12/96; REV: 2/10
TITLE
ASSOCIATE EMS COORDINATOR
DEPARTMENT
Coordinates the daily activities of McHenry Western Lake County Emergency Medical
Services representing the Associate Hospital. Adheres to system policies, procedures,
and standards of patient care in accordance with the rules and regulations of the Illinois
Department of Public Health, Emergency Medical Services Act.
1. Assists in the coordination of training for ECRN's and System Providers for
continuing education, disaster drills and seminars.
2. Maintains a working knowledge of the McHenry Western Lake County EMS
System Policy/Procedure and Standard of Care Manual and the operations of the
CHM/CHW EMS office (in accordance with the Emergency Medical Services Act,
Rules and Regulations established by the Illinois Department of Public Health).
3. Works with Emergency Medical Service providers to facilitate the delivery of
prehospital patient care within the McHenry Western Lake County EMS System.
Communicates with EMS associates and EMS provider agencies regarding
provider performance and quality of care issues.
4. Assists in coordinating System Entry procedures and provisional field experience
for EMT-Basic, EMT-Paramedic, PHRN and ECRN candidates as requested.
5. Maintains System EMS Run Records, communication tapes and logs. Provides
access to records upon request.
6. Maintains information related to EMS licensure through the IDPH-HHAN EMS
licensing database.
relative to the patient's age specific needs.
8. Demonstrates knowledge of the principles of growth and development over the
life span, and posses the ability to assess data reflective of the patient's status.
Includes being able to interpret the appropriate information needed to identify
each patient's requirements for treatments relative to the patient's age specific
needs.
9. Coordinates the EMS Quality Improvement Program. Serves as System Liaison
to the Region CQI Committee.
11. Performs other duties as assigned.
Education Certification/Registration:
- IDPH EMS Instructor Certification-Required
- ACLS certification-Required; Instructor Preferred
- ITLS or TNS certification-Required; Instructor Preferred
- CPR for Healthcare Provider-Required; Instructor Preferred
- PALS certification-Required; Instructor Preferred
Experience:
- 3 years experience providing ALS patient care in the prehospital, ED or Critical
Care setting-minimum
- 1 to 3 years experience as in EMS education or Quality improvement activitiesPreferred.
Other:
- - Physical ability to perform functional requirements as detailed.
PDASSOC
IMPL: 12/96; REV: 2/10
TITLE
EMS EDUCATOR
DEPARTMENT
Coordinates the educational programs offered to the prehospital care providers served
by the McHenry Western Lake County EMS System, for the purpose of licensure
renewal, skill proficiency and professional growth.
1. This position integrates living the CHS values into each of the responsibilities of
this job and daily communication with our customers and co-workers.
2. Develops educational goals as identified through needs assessment of
prehospital providers or as indicated as a results of Quality Improvement studies.
3. Organizes an annual education calendar, to include the ALS CE and testing
program, as well as additional programming designed to enrich the professional
practice of prehospital patient care as an EMT-Basic, EMT-Paramedic, EMTIntermediate, ECRN, and Prehospital RN.
4. Participates in education and training, as a representative of Centegra Health
System in coordination with Region IX EMS
5. Coordinates continuing education programs to include: room scheduling,
curriculum design, assisting instructor scheduling and orientation, program
registration, instructor evaluations, and program recognition through the
appropriate agencies (AHA, ACEP, IDPH, etc.)
6. Develop a program of educational resources accessible to provider agencies
associated with the McHenry Western Lake County EMS System. Maintain
account of the utilization of this resource and the provider response to program
presentation.
7. Applies principles of adult learning theory as well as growth and development
over the life span in the design and delivery of educational
programming.
relative to the patient’s age specific needs.
9. Participates in new product evaluation, equipment updates and equipment skill
proficiency training for prehospital providers and ECRN staff.
11. Actively participates in the McHenry Western Lake County EMS System EMS
Council to communicate educational programming goals and receive input from
system provider
agencies.
12. This position adheres to and is responsible for the safety standards of Centegra
Health System including the completion of the mandatory organizational safety
standards on
an annual basis.
13. This position actively maintains confidentiality for our patients and their families
as outlined in the CHS Patient Confidentiality Policy and shows the same level of
respect for every Associate within CHS.
14. This position performs other duties as assigned.
Education Certification/Registration
- IDPH EMS Instructor Certification- Required
- ACLS certification- Instructor Preferred
- BTLS or TNS certification- CPR for Healthcare Provider- Instructor Preferred
Experience
-3 years experience providing ALS patient care in the prehospital, ED
or Critical care setting
-1 to 3 years experience as an instructor in EMS education.
Other
- Physical ability to perform functional requirements as detailed.
PD-EMS EDUCATOR
IMPL: 2/10
TITLE
EMS AGENCY LIAISON
The EMS Agency Liaison functions as the primary contact between the EMS Provider
Agency and the EMS System Resource Hospital and Associate Hospital for administrative
communications regarding the delivery of patient care in accordance with established EMS
System Policy and Procedure. As the primary contact for the EMS Provider Agency,
he/she is the resource for the EMS Office in follow-up to any patient care issue.
1. Attend the EMS Council meetings to provide communication representation
between the EMS agency and the EMS System.
2. Represent the interests of the EMS Provider Agency to which he/she is affiliated,
regarding the ongoing management of prehospital patient care within the System.
3. Facilitate agency specific EMS training with the EMS System for IDPH recognition
site code application.
4. Assist the EMS System Coordinator/Associate EMS Coordinator in follow-up of
EMS training, QI issues or patient care concerns as indicated.
5. Communicate clinical progress for current provider agency students enrolled in
EMS coursework to appropriate leadership within the EMS Provider Agency
structure, to support the student's learning.
6. Participate in EMS committee assignments as indicated, for the ongoing
development of quality prehospital care, ie. product evaluation, policy/procedure
revision, etc.
7. Coordinate the System Entry process from the agency perspective, for EMS
providers new to the EMS System.
8. Maintain and validate training records necessary for the licensure renewal of
EMT-B system providers. The records are to be submitted to the EMS System, as
requested to facilitate the licensure renewal process.
9. Facilitate the registration process for EMS members enrolling in EMS courses, ie.
MCC classes, ACLS, ITLS, PALS, etc.
10. Maintain apparatus inventory for all EMS vehicles per system policy and
coordinate EMS vehicle inspections with IDPH and the EMS System.
PD-LIAISON
IMPL: 9/75; REV: 2/10
TITLE
EMS MEDICAL DIRECTOR/ASSOCIATE EMS MEDICAL DIRECTOR
DEPARTMENT
PURPOSE
To outline the roles and responsibilities of the McHenry Western Lake
County EMS System Medical Director / Associate Medical Director.
The EMS Medical Director coordinates the administrative activities of the McHenry Western
Lake County EMS System through CH McHenry Resource Hospital, in accordance with the
Illinois EMS Act and its’ Rules and Regulations. The EMS Medical Director will ensure that
the training and continuing education, and the delivery of prehospital patient care, at all level,
meets the guidelines of the Illinois Department of Public Health (IDPH) and the McHenry
Western Lake County EMS System.
The EMS Medical Director must:
1. Be a graduate of an approved, accredited medical school
2. Be licensed to practice medicine in all of its branches.
3. Be licensed to practice medicine in the State of Illinois.
4. Be certified by the American Board of Emergency Medicine or the American Board of
Osteopathic Emergency Medicine.
5. Demonstrate experience in the prehospital setting with an ALS EMS provider agency.
6. Have completed an approved residency program in emergency medicine or have
extensive critical or emergency care experience.
