TO: ALS and BLS Ambulance Providers Base and Receiving

TO: ALS and BLS Ambulance Providers Base and Receiving Hospitals Continuing Education Providers Fire Departments Training Centers Other Interested parties FROM: Karen Petrilla, EMS Specialist RE: Protocol, Policy and Procedure Manual Update DATE: September 1, 2010 Attached are the new and updated EMS policies that will go into effect on October 1, 2010. These polices have been reviewed and approved by Humberto Ochoa, MD, the EMS Agency Medical Director, and Bruce Barton, EMS Agency Director. You will note that some policies are in the new format, while others remain in the older format. As we transition to a new policy manual, all policies will eventually be in the new style. 2300, Certificate Review Process - revision 3200, EMT Certification - revision 3210, EMT Recertification - revision 3220, EMT Certification by Challenge - revision 5205, Equipment and Supplies for First Responder / EMT Emergency Apparatus - revision 5210, Equipment and Supplies for Basic Life Support Ambulances - revision 5225, Personal Protective Equipment (PPE) for Ambulances - revision 5310, Ambulance Diversion - revision 5712, Continuation of Trauma Care - new 5730, STEMI Receiving Centers - revision 5910, Self-Application (Protection) with an Emergency Escape Hood - revision Policy 5712, Continuation of Trauma Care, is a new policy. This policy allows for the expedited transfer of the critical trauma patient from a non-trauma hospital to a trauma hospital, a process which has historically been a stumbling block in our trauma system. As a non-trauma receiving hospital, if you would like additional information on how to implement this policy, contact Cindi Stoll, RN at our office. (Also review that attached notice from Dr. Ochoa.) Included with these policies are a synopsis of all the changes and an updated Table of Contents for your policy manual. (continued)

Policy Update Memo - Oct 2010 p. 2 of 2 Please distribute to your personnel and schedule training as necessary/required within the next 30 days. Existing copies of these policies should be discarded and replaced with the enclosed policies in your Riverside County Emergency Medical Services Protocol, Policy and Procedures Manual. This update packet should be available on-line at our website - - www.rivcoems.org - - by mid- September. Should you have any questions on these policies, please contact me at the EMS Agency office - - (951) 358 – 5029. Attachments

http://www.rivcoems.org/

Page 1 of 1

Synopsis of Changes - October 2010 2300 - Certificate Review Process totally revised policy to comply with the new 2010 EMT and disciplinary process regulations -- effective date 9-1-10 3200 - EMT Certification revision of policy issued 7-1-10 to comply with additional State changes and a more correct interpretation of the regulations -- effective date 9-1-10 change in the “Payable to” line on MO/CC for payment of State fees rearrangement and clarification of the “responsibilities” sections 3210 - EMT Recertification revision of policy issued 7-1-10 to comply with additional State changes and a more correct interpretation of the regulations -- effective date 9-1-10 change in the “Payable to” line on MO/CC for payment of State fees rearrangement and clarification of the “responsibilities” sections 3220 - EMT Certification by Challenge multiple revisions to comply with the new 2010 EMT process regulations -- effective date 9-1-10 5205 - Equipment and Supplies for First Responder / EMT Emergency Apparatus N-95 respiratory mask replaced by P-100 mask to comply with new OSHA requirements 5210 - Equipment and Supplies for Basic Life Support Ambulances N-95 respiratory mask replaced by P-100 mask to comply with new OSHA requirements 5225 - Personal Protective Equipment (PPE) for Ambulances N-95 respiratory mask replaced by P-100 mask to comply with new OSHA requirements Emergency escape hood now optional equipment for ambulance companies 5310 - Ambulance Diversion trauma diversion criteria clarified; trauma surgeon included in trauma diversion internal authorization process; trauma diversion audited and reported to TAC for review 5712 - Continuation of Trauma Care NEW policy details the steps necessary for a non-trauma hospital to transfer a trauma patient to a trauma center on an emergent/urgent basis 5730 - STEMI Receiving Centers multiple revisions -- some for clarity/specificity, others are actual change of practice or addition 5910 - Self-Application (Protection) with an Emergency Escape Hood

changes made to comply with changes in drug and equipment lists above (5205, 5210, 5225)

