A. GENERAL
PROCEDURES
1. MPSCS 800 MHz
talkgroups are to be used by all advanced, limited advanced and basic
ambulances so equipped for communication with On-Line Medical Control
when responding to emergency calls. These talkgroups may be used for
non-emergency communications only when there is no emergency radio
traffic.
V.H.F.
(155.340) is primarily to be used for hospital communication with EMS
units not equipped with Monroe County 800 MHz talkgroups or when
activated during a disaster.
Advanced and
limited advanced units will receive on-line medical control for advanced
or limited advanced procedures only on 800 MHz talkgroups or telephone
lines that can be connected into the voice recording system. The
telephone numbers are:
(734) 240-8477
or (734) 240-8488.
UHF med channel
MED 2 can also be utilized for ambulance to medical control
communications if the other methods are not available for some reason.
NOTE:
Med 2 should be your last option for communications due to coverage
weaknesses.
2. Whenever
contacting Monroe County Medical Control, mobile units are to identify
themselves by firm/organization affiliation, County ID number, unit type
and unit number. Unit type includes:
ALPHA Advanced Life Support
Ambulance
BRAVO Basic Life Support Ambulance
CHARLIE Supervisory Vehicle
DELTA Physician Vehicle
ECHO Adv. Life Support
Non-Transport Vehicle
HOTEL Air Ambulance or Helicopter
LIFE Limited Advance Life
Support Ambulance
MIKE Limited Adv. Life Support
Non-Transport Vehicle
NOVEMBER Neonatal Unit
ROMEO Rescue & Extrication Unit
TANGO Basic Life Support
Non-Transport Vehicle
Example:
"Monroe Fire, 58 Alpha 11 to Mercy on 58MMH4".
3. Ambulance crews
are to notify Monroe County Medical Control of any changes in status.
4. Any unit
declaring an emergency of higher priority is to be given immediate use
of the radio system: Priority 1 - 5 (See Monroe County EMS Definitions
- Appendix J).
5.
All requests for additional assistance are to be made through
Monroe County Central Dispatch.
B. MEDICAL CHANNEL
ASSIGNMENT FOR TRANSPORTING UNITS
1. EMS units are
to contact on-line Medical Control on the designated EMS talkgroup
immediately after notifying Monroe County Central Dispatch of being en
route to scene.
2. After
acknowledgment by Medical Control, the EMS unit is to briefly describe
the type of run, location of run and the closest hospital.
3. Mercy Memorial
Hospital Emergency Department will function as Medical Control for the
run and assign a run number.
4. If the ultimate
destination is out of county, Medical Control will contact receiving
facility with report.
C. ON-LINE MEDICAL
CONTROL PROCEDURES FOR ASSIGNMENT OF MEDICAL TALKGROUP
1. Acknowledge
calling EMS unit.
2. Apprise
emergency room physician to type of call and determine if he/she will
act as on-line medical control.
3. Assign a run
number to the calling unit.
4. Pre-designated MED talkgroups are:
58MMH3 - contracted private provider
58MMH4 - all fire departments
NOTE:
Non-transporting fire department units may utilize 58MMH4 for Patient
Refusals (AMA).
5. Participate
with radio check from mobile unit.
6. Follow
emergency department procedures for voice recording and record keeping.
D. MEDICAL
INFORMATION TO BE TRANSMITTED TO ON-LINE MEDICAL CONTROL FOR ALL
EMERGENCY PATIENTS
1. After Medical Control answers, EMS units will proceed
with either the EMS Short Report or the EMS Long Report (See Pages D-4
through D-8).
2. Medical Control will make clear that the transmission
has been received and understood. Instructions may be given at that
time, further information or clarification may be requested, or
termination of the transmission may be affected.
3. EMS units are
to confirm and repeat all orders they receive.
4. EMS units and
Medical Control must each confirm that all transmissions are complete
prior to terminating communication.