7. Have completed, within six months of appointment, an IDPH-approved EMS Medical
Director’s course (ACEP – Principles of EMS Systems – A course for Medical Director
or Baste station Course – National Association of EMS Physicians [NAEMSP]).
8. Have experience in an EMS vehicle, or be willing to make provisions to gain
experience in the vehicle.
9. Be thoroughly knowledgeable about and able to demonstrate all skills including
extrication as presented in the EMT initial training programs at all levels.
10. Have or make provisions to gain experience instructing students at a level up to and
including EMT-Paramedic and Prehospital RN.
RESPONSIBILITIES
1. The EMS Medical Director shall establish Standing Orders for the delivery of
prehospital patient care within the McHenry Western Lake County EMS system, in
coordination with the Regional EMS Advisory Board.
2. The EMS Medical Director shall establish system policies and procedures to direct the
delivery of prehospital patient care within the McHenry Western Lake County EMS
System.
3. The EMS Medical Director shall establish an inventory of EMS medications and
supplies for all provider agencies associated with the McHenry Western Lake County
System.
4. The EMS Medical Director shall be involved in the development of curriculum and
assessment processes for EMS training programs, including validation of didactic and
clinical competency for those who complete the program.
5. The EMS Medical Director shall appoint an Associate EMS Medical Director, who shall
assume the responsibilities as designated by the EMS Medical Director in maintaining
the administrative operations of the System.
6. The EMS Medical Director, or Associate EMS Medical Director, will participate as a
member of the Region IX EMS Advisory Board as a member of the EMS Medical
Director’s Committee, being available to serve as Board Chair as elected by the
membership.
7. The EMS Medical Director or Associate EMS Medical Director will represent the
MWLEMS System to the Region IX Trauma Advisory Board and EDAP meetings as
indicated.
8. The EMS Medical Director, or Associate EMS Medical Director, will be recognized as a
Faculty member through McHenry County College for program instruction in all levels
of EMS training, as well as member of the EMS Advisory Committee for program
development.
9. The EMS Medical Director/Associate EMS Medical Director will provide medical
direction for additional educational programming to include – International Trauma Life
Support (ITLS-ACEP), Advanced Cardiac Life Support (ACLS-AHA), and Pediatric
Advanced Life Support (PALS-AHA).
10. The Associate EMS Medical Director shall assume all responsibilities of the EMS
Medical Director, in his/her absence.
STANDING EMS MEETING COMMITMENTS
EMS System Meetings
• EMS Provider Council – every other month 4th Thursday (9:00 am –
11:00 am) – Rotating EMS provider sites
• MCC EMS Advisory Committee – annual meeting – other meeting
time as needed
• McHenry County Fire Chiefs – meet monthly – EMS MD one time
annually (1st Monday of every month – 6:00 pm)
Region Meetings
• Region IX EMS Advisory Committee – quarterly meeting – Tuesday
morning 9:00 am
• Region IX Trauma Advisory Board – quarterly meeting – Wednesday
evening 6:00 pm
IDPH Meetings
• ICEP EMS Forums – quarterly meetings preceding EMS Advisory
Board schedule (quarterly)
• ICEP EMS Medical Directors – quarterly
• IDPH Governors Advisory Council – quarterly – Springfield
PD-EMS MEDICAL DIRECTOR
5/10; REV: 7/10
EMS PRECEPTOR
TITLE
NATURE AND SCOPE OF POSITION:
In an effort to provide a quality prehospital experience to the EMS student/probationary
member, the EMS Preceptor will assist with the prehospital training, supervision and
evaluation of skills performed by students enrolled in the McHenry Western Lake County
EMS system training programs and probationary members of the system. A preceptor
demonstrates critical thinking in initiating patient care protocols, leadership, and clinical
proficiency; and serves as a mentor to the student/probationary EMT.
REQUIRED QUALIFICATIONS:
•
•
•
•
Completion of Preceptor Orientation
Minimum one year experience with the McHenry Western Lake County EMS
System
Letter of recommendation from Chief/Department EMS Coordinator/approval by
EMS
EMS Medical Director/EMS System Coordinator
RECOMMENDED QUALIFICATIONS:
•
•
Advanced Cardiac Life Support (ACLS)
Pediatric Advanced Life Support (PALS)
RESPONSIBILITIES:
1. Assists the student/probationary member in the development of patient assessment
techniques, communications, and documentation practices, overall patient
management and other technical skills, while he/she makes the transition to the
leadership role.
2. Maintains an ongoing awareness of the EMS student’s advancing skill level and
communicates need for remediation to the EMS Staff.
3. Working knowledge of the goals and objectives of the EMS training/probationary
program.
4. Communicates progress of skills to student/probationary member and EMS staff,
both written and verbal summary.
5. Responsible for the quality of patient care delivered. Expected to assume
management of patient care at any time the student/probationary members does
not provide appropriate care in a timely manner.
PD-EMS PRECEPTOR
IMPL: 10/99; REV: 2/10
PROVIDER AGENCY SYSTEM ENTRY
POLICY
It shall be the policy of the McHenry Western Lake County EMS System to receive
applications for Provider Agency System affiliation. Upon completion of the System
requirements, the Provider Agency would be recognized as a participating member of the
System.
PROCEDURE
1. EMS Provider Agencies petitioning for System affiliation must submit an EMS
System Provider Application form to the EMS System Coordinator at the Resource
Hospital. This application form addresses all of the criteria specified in the IDPH
EMS Rules and Regulations.
2. EMS Provider Agencies must agree to System manpower requirements, System
Policies and Procedures and Standards of Care. In accordance with IDPH EMS
Rules and Regulations all levels of service must respond to EMS calls with a
minimum of two (2) Illinois licensed EMT’s. In the situation in which an agency is
an ALS provider, the agency must respond with a minimum of one EMT-P or
PHRN, available for patient care whenever possible. This staffing will provide the
patient with the optimal prehospital care during transport.
3. System application forms have been developed by IDPH and must be completed
by any Provider Agency seeking system affiliation. The application will not be
forwarded to IDPH for addition to the McHenry Western Lake County EMS System
until plan agreement is complete. This includes all personnel have been
recognized as System providers and all EMS vehicles have been inspected by the
EMS Medical Director/designee and the Regional EMS Coordinator to meet the
System inventory standards.
PROVIDER AGENCY ENTRY
IMPL: 12/97; REV: 2/10
QUALITY ASSURANCE / QUALITY IMPROVEMENT
The McHenry Western Lake County EMS System is committed to quality patient
care. To assure this, the following policy and procedures for adhering to that policy
will be in effect.
POLICY
It shall be the policy of the McHenry Western Lake County EMS System that quality
patient care will be the number one priority of the EMS System. ALL members of
the System, including but not limited to EMS Staff, Physicians, Nurses, ED Techs,
Administrators, and Providers, must constantly strive to provide the best patient
care possible. To assure this, the following system will be implemented for Quality
Improvement (QI) and for incident follow-up.
PROCEDURE
1. ALL runs must be documented on the appropriate patient care report form.
2. The patient care report original becomes a part of the patient's medical
record. A copy is retained by the transporting EMS Agency.
3. Specific runs, in which the documentation of patient care warrants special
notice, (e.g., drug error), will be followed up by the either the Associate
Hospital EMS Coordinator, Associate Hospital EMS Medical Director and/or
the Resource Hospital EMS Coordinator and EMS Medical Director.
4. Specific Occurrences, which may include but not be limited to treatment or
transport issues concerning medication administration, medical direction,
radio communication, patient follow-up information, or commendations
regarding patient treatment, MUST be documented on the OPPORTUNITY
TO IMPROVE FORM (attached).
A copy must be sent to the EMS
Coordinator at CHM or CHW.