RIVERSIDE COUNTY EMS AGENCY POLICY, PROTOCOL, and PROCEDURE MANUAL

TABLE of CONTENTS

POLICY NO. TITLE EFF. DATE

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Section 1000 ADMINISTRATION: The Organization

1000 Riverside County EMS Agency: Mission and Values Statement 7/1/101100 Overview of Riverside County EMS 4/1/971200 State Emergency Medical Services Framework 4/1/971300 Pertinent EMS Legislation 12/1/051400 EMS Agency Organizational Structure 4/1/971500 EMS Agency Roles and Responsibilities 11/1/081510 Emergency Medical Services Director 11/1/031515 Emergency Medical Services Assistant Director 11/1/031520 Emergency Medical Services Medical Director 11/1/031530 Emergency Medical Services Specialist / Senior Specialist 11/1/031540 Trauma Coordinator 11/1/031550 Disaster Preparedness Planner 8/1/021560 Office Assistant I / II / III 4/1/971620 Emergency Medical Care Committee (EMCC) 12/1/051630 Prehospital Medical Advisory Committee (PMAC) 5/1/041700 Service Providers 7/1/101800 Policy Review Procedure 10/1/09

Section 2000 ADMINISTRATION: Quality Assessment / Improvement

2000 Quality Assessment / Improvement Responsibilities 8/1/022100 EMS Agency 4/1/972110 Emergency Medical Dispatch (EMD) Provider Agencies 12/1/052120 EMT-I and First Responder Provider Agencies 2/1/052130 Defibrillation Medical Oversight 11/1/072140 ALS Provider Agencies 4/1/972150 Base Hospitals 4/1/972200 Confidential Incident Review Process 4/1/972300 Certificate Review Process 9/1/102400 Trauma Audit Committee 12/1/052450 Trauma Program Managers Committee 11/1/072500 Receiving Hospital Trauma Patient Registry 7/1/06

Section 3000 ADMINISTRATION: Certification

3000 Fee Schedule 2/1/043100 Continuing Education (CE) For EMS Personnel 1/1/053200 EMT Certification 9/1/103210 EMT Recertification 9/1/103220 EMT Certification by Challenge 9/1/10


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3400 EMT-Paramedic Accreditation 2/1/103410 EMT-Paramedic Continuing Accreditation (Reverification) 2/1/103500 Mobile Intensive Care Nurse (MICN) 2/1/103510 Mobile Intensive Care Nurse (MICN) Reauthorization 2/1/103520 Mobile Intensive Care Nurse (MICN) Authorization by Challenge 2/1/10

Section 4000 ADMINISTRATION: Program Approval

4000 Emergency Medical Technician-I (EMT-I) Training 10/1/094110 EMT AED Service Provider 2/1/054120 First Responder – Defibrillation Provider Agency 2/1/054130 EMT Skills Competency Verification 7/1/104200 Emergency Medical Dispatch (EMD) Training 12/1/054210 Emergency Medical Dispatch (EMD) Provider Agency 12/1/054300 Continuing Education Provider 10/1/094400 Emergency Medical Technician-Paramedic (EMT-P) Training 10/1/09

Section 5000 OPERATIONS: General Policy (BLS/ALS)

5100 Authority for Medical Emergency Scene Management 9/1/065110 Initial Responder Policy 7/1/065120 ALS Responder 4/1/975130 Emergency Medical Services Aircraft Operations, Equipment, and Personnel 7/1/105205 Equipment and Supplies for First Responder / EMT Emergency Apparatus 10/1/105210 Equipment and Supplies for Basic Life Support Ambulances 10/1/105215 Equipment and Supplies for Advanced Life Support Emergency Apparatus 10/1/095220 Equipment and Supplies for Advanced Life Support Ambulances 10/1/095225 Personal Protective Equipment (PPE) for Ambulances 10/1/105230 Radio Communication Standard 6/1/085250 Patient Care Documentation Standards 7/1/105300 ReddiNet Operations 11/1/065310 Ambulance Diversion 10/1/105320 Cancellation / Reduction of Ambulance Equipment At Scene 4/1/975325 Utilization of BLS Ambulance When Primary ALS Ambulance is Delayed 7/1/065330 EMT-P Non-Acceptance of Patient Care Responsibility 11/1/085350 BLS Transport After ALS Assessment for Rural Transport Providers 10/1/095410 Crime Scene Management 4/1/975500 Consent and Refusal of Medical Treatment 10/1/095510 5150 Transport 7/1/995520 Restraints 7/1/995600 Withholding Resuscitation Efforts 7/1/105610 Withdrawal of Resuscitation Efforts 11/1/085620 Do Not Resuscitate (DNR) 11/1/085700 Prehospital Medical Destination 6/1/085710 5712

