Rhode Island Emergency Medical Services Statewide EMS ProtocolsOctober 2016Rhode Island Department of Health

General Patient CareSection 1

1.01 Routine Patient Care

General Changes and Additions• Routine Patient Care Protocol

was previously Protocol 1.1 Standard Management of All Patients.

• Significant changes in this protocol are in red solid rectangles and additions are in blue dotted rectangle.

• This protocol is to be practiced by ALL levels of care as it related to their level of licensure, and is denoted at the beginning of all protocols as Routine Patient Care.

ROUTINE

PATIENT

CARE

1.01 Routine Patient CareProtocol Summary• Respond to the scene in a safe

manner• Approach the scene cautiously

and assess scene safety• Utilize Multiple Patient Incident

Protocol if indicated• Bring equipment to the patient• Determine age criteria (Adult

or Pediatric)• If trauma – Evaluate

Mechanism of Injury (MOI)• Document Chief Complaint

(CC), History of Present Illness (HPI), Past Medical History (PMH)

• Perform Primary Assessment• Perform Secondary

Assessment• Treat life threatening

conditions• Assess level of pain • Follow age-appropriate Patient

Comfort Protocols

1.01 Routine Patient CareProtocol Summary• Provide Airway Management• Presume Cardiac etiology in

patients with dyspnea/shortness of breath, or chest pain/discomfort

• ALS may establish IV access in patients that are unstable or potentially unstable or as required for protocol directed medication administration

• Calculations of Pediatric IV fluids

• Use of electronic Infusion Pump

• Obtain a multi-lead ECG in patients with symptoms that suggest Cardiac Ischemia/Infarction.

• Document ALL procedures in Electronic Patient Care Report

• Communicate with MEDICAL CONTROL as indicated

• Practice Safe Transport

1.01 Routine Patient CareProtocol Summary• Practice Safe Transport of

Pediatric Patients• Utilize warning devices and

siren ONLY when transporting patients requiring time sensitive interventions

• Reference Pediatric systolic blood pressure

• Face-to-face verbal report at receiving facility

• Follow EMS Documentation Protocol

• Non-transporting RI licensed ambulances MUST document all care

1.01 Routine Patient Care

1.02 Documentation

Protocol Summary• The Documentation Protocol

is new.• ALL patient contacts in RI

MUST be documented.• Paper documentation is

UNACCEPTABLE. Only accepted if the electronic documentation fails.

• PCR data shall be transmitted to Center of EMS.

• Follow recommendations for adequate documentation.

1.03 Medical Control Protocol Summary• Most appropriately

trained/senior highest licensed EMS provider present at the scene is responsible for direction.

• A private physician that is present and assumes responsibility for care.

• Intervener physician that is present, is appropriately identified, and assumes responsibility for care.

1.04 Biological Death and Deceased Persons

Protocol Summary Protocol previously known as Biological Death.Significant change in recognition of Biological Death and Deceased Persons:Adult: Without vital signs and at least one of the following:

1. Rigor Mortis – Rigid Stiffness of the body

2. Fixed lividity – See Pearls3. Obvious injury incompatible with life

(e.g. decapitation)4. Obvious changes of decomposition

(bloating, skin slippage, extensive green or black skin discoloration).

Pediatric: Without vital signs and at least one of the following:

5. Obvious injury incompatible with life (e.g. decapitation)

6. Obvious changes of decomposition (bloating, skin slippage, extensive green or black skin discoloration).

1.04 Biological Death and Deceased Persons

Protocol Summary • If the above criteria is not

met, then resuscitative care is required unless patient has a MOLST form or Comfort One status.

• The determination of death is not pronouncement of death.

• After determination, Law Enforcement is responsible.

• EMS documentation must be accurate as to specific criteria.

1.05 Mobile Integrated Healthcare

• Mobile Integrated Health is a new program adopted by the RI Department of Health Center for EMS.

• This protocol enables an EMS service to form a coalition of partners for the purpose of providing community based health care services within scope of practice.

• Only Advanced EMT Cardiacs and Paramedics are license to practice within this program.

• To establish a MIH program in RI, interested EMS agencies must provide:

• General Project Description • Community Needs Assessment• Medical Direction

1.05 Mobile Integrated Healthcare

• To establish a MIH program in RI, interested EMS agencies must also provide:

• Patient Interaction Plan that describes EMS role with patients

• Training Plan that describes training provided and lists objectives and outcomes

• Quality Management Program and Data Collection that incorporated all the components of and EMS QM Program as specified in Rules and Regulations

• Documentation of all instances in Patient Care Report

• Scope and Applicability including providing urgent follow-up care , part of a multidisciplinary team, assessing patients and providing on scene treatment without transportation

1.05 Mobile Integrated Healthcare

• To establish a MIH program in RI, interested EMS agencies must also:

• Be a licensed Emergency Medical Services Agency

• Obtain full commitment from patient’s primary care provider

• Respect the roles within scope• Have a process for Referral and

Eligibility

Referral and Eligibility • Referral from PCP • Referral from ED• Referral from Home Nursing

care provider• EMS initiated Referral

1.05 Mobile Integrated Healthcare

• To establish a MIH program in RI, interested EMS agencies must establish coordinated care

• If an emergency exists, then patient needs to be transported

• MIH allows for Field Treatment without transportation

• MIH allows for transportation to a non-hospital facility

• At NO time should EMS practitioners practice OUTSIDE of their SCOPE

Continue on to RI EMS Protocol Education ModulesSection 2