Follow-up regarding performance
improvement/educational review with EMS agency providers will be
coordinated by EMS System Coordinator or Associate EMS Coordinator.
5. Special Quality Assurance meetings may be scheduled by the EMS Medical
Director as he/she determines the need for such a meeting. The structure of
such meeting to be left to the discretion of the EMS Medical Director and is
to be focused on performance improvement as related to EMS practice
standards and privileges.
QUALITY ASSURANCE
IMPL: 5/82; REV: 2/10
OPPORTUNITY TO IMPROVE
All information on this form, including appended materials is confidential, and, except for EMS
System/hospital/quality review activities may not be disclosed. This report is a quality review
tool to be used solely in the course of internal Quality Control for the purpose of improving the
quality of patient care and the safety of our environment for patients, EMS providers and
hospital associates.
Date Concern Identified: ______________________________________ Time: _____________
Individual Initiating Report: _______________________________________________________
Department Involved: __________________________Date of Incident: ___________________
Received by:
CHM EMS ___________
CHW EMS ___________
NATURE OF REVIEW:
_____ COMPLIMENTARY
_____ COMMUNICATIONS
_____ PATIENT INJURY
_____ EQUIPMENT/PROCEDURE
_____ MEDICATION
_____ REQUEST FOR PT. FOLLOW-UP
_____ OTHER __________________________________________
(specify)
BRIEF DESCRIPTION:
(Include date of occurrence)______________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
RESOLUTION/FOLLOW-UP:
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
SEND WITHIN 48 HOURS TO: CHM EMS or CHW EMS
OPPORTUNITY
RADIO REPORT
POLICY
It shall be the policy of the McHenry Western Lake County EMS System that where
possible prehospital and interhospital patient care, including those patients refusing
treatment, must be documented via radio transmission to the base hospital. The
following procedures will serve as guidelines:
1. All System EMS Agencies must maintain two means of communication
capability to include MERCI and/or cellular phone or telemetry radio.
2. As appropriate to the situation, contact the base hospital (CHM, CHW, or
Good Shepherd) utilizing the MERCI channel or cellphone. When
cellular contact is not available, or in cases of minor injury where radio traffic
allows, MERCI may be used for transmission of patient information.
3. The base hospital will provide an ECRN or ED physician recognized by the
System to receive the patient report and provide medical orders as indicated.
The ECRN will communicate the EMS patient report to the ED physician in
charge. The ECRN may provide medical orders in accordance with System
policy and Standards of Care.
4. The ECRN/ED physician will document EMS patient report information the
McHenry Western Lake County EMS System Report Form.
5. Radio transmission should be brief but accurate, and should follow the Standard
Data Transmission Format.
6. The base hospital must be notified of changes in patient condition.
7. Courtesy calls to receiving facilities should be made by the transporting
ambulance.
8. When ambulances are transporting patients and they cannot maintain contact
with the base hospital, or when unable to reach the base hospital, they may act
under protocol. The transport ambulance should also attempt to contact the
receiving facility and may accept orders from them after explaining their
situation.
9. All refusals should be documented on a telemetry channel by cellular phone
PRIOR to leaving the scene.
10. Patient confidentiality MUST NOT BE violated. The patient may consent to his/her
name being used via cellular phone for the purpose of gathering previous records.
11. In a disaster situation, transmission MUST be limited to number of patients and
general patient conditions. MERCI radio or a dedicated recorded phone line
would be used.
RADIO REPORT
IMPL: 5/80; REV: 2/10
REPORTING ABUSE AND/OR NEGLECT
POLICY
The State of Illinois specifies EMS responders as mandated reports of abuse and/or
neglect. It is the policy of the MWLCEMS System that EMS providers shall provide
immediate, effective assistance and medical treatment for victims and witnesses of
domestic or personal violence, abuse or neglect.
Persons protected by the Illinois Domestic Violence Act of 1986 include:
•
•
•
•
Persons abused by a family or household member
Adults with disability who are abused, neglected or exploited by a family or
household member.
Minor children or dependent adult in the care of family or household member or
legal guardian.
Person residing or employed at a private home or public shelter which is sheltering
an abused family or household member.
PROCEDURES
Child Abuse/Neglect – children suffering from suspected abuse or neglect shall not
remain in an environment of suspected abuse or neglect.
1. Children are defined as under eighteen years of age, unless legally emancipated
by marriage, pregnancy, entry into a branch of the U.S. Armed Forces, or legal
proclamation.
2. EMS personnel are required by law to report suspicions of child abuse/neglect.
3. All EMS personnel having reasonable cause to believe a child known to them in
their official or professional capacity may be an abused or neglected child shall
report the circumstances to Illinois Department of Children and Family Services
(DCFS) upon completion of patient care.
4. Initial reports shall be by DCFS hotline: 1-800-252-2283.
Reports shall be confirmed in writing to the appropriate Child Protective Services
Unit on forms provided by DCFS within twenty-four (24) hours of the initial report.
These forms are available in the Emergency Department of all system hospitals.
5. EMS personnel shall also report their suspicions to the Emergency Department
physician at the receiving hospital.
6. If child abuse/neglect is suspected and parents and/or esponsible adults are
uncooperative and/or refusing transport, notification of the local police authority is
indicated. Request that the child be placed in protective custody pending medical
evaluation at the Emergency Department. If the police refuses to assume
protective custody, request they remain on the scene, while medical control
contact is established. Request the medical control physician place the child
under protective custody pending medical evaluation at the ED. Once protective
custody is secured, transport the child.
7. In the event of the death of a child suspected to be related to abuse/neglect EMS
personnel shall, in addition to DCFS, notify the local coroner or medical examiner.
Elder Abuse/Neglect
1. All EMS personnel who have reasonable cause to believe a geriatric patient known
to them in their official or professional capacity may be abused or neglected shall
report the circumstances to the appropriate authorities upon completion of patient
care.
2. Reports shall be made to:
• Resident of nursing home/extended care facility – 1-800-252-4343
• Not in a nursing home or extended care facility – 1-800-252-8966
(Note: The emergency phone lines may not be staffed 24/7; leave a message.)
3. EMS personnel shall also report their suspicions to the ED physician at the
receiving hospital.
4. If there is reason to believe the geriatric patient has been abused and/or
neglected, EMS personnel shall make every reasonable effort to transport the
patient.
Domestic Assault/Violence
1. All EMS personnel who have reasonable cause to believe a patient is the victim of
domestic assault and/or violence are required by law to provide immediate and
appropriate referral information to that patient. This requirement may be fulfilled
by the receiving hospital. In the event of a non-transport, the information shall be
provided by the EMS personnel at the scene. Agencies which may provide
information and assistance:
Family Services for McHenry County (815)385-6400
McHenry County Crisis Line
(800)892-8900
REPORT ABUSE
IMPL: 1/98; REV: 2/10
REPORTING OF SUSPECTED CRIMES/PRESERVATION OF EVIDENCE
POLICY
cooperatively with local and state agencies in the recognition and reporting of suspected
crimes, with consideration to the practices of law enforcement in their need to collect
evidence related to the alleged offense.
PROCEDURE
1. EMS providers must maintain the obligation to scene safety. Any situation which
presents with a risk of danger to the EMS provider should be secured by the
appropriate authority prior to patient contact.
2. Patients who are victims of a crime or suspected criminals must receive care equal
to any other patient.
3. EMS providers who arrive at a scene and suspect that a crime has been
committed, MUST report the suspected crime to the appropriate agency at the
earliest opportunity. These scenes include, but are not limited to:
a. child abuse
b. spousal abuse
c. elder abuse
d. battery
e. drug abuse
f. suspicious death
4. In any situation where a possible crime may have occurred, caution must be taken
by the EMS providers to preserve the evidence present at the crime scene. Patient
care must not be compromised, but should be provided with regard to the
surrounding environment.