Trauma Triage Indicators and Destination Continuation of Trauma Care

11/1/06 10/1/10

5720 Burn Patient Destination 6/1/085730 STEMI Receiving Centers 10/1/105800 Multiple Casualty Incident (MCI) Scene Management 7/1/105890 Utilization of Mobile Basic & Advanced Life Support Caches 11/1/065900 Self-Treatment with Auto-Injector Nerve Agent Poisoning Kits 7/1/105910 Self-Application (Protection) with an Emergency Escape Hood 10/1/10


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Section 6000 OPERATIONS: Patient Care Policy (BLS)

6000 Introduction to BLS Protocols 6/1/086020 Preprescribed Medical Devices 7/1/106030 EMT-I Medical Adjuncts Monitoring 6/1/086040 EMT-I Interfacility Transport of Patients With IV Lines 6/1/086050 BLS Defibrillation Protocol 6/1/086060 Axial Spinal Immobilization 6/1/08

Behavioral Emergencies

6100 Assault Victim 11/1/076110 Crisis 11/1/07

Cardiac Emergencies

6200 Chest Pain 11/1/076220 Cardiac Arrest – Severe Bradycardia 11/1/07

Environmental Emergencies

6300 Burns 11/1/076310 Drowning / Near Drowning 11/1/076320 Heat Illness / Hyperthermia 11/1/076330 Hypothermia / Frostbite 11/1/07

Medical Emergencies

6400 Abdominal Pain 11/1/076410 Anaphylaxis 11/1/076420 Hypertensive Emergencies 11/1/076440 Shock (Non-Traumatic) 11/1/07

Neurologic Emergencies

6500 Altered Level of Consciousness / Coma (Non-Diabetic) 11/1/076510 Altered Level of Consciousness / Coma (Complications of Diabetes) 11/1/076520 Acute Cerebrovascular Accident / Transient Ischemic Attack (CVA, TIA) 11/1/076530 Seizures 11/1/076550 Syncope / Near Syncope 11/1/07

OB / Gyn Emergencies

6600 Severe Pre-Eclampsia / Eclampsia 11/1/076610 Imminent Delivery (Normal) 11/1/076620 Imminent Delivery (With Complications) 11/1/076630 Vaginal Hemorrhage without Shock 11/1/076640 Vaginal Hemorrhage with Shock 11/1/076650 Neonatal Resuscitation 11/1/07

Poisonings

6700 Poisons / Drugs 11/1/07 Respiratory Emergencies

6800 Respiratory Arrest 11/1/076810 Acute Respiratory Distress 11/1/076830 Airway Obstruction 11/1/076840 Croup / Epiglottitis 11/1/07


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Traumatic Emergencies

6900 Traumatic Arrest 11/1/076910 Traumatic Shock 11/1/076920 Extremity Trauma 11/1/076950 Head-Neck-Facial Trauma 11/1/07

Section 7000 OPERATIONS: Adult Treatment Protocols (ALS)

7000 Introduction to ALS Protocols 10/1/097010 Management of Controlled Substances 2/1/057020 Physician on Scene 4/1/977030 ALS Interfacility Transfers 2/1/047040 EMT-P Interfacility Transport of Patient with IV Lines 11/1/077050 ALS Unit Reporting Format 6/1/087060 Advanced Life Support Guidelines 7/1/10

Cardiac Emergencies

7200 Cardiac Chest Discomfort 10/1/097210 STEMI Assessment 2/1/087220 Bradycardia 11/1/087230 Paroxysmal Supraventricular Tachycardia (PSVT) 6/1/077240 Wide Complex Tachycardia or Ventricular Tachycardia with Pulses 11/1/077250 Ventricular Fibrillation – Pulseless Ventricular Tachycardia 6/1/077260 Asystole 10/1/097270 Pulseless Electrical Activity (PEA) 10/1/09