EMS SHORT REPORT
GENERAL
- Agency/Unit
Number
-
Priority/Number of Patients
- Hospital
Destination and ETA
- Age and Sex
- Chief
Complaint
- Brief
History of C/C
EXAM
- Mental
Status
- Vital Signs
- Brief
Description of Illness/Injury
TREATMENT
- Treatment
in Progress
- Treatment Requested
EMS FULL REPORT
GENERAL
- Agency/Unit
Number
-
Priority/Number of Patients
- Hospital
Destination and ETA
- Age and Sex
- Chief
Complaint
- History of
C/C
EXAM
- Mental
Status
- Vital Signs
- HEENT
-
Cardiopulmonary
-
Abdomen/Pelvis
-
Extremities/Skin
HISTORY
- PMH/PSH
- Medication
and Allergies
TREATMENT
- Treatment
Given
- Treatment
Requested
EMS REPORTS -
Explanation of Terms
GENERAL
Agency/Unit #
Identify
the Agency and Unit # calling and identify other agencies on scene.
Priority/ # of Patients
Identify the # of
patients and the priority of each. Give patient reports in order of
priority - highest priority first.
Hospital Destination and ETA
Identify the most
probable hospital to which the patient(s) will be transported. If
multiple critical patients, advise Medical Control of the closest 2 or 3
hospitals which could be accessed. Identify the estimated time the
patient(s) will arrive at the hospital.
Age and Sex
Report age and sex of
patient. Include race. Never announce the patient's name or
initials over the radio.
Chief Complaint
Identify the main
illness/injury in one short sentence.
Brief History of Chief Complaint
Describe events and/or
symptoms leading up to main illness/injury - limit to one sentence.
History of Chief Complaint
Describe events and/or
symptoms leading up to main illness/injury - include all pertinent
information and any history of similar events.
EXAM
Mental Status
Describe patient's
level of consciousness or responsiveness (i.e.., AVPU - Alert,
responds to Verbal stimuli, responds to Pain, Unresponsive)
and degree of orientation.
Vital Signs
If initial vital signs
have been obtained, give pulse rate, blood pressure, respiratory rate
and O2 saturation (if available). If vital signs cannot be obtained,
indicate if pulses and respirations are present.
Brief Description of Illness/Injury
Briefly describe extent
and severity of illness/injury including pertinent signs and symptoms.
HEENT
Describe any pertinent
positive or negative findings on the examination of the head, eyes,
ears, nose, and throat/neck.
Cardiopulmonary
Describe heart sounds,
pulse rate, pulse quality, cardiac rhythm, lung sounds, respiratory
effort, chest movement and chest appearance.
Abdomen/Pelvis
Describe findings on
the examination of the abdomen, flank area and the pelvis.
Extremities/Skin
Describe findings on
the examination of all extremities and the skin.
HISTORY
PMH/PSH
Any pertinent past
medical history or past surgical history which may relate to the
patient's current condition.
Medications and Allergies
Any medications that
the patient is currently taking which may relate to the current
condition (prescription or OTC) and any medications that the patient is
allergic to.
TREATMENT
Treatment Given
Describe any
treatment which has been given (including that which was done by family
or the patient) prior to radio communication.
Treatment in Progress
Briefly
describe any treatment currently being administered to the patient.
Treatment Requested
Identify any requests
for treatments/procedures/medications. Repeat back over radio all
treatment/procedure/medication orders received from Medical Control
DISPATCH AND
TRANSPORT PROCEDURES
A. DISPATCH
PROCEDURES
1. Order of
Vehicle Dispatch
a. When
appropriate the first responder is to be dispatched on all calls for
medical assistance that are of an emergency nature.
1. Fire rescue
vehicles, where available, are to be sent as the first responder.
2. In areas not
served by a fire rescue vehicle, the basic ambulance assigned to the
area is to be sent as the first responder.
b. In the case of
calls for emergency medical conditions simultaneously dispatch the
following:
1. First Responder
personnel
2.