REPORTING SUSPECTED CRIME
IMPL: 1/98; REV: 2/10
UNSTOCKED RESERVE AMBULANCE
POLICY
It shall be the policy of the McHenry Western Lake County EMS System to define
the notification process utilized for activation and deactivation of an unstocked
reserve ambulance. An unstocked reserve ambulance may be put into service
in order to maintain response times and patient care, when a primary ambulance
unit is out of service. It is widely understood that the use of these vehicles will
reduce the need for mutual aid response, which allows neighboring communities
to maintain their level of service without interruption to their specific operational
plan.
System Provider agencies may maintain an unstocked reserve ambulance, as
long as the ambulance is currently licensed and meets the KKK-A-1822
specifications with the exception of the patient care equipment and supplies.
Licensing of these vehicles requires an approved waiver from IDPH. Each
situation, which requires either activation or deactivation of the vehicle, must
include notification to the EMS System. The provider agency must assure that
ALL REQUIRED SYSTEM AND IDPH EQUIPMENT AND SUPPLIES WILL BE
ON THE VEHICLE BEFORE IT IS PUT INTO ACTIVE SERVICE. The McHenry
Western Lake County EMS System reserves the right to inspect the vehicle once
it is placed into service.
PROCEDURE
1. The System Provider Agency maintaining the unstocked reserve
ambulance will have a written policy defining the circumstances under
which the vehicle will be placed into active service.
2. The MWLCEMS EMS System Coordinator will be notified of the activation
of the unstocked reserve vehicle within (1) one business day.
3. The “Notification Form, Unstocked Reserve Ambulance Activation/
Deactivation” will be completed and faxed to the EMS office whenever
activation/deactivation occurs.
4. The MWLCEMS will inspect the vehicle if it is to be in service for a period
of 10 days or more.
5. The MWLCEMS will monitor and track the use of the unstocked reserve
vehicle.
6. The System Provider Agency will have a plan to bring this vehicle into
compliance with a fully stocked vehicle within 2 years of the date of IDPH
approval for the first waiver. Compliance will be demonstrated by an
action plan outlining the budget for the purchase of 50% of the
supplies/equipment within the first 12 months of designation as an
unstocked reserve vehicle.
RESERVE AMBULANCE
IMPL: 2/09; REV: 2/10
NOTIFICATION FORM: UNSTOCKED RESERVE AMBULANCE
ACTIVATION/DEACTIVATION
ACTIVATION
Date and time of activation: __________________________________________
Date/Time EMS System notification: ___________________________________
EMS Office Fax:
815/759-8045
EMSSC Pager #:
815/903-6214
Vehicle being temporarily replaced:
_________________________________
Station Address: _________________________________________________
_________________________________________________
Vin #________________________Make:___________License #____________
Reason for activation:
How long do you anticipate the reserve vehicle to be active? _______________
Provider Agency Representative Signature:_____________________________
In signing this form I am verifying that all required supplies and equipment have
been placed on the reserve vehicle, as defined by the McHenry Western Lake
County EMS System and IDPH. Patient care being delivered by this vehicle will
be provided at the same level of service as the vehicle being temporarily
replaced.
DEACTIVATION
Date and time of deactivation: ________________________________________
Date and time of EMS System notification: _____________________________
EMS Office Fax:
815/759-8045
EMSSC Pager #:
815/903-6214
Vehicle being returned to service:
Vin #________________________Make:_____________License #__________
Provider Agency Representative Signature: _____________________________
In signing this notice, I am verifying that all required supplies and equipment
have been returned to the vehicle named above, which is now able to return to
service in accordance with our Agency system plan.
RESERVE AMBULANCE NOTIFICATION FORM
IMPL: 2/09; REV: 2/10
POLICY
CHM, as the Resource Hospital, may exercise Supervisory Control, and override the orders
of the Associate Hospital when the EMS Medical Director, or ED physician believe such
orders are in direct conflict with appropriate patient care or with the EMS System Protocol.
Whenever Supervisory Control is utilized, the ED physician and ECRN MUST complete and
submit an Opportunity to Improve form to the EMS office. Follow-up MUST include review
by the EMS Medical Director and, if indicated, the ED physician providing the medical
direction.
IMPL: 10/95; REV: 2/10
SPINAL IMMOBILIZATION CRITERIA
DEFINITION OF SPINAL IMMOBILIZATION
Complete spinal immobilization includes the immobilization of the patient using a long board with
straps, stiff cervical collar, and head immobilization device (head blocks or towel rolls) secured to
the board and the patient's head. Complete spinal immobilization may be applied to the supine
patient, the standing patient or to the seated patient (utilizing the KED).
INDICATIONS FOR COMPLETE SPINAL IMMOBILIZATION
1. Mechanism of Injury
- unrestrained occupant of MVA
- vehicular damage with compartmental intrusion in patients seating space
- MVA > 20mph with vehicular damage
- Victim of fall > 2x's the patient's height
2. Assessment (in conjunction with mechanism) by physical exam
- Patient c/o of pain, discomfort, tenderness, tingling, numbness, stiffness or burning to
the neck, shoulders, spine
- Sensory, Motor, Vascular deficit suspicious of spinal injury
- Multiple system injuries or findings of distracting injury or pain
- Altered LOC (chemical/trauma)
3. IF IN DOUBT COMPLETE SPINAL IMMOBILIZATION SHOULD BE APPLIED
Documentation of the method of application of spinal immobilization should be evident in
the patients run report.
Situations which may NOT indicate the application of complete spinal immobilization.
1. MVA, patient ambulatory at the scene without evidence of indicated mechanism or
assessment findings for spinal injury.
2. MVA or other trauma, demonstrating an isolated injury without evidence of assessment
findings indicating spinal injury.
3. Syncopal event, in which patient was already seated or supine, prior to the syncope.
4. Syncopal event, in which patient was assisted to a supine position by a bystander or crew
member.
5. Non-traumatic back pain or back spasm.
6. Isolated minor head laceration/injury without mechanism indicative of spinal injury.
The EMS run report must reflect the negative assessment findings, a history non-suggestive of a
mechanism or patient refusal, with refusal of treatment consent attached, if spinal immobilization
is not applied.
SPINAL IMMOBILIZATION
IMPL: 8/95; REV: 2/10
SYSTEM PARTICIPATION SUSPENSIONS
(IMMEDIATE SUSPENSIONS)
POLICY
It shall be the policy of the McHenry Western Lake County EMS System that the EMS
Medical Director (EMS MD) may immediately suspend from participation within the system
any EMT or provider if he/she finds that the information in their possession indicates that
the continuation in practice by an EMT or provider would constitute an imminent danger to
the public. The suspended EMT or individual provider shall be issued an immediate
verbal notification followed by a written suspension order to the individual or individual
providers by the EMS MD which states the length, terms and basis for the suspension.
1. Within 24 hours the EMS MD shall deliver to IDPH a copy of the suspension order
and copies of any written materials which relate to the EMS MD’s decision to
suspend the EMT or provider.
2. Within 24 hours the suspended EMT or provider may deliver to IDPH a written
response to the suspension order and copies of any written materials which the
individual or individual provider feels relates to the response.
3. Within 24 hours of receipt of the suspension order or the EMT’s response,
whichever is later, IDPH shall determine if the immediate suspension should be
stayed or continued pending the individual or provider’s opportunity for a hearing or
review, OR whether the suspension should continue during the course of the
hearing or review. IDPH shall issue this determination to the EMS Medical
Director, who shall immediately notify the suspended EMT or provider.
