Protocol 5

Medical Communications

Medical Priorities

Communications with a Receiving Facility

Telephone Communications with Physicians

Quality Management



A.  General Information

1.      All patient related medical communications will be conducted through the Fire Alarm Office by means of recorded telecommunications utilizing only department authorized equipment.

2.      A "Trauma Alert" will be declared and transmitted to Fire Alarm on your dispatch frequency as soon as it is determined that the patient(s) meet our Trauma Alert Criteria (TAC).  The Fire Alarm Communications Operator will then notify the appropriate receiving facility.  This however, will not replace the need for the OIC to contact the receiving facility as soon as possible to relay pertinent patient information.

3.      A “Cardiac Alert” will be declared and transmitted to Fire Alarm immediately upon determining that a patient meets Cardiac Alert Criteria.  The Fire Communications Center will notify the appropriate personnel.  A Cardiac Alert is used for those patients being treated under Protocol 11 and having 12-Lead EKG changes with >1mm ST elevation in limb leads and /or > 2mm ST elevation in chest leads.  This however, will not replace the need for the OIC to contact the receiving facility as soon as possible to relay pertinent patient information.

4.      Use of the Medical Communication Channels is authorized and appropriate under the following circumstances:

a)   When required under medical protocol.
b)   For clarification of a diagnosis or treatment in complex situations not covered by protocol/procedure or, when beyond the paramedic's scope of knowledge.
c)   For instructions covering treatment over and above protocol/procedure.
d)  In situations where medical supervision is deemed necessary or desirable by the prehospital provider.
e)   In situations where consultation or administrative intervention by EMS Division Staff is necessary.
f)    For routine radio checks.

B.  Medical Priorities

1.      Priority I- Critical
Used for patients presenting with an immediately life-threatening illness or critical injury.

2.      Priority II- Serious:
Used for those patients presenting with an illness or injury requiring immediate medical intervention, which has the potential for becoming life threatening if not treated promptly.

3.      Priority III- Stable:
Used for those patients presenting with an illness or injury not requiring immediate medical intervention, or is so easily managed that medical direction is not required.  Also used for notification of impending patient arrival.

4.      Priority IV - Administrative:
Used for all transmissions not involving care of a patient.

5.      Trauma Alert
Used for those patients meeting Trauma Alert Criteria (TAC).

6.      Cardiac Alert
Used for those patients meeting Cardiac Alert Criteria.

C.  Communications with a Receiving Facility

1.      Establish communications with receiving hospital.  Announce name of receiving hospital, followed by department and unit number.

2.      After receiving acknowledgment from hospital, state callers rank and name followed by:

a)   Priority of the call.  Communications with a Trauma Center / Pediatric Trauma Referral Center for patients meeting TAC must begin with the statement "This is a Trauma Alert" and the specific Trauma Alert Criteria.
b)   Age, sex, approximate weight (if appropriate, i.e.: pediatric patients) and chief complaint.
c)   A brief, pertinent history of the present illness, condition, situation, mechanism of injury, etc.
d)  Level of consciousness (oriented to time, place & person), Glasgow Coma Score.
e)   Vital signs (B/P, pulse, respirations).
f)    Physical findings-skin color, temperature and turgor, obvious injuries or deformities, breath sounds, neurological status, EKG.
g)   Treatment given and any results observed.
h)   Estimated time of arrival.

3.      Await response to transmission and be prepared to carry out instructions for further patient management from emergency department physician.

4.      Medication orders received by the paramedic must be repeated back to the hospital prior to administration.  Paramedics receiving treatment orders that exceed or violate accepted medical practice or protocol will:

a)   Re-confirm the treatment order and advise the physician of your belief that it exceeds or violates established protocol.
b)   If unresolved, immediately seek on-line intervention by the Medical Director, Assistant Medical Director(s), or an EMS Division staff officer.

D.  Telephone Communications with Physicians

A physician wishing to consult with the paramedic will be asked for a phone number where he can be reached and advised that his/her call will be returned immediately on a monitored phone line.  The paramedic will then contact FAO and request an "outgoing patch" to the physician's telephone number.  The appropriate receiving facility may also be patched-in to allow for three-way communications if the paramedic so desires.

E.   Quality Management

1.      The following types of calls must have the LifePak or AED data transmitted to the EMS Quality Management Office:
a)   Any Department AED use.
b)   Any Cardiac Alert (whether or not Retavase is administered).
c)   Any cardiac arrest where the LP 12 was used.

2.      Transmit the information via telephone to the EMS QM Office at 786-331-4429.  If using an LP 12, this number will be dialed automatically if you select "DATA" in the "OPTIONS/ARCHIVE" mode and select "EMS".  AED's will dial this number by default.

3.      This transmission will take place within the same shift as the call.  All data shall be sent to the EMS QM Office in DATA MODE Only.

4.      If you use the AED, you will not be able to enter patient information into the AED.  Therefore, you must call 786-331-4423 and leave a message with the following information:

a)   Unit number
b)   Alarm number
c)   Patient's name

5.      If you use the LP 12 and did not enter the patient information you will have to follow #4 above.

6.      Monday morning EMS QM transmissions will be sent in the DATA MODE ONLY.  DO NOT send morning LifePak checks in the FAX mode to the EMS QM Office.


© 2009 Greg Rubin
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