Advanced Life Support Vehicle
2. METHOD OF
DISPATCH
a. Monroe County Central Dispatch (MCCD) will notify ambulance
services of emergency calls by
placing a telephone call to the ambulance service's dispatch center.
Exceptions will be made to this procedure when telephone disruption has
occurred or Monroe County Central Dispatch is aware that a particular
ambulance is available to communicate on the MPSCS.
b. Upon receipt of
a call from Monroe County Central Dispatch, the ambulance service is to
indicate to the MCCD the location from which a response is being
initiated and an approximate E.T.A.
c. If the
ambulance service being given a call is unable to initiate a safe and
timely response, the service shall initiate mutual aid to provide a
timely response.
3.
NOTIFICATION WHEN NO AMBULANCE IS AVAILABLE
Any
time that an ambulance service, having all or part of Monroe County as
its primary service area, does not have an ambulance staffed according
to P.A. 375 of 2000 and applicable rules available for immediate
response within the bounds of the primary geographical service area, the
ambulance operation shall immediately notify Monroe County Central
Dispatch and Monroe County Medical Control where an ongoing record will
be kept of each operations' status.
Monroe County Central
Dispatch will notify another land based ambulance operation that
provides service within Monroe County, and that serves an area that
overlaps or is contiguous to the ambulance service that is unavailable,
of the potential for increased service requests.
When being contacted in
this fashion, the covering ambulance service will be informed that it
may be necessary for them to respond within another provider's area. If
no other Monroe County based ambulance service is available, an
ambulance operation whose service area is contiguous to Monroe County
will be notified and requested to respond through a pre-arranged mutual
aid agreement/policy.
B. TRANSPORT
PROCEDURES
1. Once an
Advanced Life Support (ALS) unit has been dispatched by protocol or
request of the first responder, no basic ambulance is to initiate
transport prior to the arrival of the ALS unit unless the basic unit is
going to intercept the ALS unit or transport is ordered by on-line
medical control.
The following cases
must be transported via ALS unit or with continued ALS care unless
otherwise directed by on-line medical control.
a. Life
threatening or potentially life threatening emergencies.
b. Whenever any
medication, IV solution or any other invasive medical procedure is
administered.
2. Consultation on
all patients seen by ALS units is required. Other patients must,
when practical, be transported via basic ambulance or other means when
there is no threat to life after consultation with and
approval of on-line medical control.
3. Patients
refusing treatment or transport should sign the refusal of treatment
form and should be made fully aware of possible consequences of their
specific conditions (family member signature is also highly desirable).
4. Transport will
be made by ALS units to the nearest medical facility capable of handling
the emergency unless on-line medical control concurs with the patient's
request.
5. See helicopter
policy.
EMERGENCY MEDICAL PRIORITY DISPATCH
PURPOSE:
1. To obtain
necessary patient information from a caller requesting emergency medical
services.
2. To determine
the priority level of response required for emergency medical service
vehicles when responding to a medical emergency or injury accident,
including which resources are needed.
3. To dispatch the
appropriate emergency medical service agencies to the scene of a medical
emergency or injury accident.
4. To relay
all important, pertinent patient information to the responding EMS
agencies.
5. To provide
verbal instructions of initial basic treatments and simple life-saving
techniques (pre-arrival instructions) to the caller requesting EMS
response, thereby providing patient treatment before arrival of any EMS
personnel at the scene.
6. To limit
overuse and duplication of emergency medical service resources.
7. To improve
safety of EMS personnel and the public when EMS vehicles are responding
to medical emergencies or injury accidents,
QUALIFICATIONS:
Emergency Medical Priority Dispatch for Monroe County is
based on using the "Advanced Medical Priority Dispatch System" provided
by Medical Priority Consultants. All Communications Specialists are to
be certified by attending a twenty-four (24) hour training program and
successfully passing a written test. Communication Specialists are
further required to complete twenty-four (24) hours of continuing
education during a two year period to remain certified.