7300 Burns 10/1/097320 Heat Illness 12/1/057330 Hypothermia – Frostbite 4/1/97

Medical Emergencies

7410 Allergic Reaction 4/1/977430 Hypoglycemia – Diabetic Ketoacidosis 4/1/977440 Non-Traumatic Shock 10/1/09


7500 Altered Level of Consciousness 12/1/057520 Acute Cerebrovascular Accident 11/1/087530 Status Seizure 12/1/05

OB / Gyn Emergencies

7600 Eclamptic Seizures 11/1/077615 Childbirth 7/1/99

Poisonings

7710 Beta Blockers – Calcium Channel Blockers 7/1/107730 Caustics – Corrosives 4/1/977740 Cyclic Antidepressants 12/1/057750 Narcotics – Sedatives 10/1/09


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7760 Organophosphates 6/1/087770 Dystonic Reactions to Phenothiazine Drugs 4/1/97

Respiratory Emergencies

7800 Respiratory Arrest 4/1/977820 Chronic Obstructive Pulmonary Disease – Asthma – Bronchospasm 6/1/087830 Airway Obstruction 8/1/027850 Acute Pulmonary Edema 10/1/09

Trauma

7900 Traumatic Arrest 7/1/067910 Traumatic Shock 4/1/977920 Abdominal Trauma 4/1/977930 Chest Trauma 4/1/977940 Extremity Trauma 11/1/077950 Head – Neck – Facial Trauma 4/1/97

Section 8000 OPERATIONS: Pediatric Treatment Protocols (ALS)

8000 Principles of Pediatric Treatment 7/1/10 Cardiac Emergencies

8220 Bradycardia 7/1/108230 Tachycardia with Pulses 11/1/088250 Ventricular Fibrillation – Pulseless Ventricular Tachycardia 11/1/068260 Asystole 10/1/008270 Pulseless Electrical Activity (PEA) 2/1/05


8300 Burns 2/1/058320 Heat Illness 12/1/058330 Hypothermia – Frostbite 4/1/97

Medical Emergencies

8410 Allergic Reaction – Anaphylaxis 4/1/978440 Non-Traumatic Shock 4/1/97


8500 Altered Level of Consciousness 12/1/058530 Status Seizure 6/1/08

OB – Newborn

8600 Newborn Resuscitation (less than 24 hours of age) 12/1/05 Poisonings

8730 Caustics – Corrosives 4/1/978740 Cyclic Antidepressants 12/1/058750 Narcotics – Sedatives 6/1/088760 Organophosphates 6/1/088770 Dystonic Reactions to Phenothiazine Drugs 4/1/97


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Respiratory Emergencies

8800 Respiratory Arrest 11/1/038810 Respiratory Distress 10/1/008830 Airway Obstruction 7/1/06

Trauma

8900 Traumatic Arrest 6/1/088910 Traumatic Shock 4/1/978920 Abdominal Trauma 4/1/978930 Chest Trauma 4/1/978940 Extremity Trauma 7/1/108950 Head – Neck – Facial Trauma 4/1/97

APPENDIX

10 End-Tidal CO2 Monitoring Devices 4/1/9717 Endotracheal Introducing Stylet 2/1/0519 Intranasal Administration of Medications 12/1/0520 Intraosseous Infusions 7/1/1025 King Airway 10/1/0928 Multi-Lumen Airway Intubation 7/1/1030 Nasopharyngeal Airway Insertion 4/1/9740 Nasotracheal Intubation 7/1/1045 Needle Cricothyrotomy 4/1/0550 Needle Thoracostomy 4/1/9760 Pediatric Intubation 4/1/9767 Transcutaneous Pacing (TCP) 8/1/9870 Transtracheal Instillation of Medication 6/1/0880 Twelve Lead (12L) EKG 7/1/06