4. Upon the action of an immediate suspension, the suspended EMT or provider has
the right to bypass the local review board and go directly to the State EMS
Disciplinary Review Board.
SYSTEM IMMEDIATE SUSPENSION
IMPL: 1/80; REV: 2/10
SYSTEM SUSPENSION
POLICY
It is the policy to afford all McHenry Western Lake County EMS System participants the
latitude to perform their work, so long as it is within the guidelines of the EMS ACT, IDPH
Rules and Regulations and the System Policies and Procedures. Where participants fail
to meet such guidelines and/or standards, they may be suspended from practice of their
EMS skills.
PROCEDURE
1. An EMT/PHRN/ECRN may be suspended for one or more of the following:
a. Failure to meet continuing education requirements;
b. Violation of the EMS Act, Rules and Regulations;
c. Failure to maintain proficiency in the provision of basic or ALS services;
d. Failure to comply with the provisions of the System's Program Plan approved
by the Department;
e. Intoxication or personal misuse of any drugs or the use of intoxicating
liquors, narcotics, controlled substances, or other drugs or stimulants in such
manner as to adversely affect the delivery, performance or activities in the care
of patients requiring medical care;
f. Intentional falsification of any medical reports or order, or making
misrepresentations involving patient care;
g. Abandoning or neglecting a patient requiring emergency care;
h. Unauthorized use or removal of narcotics, drugs, supplies or equipment from
any ambulance, health care facility, institution or other work place location;
i. Performing or attempting emergency care, techniques or procedures without
proper permission, licensure, education or supervision;
j. Discrimination in rendering emergency care because of race, sex, creed,
religion, national origin or ability to pay;
k. Medical misconduct or incompetence, or a pattern of continued or repeated
medical misconduct or incompetence in the provision of emergency care;
l. Violation of the System's standard of care;
m. Physical impairment of an EMT/PHRN/ECRN to the extent that he/she
cannot physically perform the emergency care and life support functions for
which he/she is licensed, as verified by a physician, unless the
EMT/PHRN/ECRN is on inactive status;
n. Mental impairment of an EMT/PHRN/ECRN to the extent that he/she cannot
provide appropriate judgement, skill and safety for performing emergency care
and life support functions for which he/she is licensed, as verified by a
physician, unless the EMT/PHRN/ECRN is on inactive status.
2. The EMS Medical Director shall provide the EMT/EMS provider with a written
explanation of the reason for suspension; the terms, length and condition
of this suspension; the date the suspension will commence; and the opportunity
to request a hearing of the Local System Review Board.
a. Notification of an impending suspension will be made in writing by the EMS
Medical Director and delivered via certified mail to the involved EMT/EMS
provider.
b. The EMT/EMS provider will have 15 days from date of receipt of notification to
respond to the opportunity for a Local System Review Board hearing. The
request must be made in writing to the EMS Medical Director.
c. If the EMT/EMS provider requests to be heard before a Local System Review
Board, a hearing must commence as soon as possible, but at least within 21
days after receipt of the written request for the hearing.
d. If the EMT/EMS provider chooses to be heard before the Local System Review
Board, he/she must select 3 members from the list provided by the Resource
Hospital, one of whom must be an ED Physician knowledgeable in EMS; an
EMT; and one of whom is of the same professional category as the individual
requesting the hearing.
e. The EMT/EMS provider may waive their option for a local hearing and seek
direct review of the EMS Medical Director’s suspension order by the state EMS
Disciplinary Review Board.
3. When a Local System Review Board is convened:
a. The EMS Medical Director will arrange for a certified shorthand reporter to make
a stenographic record of the hearing and prepare a transcript of the
proceedings.
b. The transcript and all documents or materials submitted as evidence during the
hearing, along with the system review boards written decision shall be retained
by the EMS System.
c. The EMS System shall implement the decision of the Local System Review
Board, unless the decision is appealed to the State EMS Disciplinary Review
Board.
d. The Local System Review Board shall state its decision to affirm, modify or
reverse the suspension order. The decision will be delivered via certified mail
or personal service to the EMS Medical Director and the EMT/EMS Provider
who requested the hearing within 5 business days following conclusion of the
hearing.
e. The EMS Medical Director shall notify IDPH in writing within 5 business days
after the board’s decision to either uphold, modify or reverse the EMS Medical
Directors suspension order. The notice shall include a statement detailing the
duration and grounds for the suspension.
4. The EMS Medical Director shall have the opportunity to request a review by the
State EMS Disciplinary Review Board, if the Local System Review Board modifies
or reverses the initial suspension order.
5. The EMT/EMS Provider has the opportunity to request a review of the Local
System Review Board decision by the State EMS Disciplinary Review Board.
6. Request for review by the State EMS Disciplinary Review Board, shall be
submitted in writing to the Chief of IDPH, Division of EMS & HS, within 10
days of receipt of the Local System Review Board decision or the EMS Medical
Directors suspension order. A copy of the board’s decision or suspension order
shall be enclosed.
SYSTEM SUSPENSION
IMPL: 1/80; REV: 2/10
SYSTEM REVIEW BOARD
EMERGENCY PHYSICIANS
Joe Keenan, M.D.
Linda Furlan, D.O.
ECRN
Peter Koenig, R.N. (CHM)
Joyce Kirk, R.N. (CHW)
PREHOSPITAL RN
Kelly Monestero, R.N. (FFL)
Karen Battaglia, R.N. (Fox Lake)
EMT-PARAMEDIC
Cynthia Tomusiak, EMT-P (Fox Lake)
Nathaniel Burns, EMT-P (Woodstock)
Mike Kempster, EMT-P (McHenry/Fox Lake)
Allen Fink, EMT-P (A-TEC)
EMT-B
Gene Sankey, EMT-B (Woodstock)
Al Thennes, EMT-B (McHenry)
Dennis Krenz, EMT-B (Cary)
Jay Marshall, EMT-B (Richmond)
SYSTEM REVIEW BOARD
IMPL:12/97; REV: 11/10
SYSTEM-WIDE CRISIS MANAGEMENT
POLICY
provide prehospital care to the patients within our service area to the extent that
our resources provide. In the event of a system-wide crisis, the Resource
Hospital will evaluate the scope of service required to effectively manage the
patient care needs, as identified by the prehospital provider agency responding
to the event.
GUIDELINES
1. A system-wide crisis is defined as a scenario which creates a demand for
patient care services which cannot be effectively managed by the
resources available within the system at that particular point in time. This
may include, but not limited to a mass casualty scenario, a natural
disaster, an event of chemical/biological terrorism or pandemic disease
outbreak.
2. The Resource Hospital may be notified by the EMS provider directly or by
the Associate Hospital receiving report of the specific event, of the nature
of the incident and the scope of services required to effectively manage
the patients presenting for treatment. In the event of disease outbreak
symptom surveillance, IDPH/CDC commuications may create the trigger
for crisis response.
3. If the nature of the crisis event is such that the System resources cannot
effectively provide the services required for patient care, the Resource
Hospital will notify Region IX RHCC for additional support as accessible
through activation of the Region IX Disaster Plan or IDPH Hospital
Emergency MOU.
4. Documentation and follow-up will be maintained in accordance with the
IDPH Rules and Regulations and the Region IX Disaster Plan, to include:
a. names of Associate Hospitals requesting bypass or experiencing
increase in E.D. visits due to the crisis event;
b. common signs/symptoms of patients seeking treatment;
c. names of providers affected by increased patient transports;
d. time EMS MD/EMS System Coordinator notified;
e. date/time IDPH notified (see attached form).