AGENCIES:
- Monroe
County Central Dispatch
- All
private ambulance services responding in Monroe County
- All Monroe
County Fire Departments
- Monroe
County Medical Control Authority
DISPATCH PROCEDURES:
Calls received direct
to the appropriate Dispatch Center will be taken and handled per the
Medical
Priority Dispatch
System. All unknown calls received where no information can be obtained
will be dispatched as a "Bravo Response".
The order of dispatch
will be:
1) Medical
First Responders (MFR)
2) The
Ambulance service
The radio procedure for
dispatching EMS agencies will be as follows:
1. Radio or
telephone announcement advising the appropriate department of the call
be dispatched (See EMS Definitions - EMS Response Levels).
2. After
contacting the appropriate agency, the following information will be
provided:
- type of call
(rescue, etc.)
- location
- chief
complaint
- age
- number of
patients
- level of consciousness
- sex
- respiratory status
- priority
level of response
- other pertinent information
3. As required,
the Medical First Responder department's siren will be activated.
4. At the time the
department responds to the radio, the above information will be repeated
to ensure acknowledgment of the call and accuracy of the information
received. Any updates or further information obtained after the initial
dispatch will be relayed to the Medical First Responders and ambulances.
5. Ambulance dispatch
will be given to the appropriate service(s) using the same format and
providing the same information given to the Medical First Responders.
6. In the event
the ambulance service is being dispatched into an area not serviced by
Medical First Responders, the ambulance will then be given the same
priority level of response as a Medical First Responder
7. An emergency
call direct to the ambulance service from the public will be relayed to
the Monroe County Central Dispatch.
CONTINUOUS QUALITY IMPROVEMENT PROCESS:
If a question, concern,
complaint or other problem arises involving the quality or
appropriateness of EMPD, the following steps are to be taken for
resolution:
1. Contact the
appropriate dispatch administrator to discuss the issue. If the issue
cannot be readily resolved, proceed to Step 2.
2. In writing,
forward the issue to the Continuous Quality Improvement (CQI) Committee
of the Monroe County Medical Control Authority for audit. Include in
writing the following:
- Date
- Time of day
- Run number
- Name of
individual and agency requesting audit
-
Explanation of Issue and circumstances
- Reason for
audit request
3. Complete the
appropriate Complaint Report Audit Request form and forward to Mercy
Memorial Hospital Emergency Department for review by the Continuous
Quality Improvement Committee.
Audit Process:
The CQI Committee of
the Monroe County Medical Control Authority will address all audit
requests of the EMPD System.
1. All written
audit requests will be reviewed by the Committee.
2. Investigation
of an issue will include any or all of the following which apply:
Review of Dispatch Tape
Review of EMS Run Reports
Interview Parties Involved
Evaluate Patient Treatment and Outcome
3. Following the
investigative phase, the CQI Committee will take appropriate action
which may include education, warning, or recommendation of disciplinary
Action of the individual(s) involved.
4.
Recommendations of disciplinary action will be taken to the Medical
Control Authority. Other issues not resolved by the CQI Committee will
be forwarded to the Medical Control Authority for action.
5. An agency's
failure to comply with Monroe County Medical Control Authority Protocols
will be reported to the Michigan Department of Community Health -
Division of Emergency Medical Services as required by the rules for
Public Act 179 of 1990.
AMBULANCE MORNING RADIO CHECKS
PURPOSE:
To assure proper
functioning of radio equipment.
PROCEDURE:
1. A morning radio
check will be done each morning before 10:00 am. Each ALS unit and the
crews will be identified at that time.
2. Outcome of each
radio check will be recorded on the "Morning Radio Check Sheet" by MMH
ED personnel.
3. If equipment is
not functioning properly, plans will be made to correct the problem and
a repeat check will be made that same morning.
4. A monthly
compliance check will be done by the EMS CQI Committee to include the
following:
a. Full compliance
of personnel staffing of ALS units with two (2) paramedics.
b. Radio checks
done daily.
c. Equipment
failure was corrected and rechecked the same day.
Revised: March 2005
Medical Control Approved: March 2005 EMS Division
Approved:_June 2005
