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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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