SYSTEM WIDE CRISIS
IMPL: 4/01; REV: 2/10
SYSTEM-WIDE CRISIS FORM
Date: _______________________
Time: __________________________
_______________________________ _______________________________
Names of Resource Hospital
Name & title of person completing form
_______________________________
Phone Number
Names of Associate Hospitals/Participating Hospitals requesting bypass or who
are experiencing an increase in E.D. visits:
________________________________________________________________
________________________________________________________________
Name(s) of providers in the area who have seen an increase in runs:
________________________________________________________________
________________________________________________________________
Name and time of EMS System Coordinator or EMS Medical Director notification:
________________________________________________________________
Date/time Region IX RHCC Coordinator notified: _________________________
Date/time/name of person notified at the State (i.e., Chief of EMS)
__________________________ _____________ ___________ ___________
Name
How contacted Time notified Date notified
(pager,phone,fax)
SYSTEM WIDE CRISIS FORM
IMPL: 4/01; REV: 2/10
EMS PROVIDER/ASSOCIATE & PARTICIPATING HOSPITALS
SYSTEM-WIDE CRISIS WORKSHEET
_________________________________ __________
Name of Hospital/Provider
Date
_______________
Time
__________________________________________
Name of Person Reporting
HOSPITALS ONLY
__________________________________________________________
Number of Patients with same/like symptoms seen in last six (6) hours
PROVIDERS ONLY
__________________________________________________________
Number of patients transported to ED’s by all ambulances in our
service with same/like symptoms
Any increase in response time:
Yes _____
No _____
HOSPITALS AND PROVIDERS
Common like complaints by patients: __________________________________
________________________________________________________________
________________________________________________________________
ANY OTHER PERTINENT INFORMATION: ____________________________
________________________________________________________________
________________________________________________________________
SYSTEM WIDE CRISIS WORKSHEET
Page 2
Resource Hospital Contacted:
Yes _____
No _____
Person contacted at Resource Hospital:
________________________________________________________
Name & Title
How was information reported?
Phone __________________
Fax __________________
Page __________________
Dedicated phone line ______
Person to person _________
Other __________________
Names/organizations and/or titles of other persons contacted:
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
SYSTEM WIDE CRISIS WORKSHEET
IMPL: 4/01; REV: 2/10
WITHHOLDING OR WITHDRAWING RESUSCITATIVE EFFORTS
POLICY
It shall be the policy of the MWLCEMS System to provide medical guidance and direction
to EMS responders in situations where it may be appropriate to withhold or withdraw
resuscitative efforts in providing patient care.
In consultation with medical control, EMS personnel may withhold or withdraw resuscitative
care in the following circumstances:
•
•
•
•
•
•
•
There is a risk to the health/safety of EMS personnel
Resources are inadequate to treat all patients (i.e., mass casualty)
Death has been declared by a physician, medical examiner or coroner
A child (under 18 years old) where a court order is presented to EMS personnel
indicating “CPR” is not to be commenced
An adult patient with blunt trauma who is assessed to be apneic, pulseless
and asystolic upon the arrival of EMS
Patients who demonstrate a valid DNR order
Injuries/presentations which are incompatible with life-decapitation, mummification,
putrification, thorac-abdominal transaction, massive cranial/cerebral destruction,
profound dependent lividity, decomposition, incineration, frozen state, rigor mortis
without hypothermia, trauma where CPR is not possible.
PROCEDURE
1. Upon assessment of the patient’s situation, establish medical control contact via
UHF (telemetry) radio or cellular phone. Report assessment findings indicating the
appropriate circumstance to withhold or withdraw resuscitative care.
2. Provide emotional support to family/significant other in communicating the decision
to withhold or withdraw resuscitative treatments.
3. Contact local law enforcement and coroner.
4. Document date and time of patient assessment indicating death and the physician’s
name involved in providing medical direction, in the patient care report. Include
supporting information, i.e., DNR order, living will, power of attorney for healthcare.
5. If CPR has been initiated prior to the arrival of EMS and a valid DNR order is
present, resuscitative efforts may be withdrawn after consultation with medical
control.
6. Do Not Resuscitate orders and an appropriately executed DNR order may be
presented on the IDPH statewide form or any other written document which
contains the required elements as identified in IDPH EMS Rules and Regulations.
7. Living wills may not be honored by EMS providers without the presence of a valid
DNR.
8. If a power of attorney for healthcare document is presented by the “agent”, the EMS
provider must confirm that the document is in effect for the current situation. If it is
appropriate, EMS would honor the agent’s instructions. If there is any doubt,
continue treatment and contact medical control.
9. Hospice patients or transport of DNR patients who are not in cardiac/respiratory
arrest should receive supportive/comfort care enroute to the hospital. Do not
withhold oxygen and medications unless specifically included in the DNR order.
When in doubt, initiate BLS supportive care and contact medical control for
additional direction.
10. Contact medical control and report events of the call and any response to ALS
treatments. An order from the physician is required before stopping the
resuscitation procedure.
a. Affirm each of the following:
o The patient is a NORMOTHERMIC adult, in cardiac arrest,
which did not occur in the presence of the EMT's;
o The patient remains pulseless in asystole;
o ET and vascular access have been established by appropriate
drug therapy, and CPR attempts have been carried out in accordance
with SOP’s;
o The monitored asystolic arrest interval is at least 10 minutes (there
are no identified reversible causes for this arrest).
b. At the discretion of the medical control physician, the order to withdraw
care may be initiated.
c. Document the time of death, at which resuscitative efforts were
withdrawn.
11. If resuscitation efforts are withdrawn during transport, the patient must be
transported to the ED. If resuscitative efforts are withdrawn, while still at the scene,
the patient will be transported in accordance with local/county procedure.
12. If unable to establish communication with medical control, resuscitative efforts
must be continued until the patient reaches the ED.
WITHDRAW RESUSC.
IMPL: 3/01; REV: 2/10
Region IX Policies
Region IX EMS Plan
Inter-system/Inter-region Transports
Bypass/Diversion
Approved: 10/2/97
Rev. 3/9/10
I.
Effective Date: 3/9/10
Supersedes: 11/1/97
Page No: 1 of 2
PURPOSE
EMS Region IX participants acknowledge the transport of patients by EMS System providers within
the geographic boundaries of the individual EMS systems, as well as the EMS region. We also
acknowledge the transport of patients to receiving facilities located within other EMS regions.
II.
PROTOCOL
A.
Communications
Communications with an EMS system hospital will be initiated by EMS providers at the
point of patient contact. If the receiving facility is different from the hospital initially
contacted, the hospital receiving the initial report will contact the receiving facility to relay
the patient assessment findings.
B.
Patient Care Practice
Prehospital patient care will be provided to all adult and pediatric patients in accordance
with the governing EMS System's protocols specific to the provider's level of licensure and
appropriate for the patient, as determined through patient assessment findings. EMS
patients may only be transported to an emergency department classified as
comprehensive under the Illinois Hospital Licensing Act.
C.
Transport of Patients with Special Needs/Requests
1.
Patient care circumstances may indicate the need to bypass the nearest hospital in
order to best manage the needs of the patient based on the presenting
assessment. Situations involving special needs may include, but are not limited to:
a.
b.
c.
d.
e.
f.
g.
2.
Level I or Level II trauma care (refer to SOPs)
Specialized pediatric or neonatal services (refer to SOPs, EDAP)
The potential for specialized diagnostics (i.e., MRI, CT, etc.)
The potential for specialized services (i.e., CABG, angioplasty,
hypothermia, etc.)
Suspected stroke (refer to SOPs)
Suspected STEMI (based on system policy)
Patient request for transport to a specific healthcare facility
There are many factors which must be considered in making a decision to transport
to a specialty (tertiary) facility. Risk versus benefit must be determined by a
physician based on the following:
a.
b.
c.
d.
