Potential Procedures Potential Procedures for Response to EMS for Response to EMS Agency Request for Agency Request for
Paramedic Paramedic
Vermont EMS District 3Vermont EMS District 3October 2009October 2009
OverviewOverview
Providing paramedic care Providing paramedic care requires a significant commitment requires a significant commitment of resources by an EMS agencyof resources by an EMS agency
Need to clarify expectations and Need to clarify expectations and procedures between agencies procedures between agencies receiving and providing receiving and providing paramedic careparamedic care
OverviewOverview
Goal of system: provide timely Goal of system: provide timely paramedic care to patients in paramedic care to patients in District 3 who would benefit from itDistrict 3 who would benefit from it– by building on existing foundation of by building on existing foundation of
cooperation and assistancecooperation and assistance– through education of EMS providers through education of EMS providers
and community leaders on which pts and community leaders on which pts are most likely to benefit from are most likely to benefit from paramedic careparamedic care
OverviewOverview
Most important principle: Most important principle:
Do what is best for the Do what is best for the patientpatient
AssumptionsAssumptions
The “radio room” has evolved into The “radio room” has evolved into a true Communications Center a true Communications Center
EMS agencies and Comm Ctr will EMS agencies and Comm Ctr will have list of conditions and have list of conditions and situations that may merit situations that may merit immediate call for paramedic immediate call for paramedic responseresponse
AssumptionsAssumptions
EMS crew chief can request paramedic EMS crew chief can request paramedic when may be helpful (first responders when may be helpful (first responders go through crew chief)go through crew chief)
EMS crew chief can cancel paramedic EMS crew chief can cancel paramedic after suitable evaluation of scene or pt after suitable evaluation of scene or pt
On-line medical direction is a resource On-line medical direction is a resource for determining whether to cancelfor determining whether to cancel
AssumptionsAssumptions
INITIALLY, these services are INITIALLY, these services are planning to provide paramedic planning to provide paramedic care: care: – Essex RescueEssex Rescue– Colchester RescueColchester Rescue– South Burlington Fire DeptSouth Burlington Fire Dept
Coverage will increase as more Coverage will increase as more agencies come on lineagencies come on line
What would happen when an EMS What would happen when an EMS agency requests paramedic agency requests paramedic service in District 3?service in District 3?
Assume the non-paramedic Assume the non-paramedic service and a neighboring service and a neighboring paramedic service have signed an paramedic service have signed an agreement for paramedic agreement for paramedic interceptsintercepts
Comm Center Role: Comm Center Role: – coordinate and communicate with coordinate and communicate with
paramedic servicesparamedic services– NOT command and control – full NOT command and control – full
authority remains with the servicesauthority remains with the services– take daily roll call to determine take daily roll call to determine
which paramedic services availablewhich paramedic services available
Scenario Scenario
High speed MVC with pt High speed MVC with pt ejected in town without ejected in town without paramedic serviceparamedic service
Crew chief requests Crew chief requests paramedic dispatchparamedic dispatch
Comm Ctr coordinates Comm Ctr coordinates dispatching of first dispatching of first available paramedicavailable paramedic
Scenario Scenario
If paramedic available, responds in If paramedic available, responds in response vehicleresponse vehicle
Crew treats and packages pt for Crew treats and packages pt for transporttransport– If paramedic arrives before ambulance If paramedic arrives before ambulance
leaves scene, gets in ambulanceleaves scene, gets in ambulance– If ambulance has left, crew chief and If ambulance has left, crew chief and
paramedic coordinate rendezvous if paramedic coordinate rendezvous if feasiblefeasible
Scenario Scenario
If ambulance and paramedic If ambulance and paramedic rendezvous, paramedic gets in rendezvous, paramedic gets in ambulance and works with crew ambulance and works with crew treating pt during transporttreating pt during transport
If no rendezvous, paramedic If no rendezvous, paramedic cancels response and ambulance cancels response and ambulance continues transport continues transport
Scenario Scenario
If paramedic not initially If paramedic not initially available, Comm Ctr coordinates available, Comm Ctr coordinates dispatch of closest paramedic dispatch of closest paramedic
Scenario Scenario
ResultResult– the only time transport the only time transport maymay be be
delayed is in unusual circumstance delayed is in unusual circumstance when the ambulance and paramedic when the ambulance and paramedic agree (with medical direction agree (with medical direction consult, when appropriate) that consult, when appropriate) that paramedic interventions justify paramedic interventions justify delaydelay
Scenario Scenario
ResultsResults– If no ambulance crew member able If no ambulance crew member able
to drive paramedic vehicle to to drive paramedic vehicle to hospital, ambulance returns hospital, ambulance returns paramedic to vehicle after callparamedic to vehicle after call
– Ambulance bills for treatment and Ambulance bills for treatment and transporttransport
– Cost of paramedic response Cost of paramedic response determined beforehanddetermined beforehand
Crew chief requests dispatch of Crew chief requests dispatch of paramedicparamedicClosest paramedic available?Closest paramedic available?
YES
NOParamedic respondsParamedic respondsArrive before ambulance leaves Arrive before ambulance leaves scene?scene?
YESAmbulance transports Ambulance transports
with paramedic on with paramedic on boardboard
NOAmbulance & paramedic Ambulance & paramedic conferconferIs rendezvous feasible?Is rendezvous feasible?
YES
NO
Ambulance & paramedic Ambulance & paramedic meetmeet
Paramedic cancels and Paramedic cancels and ambulance transports without ambulance transports without paramedic paramedic
Dispatcher consults back-up listDispatcher consults back-up listIf no other paramedic available, If no other paramedic available, ambulance treats & transports ambulance treats & transports alonealone
Algorithm for Dispatch of Algorithm for Dispatch of ParamedicParamedic
Determination of Determination of CriteriaCriteria Adopted criteria based on Adopted criteria based on
nationwide priority dispatch as well nationwide priority dispatch as well as models currently being used in as models currently being used in the state of VT and New Englandthe state of VT and New England– Regional Ambulance (Rutland) Regional Ambulance (Rutland) – CALEX Ambulance CALEX Ambulance – Rescue IncRescue Inc– Southern MaineSouthern Maine
Criteria for Paramedic Criteria for Paramedic DispatchDispatch Cardiac: chest pain, chest pressure, Cardiac: chest pain, chest pressure,
dysrhythmias, cardiac arrestdysrhythmias, cardiac arrest Respiratory: dyspnea, apnea, Respiratory: dyspnea, apnea,
asthma, COPD exacerbationasthma, COPD exacerbation Unconscious/unresponsiveUnconscious/unresponsive CVA/StrokeCVA/Stroke Overdose/poisoningOverdose/poisoning Gunshot wound/stabbingGunshot wound/stabbing
CriteriaCriteria
Allergic reaction/symptomatic insect Allergic reaction/symptomatic insect stings/anaphylaxisstings/anaphylaxis
MVC with: multiple patients, car vs. MVC with: multiple patients, car vs. pedestrian/bicycle/motorcyclepedestrian/bicycle/motorcycle
Obvious major mechanisms of Obvious major mechanisms of trauma: fall >15 feet, crush injuries, trauma: fall >15 feet, crush injuries, injury involving machinery/power injury involving machinery/power toolstools
Pain management as requiredPain management as required
CriteriaCriteria
Pediatric patients meeting any of Pediatric patients meeting any of previous criteriaprevious criteria
Future criterion:Future criterion:– Request by trained personnel on Request by trained personnel on
scenescene