Severity of patient condition
Time and distance factors which may affect patient outcome
Regional trauma guidelines
Local ordinances concerning transport boundaries for
ambulances
municipal
Region IX EMS Plan
Inter-system/Inter-region Transports and Bypass/Diversion
Approved: 10/2/97
Rev. 3/9/10
3.
III.
Supersedes: 11/1/97
Page No: 2 of 2
The decision to approve or deny a transport of this nature rests with the EMS
Medical Director or his/her designee responsible for the on-line medical direction of
the call.
System Bypass/Diversion
The Region recognizes that each EMS system has a mechanism in place to effectively manage
bypass/diversion situations related to capacity census. Transfer patterns are considered in the
notification of EMS agencies when a bypass/diversion situation exists. Neighboring hospitals which
may be impacted by the situation will also be notified. There are specific instances where
bypass/diversion may not be possible:
A.
B.
C.
D.
IV.
The patient is critical and unable to tolerate transport to a more distant comprehensive
medical facility
The patient refuses transport to another medical facility
The patient assessment does not indicate the need for patient admission to the hospital for
inpatient stay
OB emergencies
Quality Assurance/Continuous Quality Improvement
Patient care issues related to inter-system/inter-region transports will be directed to the EMS
provider's EMS System for follow-up. Unresolved issues will be managed in accordance with
System and regional conflict resolution policies.
Region IX EMS Plan
CONTINUING EDUCATION POLICY
Approved: 10/2/97
Rev. 3/9/10
I.
II.
Supersedes: 11/1/97
Page No.: 1 of 1
Policy
A.
The Illinois Department of Public Health (IDPH), Division of EMS, published Rules and
Regulations stipulating that an EMT (A/B, I/D or P) and/or Prehospital RN (PHRN) must
complete 120 hours (h) of continuing education (CE), addressing both adult and pediatric
care in each four-year licensure cycle, earned in accordance with Region IX and their EMS
System's policies.
B.
Each System will hold EMS CE offerings. EMTs/PHRNs are ultimately responsible to
complete state and system-required CE.
C.
EMTs and PHRNs within Region IX are required to complete all mandatory CE offerings
within each of the Systems with which they are affiliated unless prior exemption is granted
by the EMS System holding the mandatory review.
D.
Although CE records are kept at system hospitals, each EMT/PHRN is responsible for
keeping their own records and maintaining a copy of time accrued to compare with any
record kept by the System or by their employer.
E.
Didactic CE approved by a System's EMS Medical Director may be accepted by any of the
other systems within Region IX as long as the content is based on topics or materials from
the National EMS Education Standards. Approval of other continuing education will be
determined on an individual System basis.
F.
Clinical CE may be awarded as per existing Systems' policies.
G.
No more than 25% of the hours accrued by one individual towards relicensure may be in
the same subject.
Options for Obtaining CE Hours
A.
CE options are System-specific. See individual System policies.
B.
If an EMT, paramedic or ECRN wishes to have EMS CE credits accepted by a System in
Region IX that did not conduct the educational offering, submit evidence of attendance or
successful completion of class requirements which lists the date, times, topic, site code
number and the signature of the educator presenting the class to the EMS System
Coordinator for consideration.
Reference: EMS Rules Sections 515.560, 515.570 and 515.580
Region IX EMS Policy
DO NOT RESUSCITATE (DNR)
Approved: 3/1/01
Rev. 3/9/10
Effective date: 3/9/10
Supersedes: 7/1/01
Page No.: 1 of 2
Reference: EMS Rules Section 515.380 (June 10, 2000)
I.
II.
POLICY
A.
For purposes of this policy, a Do Not Resuscitate order refers to the withholding of
cardiopulmonary resuscitation (CPR), electrical therapy to include pacing, cardioversion
and defibrillation, tracheal intubation and manually or mechanically assisted ventilation
unless otherwise stated on the DNR order.
B.
This policy shall include, but not be limited to, cardiac arrest/DNR situations arising in longterm care facilities, with hospice and home care patients, and with patients who arrest
during inter-hospital transfers or transportation to or from home.
PROCEDURE
A.
CPR may be withheld in situations where explicit signs of biological death are present
including decapitation, rigor mortis without profound hypothermia, profound dependent
lividity, incineration, mummification, putrefaction, decomposition, frozen state, severe
trauma in which performance of CPR is not possible, or drowning with documented
submersion time of greater than one hour. CPR shall be withheld if the patient has been
declared dead by the coroner, medical examiner, or a licensed physician. Documentation
shall include recording such information on the run sheet and requesting the physician or
coroner to sign the run sheet (if applicable).
B.
For situations not covered by this policy or where circumstances or the order is unclear,
resuscitative procedures shall be followed when indicated unless a valid DNR order is
present or is issued by medical direction.
C.
The Illinois Department of Public Health approved "Do Not Resuscitate (DNR) Order" form
which has not been revoked shall be the expected and accepted document for use in the
prehospital setting.
In the absence of a completed IDPH approved form a valid DNR order shall consist
of a written document, which has not been revoked, containing at least the following
information:
D.
1.
Name of the patient;
2.
Name and signature of attending physician;
3.
Effective date: The validity of an order will not expire unless modified or revoked at any
time by the maker;
4.
The words "Do Not Resuscitate" or "DNR" (pre-checked on form);
5.
Evidence of consent - either:
a.
signature of patient,
b.
signature of legal guardian, or
c.
signature of durable power of attorney for health care agent (see Durable
Power of Attorney of Health care policy), or
d.
signature of surrogate decision-maker (an individual previously named by
a physician in accordance with the Illinois Health Care Surrogate Act to
make decisions on behalf of the patient; and).
6.
1 witness signature.
A living will by itself cannot be recognized by prehospital care providers, however, a living
will or advanced directive attached to a DNR order may be considered evidence of patient
consent.
DO NOT RESUSCITATE (DNR)
Approved: 3/1/01
Rev. 3/9/10
E.
Supersedes: 7/1/01
Page No.: 2 of 2
Revocation of a DNR order shall be made in one or more of the following ways:
1.
The order is physically destroyed or verbally rescinded by the physician who signed
the order, or
2.
The order is physically destroyed or verbally rescinded by the person who gave
consent to the order.
F.
EMS personnel shall make a reasonable attempt to verify the identify of the patient named
in the DNR order (for example, identification by another person or an identifying bracelet).
G.
EMS personnel will act on DNR orders only after consultation with an appropriate System
hospital. ECRNs may approve DNR orders unless the situation is unclear, at which time
consultation with an ED physician is indicated for clarification.
H.
All levels of EMTs and prehospital RNs will be authorized to respond to a valid DNR order.
I.
If appropriate, the coroner or medical examiner will be notified in accordance with System
policy.
J.
Continuing education will address implementation of DNR orders annually or as
appropriate.
K.
All cases with DNR orders implemented will be reviewed as a component of the System's
quality improvement program. Each System will submit an annual report to the Illinois
Department of Public Health indicating issues or problems that have been identified and the
System's responses to those issues or problems.
Region IX EMS Plan
DURABLE POWER OF ATTORNEY FOR HEALTH CARE
Approved: 10/2/97
Page No.: 1 of 1
Reviewed: 3/09/10
Reference: IL Rev. Stat, Ch 110½, Par. 801-1 et seq.
I.
POLICY
A.
Durable Power of Attorney for Health Care is defined by Illinois law as the designation to an
agent named in the document broad powers to make health care decisions, including
power to require, consent to, or to withdraw any type of personal care or medical treatment
for any physical or mental condition. The document must describe the scope of authority
given to the agent with limitations defined by the patient in the document.
B.
When a Durable Power of Attorney for Health Care agent and document is physically
present, consultation with medical direction is required to clarify any requests regarding the
patient's treatment.
C.
The agent named in a Durable Power of Attorney for Health Care document may consent to
or refuse any or all care, including resuscitation, on behalf of the patient. Any requests must
be reported to medical direction and orders issued by an appropriate System hospital to
comply with the agent's request. Follow all subsequent orders of the medical direction
physician, even if such orders contradict the requests of the agent.
D.
The recommended IL Statutory Short Form Power of Attorney for Health Care may be
used, although the law expressly permits the use of any different form.
Region IX EMS Plan
INTER-SYSTEM/REGION CONFLICT
Approved: 10/2/97
I.
Page No.: 1 of 1
Reviewed: 3/9/10
POLICY
A.
When an issue occurs involving two or more EMS Systems in Region IX, the EMS System
Coordinators will attempt resolution with all parties involved.
B.
If resolution cannot be reached, the issue will be referred to the involved EMS Medical
Directors for resolution.
C.
If resolution is not achieved, the issue will be considered by the Region EMS Medical
Directors Committee which will make recommendations for resolution. The EMS Medical
Directors Committee may include appropriate representation from the Region IX EMS
Advisory Board in their discussion.
D.
If the recommendation of the EMS Medical Directors Committee is not acceptable to one or
more of the involved parties, the issue may be referred to IDPH.
Region IX EMS Plan
Paramedic Education Policy
Approved: Draft
Effective Date:
Page No.: 1 of 2
Reviewed:
Supersedes: 7/1/01
Page No.: 1 of 2
Paramedic Education
Approved: 3/1/01
Rev. 3/9/10
I.
II.
III.
Purpose
A.
This policy is to provide uniform guidelines for Paramedic Entrance exam testing and
acceptance into paramedic programs within EMS Region IX.
B.
This policy is to define the procedure for approving out-of-system riders for paramedic
class students during their Field Clinical or Field Internship within Region IX.
Entrance examination procedure
A.
Applicants must complete and submit the Region IX Paramedic Training Course
Application to the EMS System to which he/she is applying for admission.
B.
All applicants are encouraged to apply to the Paramedic Training Program conducted by
the EMS System where they are currently functioning as an EMT and where they will be
completing their Field Clinical /Field Internship.
C.
All applicants must pass the Region IX EMT entrance examination with a minimum score
of 75% or higher. There may be additional testing requirements for reading/math
depending on each individual EMS System’s educational policies.
D.
Applicants failing the EMT entrance examination must wait at least 72 hours prior to
retesting to ensure adequate time to self-remediate areas of deficiency.
E.
Retesting must be completed at the initial testing site. Applicants cannot retake the initial
entrance examination, but are required to take the Region IX approved retest.
F.
Applicants failing the initial and retest examinations must wait one year before applying to
another paramedic training course within Region IX.
Out-of-System Riders for Paramedic Class Students
A.
As per Section 515.520 of the Illinois Administrative Code, before a candidate is
accepted into the program, documentation must be submitted that an EMS System
vehicle and preceptor will be available to accommodate field experience needs.
B.
If an applicant cannot attend a paramedic training course within his/her EMS System,
they must complete the System Agreement form that is attached to the Region IX
Paramedic Training Course Application prior to acceptance in any Region IX Course.
Each case will be evaluated for approval by the appropriate EMS System Coordinators.
C.
Students approved for the out-of-system course must provide a Certificate of Insurance
to the EMS System where they will be completing the Field Clinical/Field Internship.
D.
Students in dual EMS Systems must also complete the System Agreement form if they
want to perform ALS skills in both EMS Systems.
E.
In the event an applicant is unable to attend a paramedic training course within his/her
EMS System, the System Agreement form attached to the Region IX Paramedic Training
Course Application must be completed and evaluated for approval by the appropriate
EMS System Coordinators prior to acceptance to any Region IX Paramedic Course.
F.
Prior to the Field Clinical and/or Field Internship, the Lead Instructor must provide a letter
to the appropriate EMS System Coordinator verifying cognitive and psychomotor
competencies in any skills and procedures that the student will be performing in the field.
Region IX EMS Plan
Paramedic Education Policy
Approved: Draft
Effective Date:
Page No.: 2 of 2
Reviewed:
G.
Progress reports must be sent as the student progresses through the course.
H.
Any patient care errors will be reported to both EMS System Coordinators within 24
hours of occurrence. If the error has an immediate life threatening effect on the patient,
the EMS System Coordinators will be notified immediately.
I.
Students must be supervised by an approved EMS System preceptor at all times when
performing ALS skills. Any student performing ALS skills without a preceptor will be
considered acting outside their scope of practice and will result in disciplinary action for
the student and paramedic.
J.
Any student found not following this policy shall be subject to the program disciplinary
process.
Region IX EMS Plan
Peak Census Ambulance Transport Policy
Approved: 3/9/10
Page No.: 1 of 1
Reviewed:
Peak Census Distribution
Approved: 3/1/01
Rev. 3/9/10
I.
Supersedes: 7/1/01
Page No.: 1 of 2
Policy
The purpose of the Peak Census - Ambulance Transport Policy is to provide reasonable
transport options for EMS agencies affected by high ED census in multiple hospitals within a
defined geographical area. The intent of a coordinated transport distribution plan is to lessen the
need for a specific hospital to need to implement Ambulance Diversion/Bypass actions.
II.
Definition
“Peak Census” occurs when a specific hospital is experiencing near capacity census with limited
access to inpatient beds, critical care equipment, support resources and staffing which impact the
management of patient care. The hospital surge capacity plan may have implemented patient
admission to overflow space, which in turn provides a strain on available support resources and
staffing.
III.
Procedure
A.
Stricken hospital implements their internal PEAK Census response plan and updates the
IDPH HHAN to reflect Peak Census Status.
B.
Assessment is made through review of the IDPH HHAN and direct contact between the
stricken hospital and the surrounding hospitals regarding “Internal Peak Census” status
within the general geographic area- ED-to-ED communication evaluates concern for
pending “Bypass” situations.
C.
EDs of stricken hospitals shall notify the EMS Coordinator of Internal Peak Census
response plan implementation activation. (Associate Hospital EMS Coordinator notifies
the Resource Hospital EMS System Coordinator to implement the plan).
D.
EMS Agencies are notified of the System/Regional Peak Census Distribution Plan for
transport of EMS patients by the EMS System Coordinator from the Resource Hospital.
E.
All hospitals will continue to accept EMS patients who are assessed to have BLS
managed assessment findings.
F.
Each EMS System will develop a distribution plan, which addresses pre-established
transport destinations for the EMS agencies impacted by Peak Census at System
Hospitals.
G.
The EMS System Peak Census Distribution plan will address at least the following:
1.
All unstable patients will be accepted by the closest ED facility regardless of
Peak Census or Bypass status.
2.
OB patients who present in active labor or with complications will be transported
to the closest facility with OB abilities regardless of Peak Census or Bypass
status.
3.
Consideration for transport of pediatric patients, when stricken facilities include a
Pediatric ED center.
4.
Transport requests for delivery to a facility other than the predetermined
destination outlined in the plan, require medical control contact prior to leaving
the scene enroute to the requested destination.
Region IX EMS Plan
Peak Census Ambulance Transport Policy
Approved: 3/9/10
5.
Page No.: 2 of 1
Reviewed:
A procedure for notification of area EDs and EMS agencies in both the
implementation and the discontinuation of the Peak Census Ambulance
Distribution Plan