AAddmmiinniissttrraattiivvee PPrroottooccoollss 2300 Effective

September 1, 2010 Review Date

December 31, 2011 Administrative Protocols

Certificate Review Process Approval: REMSA Medical Director

Humberto Ochoa, MD Signature

Applies To EMTs and AEMTs

Approval: REMSA Director Bruce Barton, CCEMT-P

Signature

REMSA – Certificate Review Process Page 2 of 8

4.8 Mitigating evidence; 4.9 Rehabilitation evidence; 4.10 In the case of a criminal conviction, compliance with terms of the sentence and/or court‐

ordered probation; 4.11 Overall criminal record; 4.12 Time that has elapsed since the act(s) or offense(s) occurred; 4.13 If applicable, evidence of expungement proceedings pursuant to Penal Code 1203.4. 4.14 In determining appropriate certification disciplinary action, REMSA may give credit for prior

disciplinary action imposed by the respondent’s employer. PRELIMINARY INQUIRY 1. All information received from credible sources, including information obtained from an application, court and/or law enforcement documents, discovery through medical audit, or the routine follow‐up of a public complaint, shall be evaluated to determine if disciplinary action may be warranted. 2. When an allegation of potential cause for discipline is received or a potential cause for discipline is discovered ‐‐ 2.1 If received by the relevant employer (as defined by Title 22, section 100206), they shall determine its validity and, if found to hold merit, will notify REMSA within three (3) working days 2.2 If received by REMSA, REMSA will determine its validity, and if found to hold merit, will notify the relevant employer within three (3) working days. 2.3 The relevant employer will have first right of refusal for full investigation of the allegation. 2.4 If the relevant employer declines the investigation or the certificate holder is not an employee of a relevant employer, REMSA will conduct the full investigation to validate allegations for disciplinary cause. 2.5 The certificate holder shall be notified of the investigation. 3. Prior to the beginning of the investigation, or at any time during the investigation, REMSA, after consultation with the relevant employer, or without consultation when no relevant employer exists, may temporarily suspend, prior to a hearing, a certificate holder upon a determination of the following:

3.1 The EMT / AEMT has engaged in acts or omissions that constitute grounds for revocation of the certificate; and 3.2 Permitting the EMT / AEMT to continue to engage in certified activity without restriction poses

an imminent threat to the public health and safety.








Signature


INVESTIGATION 1. All investigations involving EMTs or AEMTs employed by a public safety agency as a firefighter shall be conducted in accordance with Chapter 9.6, Division 4, of Title 1 of the Government Code, Sections 3250 et.seq., also known as the Firefighters’ Procedural Bill of Rights. 2. The investigation and certification action process shall be in accordance with Chapter 5 (commencing with Section 11500), Part 1, Division 3, of Title 2 of the Government Code (the California Administrative Procedure Act). 3. All certificate holders or applicants for certification will be permitted to present evidence during the investigation, and mitigating evidence during any hearing or settlement process held. DETERMINATION OF ACTION 1. If the investigation concludes that a violation of H&S Code 1798.200 has been committed and a threat to public health and safety exists, disciplinary action will be imposed on the applicant or certificate holder. Disciplinary action includes:

• denial of a certificate • placing the certificate holder on probation • suspension of the certificate • revocation of the certificate

1.1 If, after conducting the investigation, the relevant employer finds cause for disciplinary action, the relevant employer will create a Disciplinary Action Plan (DAP) and submit it to REMSA.

1.2 REMSA will review the results of the investigation and the DAP. If REMSA determines that the conduct under investigation warrants disciplinary action, and the relevant employer failed to include disciplinary action in the DAP, or the disciplinary action suggested was not in accordance with the Model Disciplinary Orders (MDOs, EMSA publication #134), REMSA can act to impose appropriate disciplinary action against the certificate holder.

2. Upon determining the disciplinary or certification action to be taken, REMSA shall complete and place

in the certification file, or any other file used for any personnel purposes by REMSA, a statement certifying the decision made and the date the decision was made. The decision must contain findings of fact and a determination of issues, together with the disciplinary plan and the date the disciplinary plan shall take effect.

2.1 A temporary suspension order shall take effect upon the date the notice is mailed to the certificate holder. 2.2 For all other certification actions, the effective date shall be thirty days from the date the notice

is mailed to the applicant for, or holder of, the certificate unless another time is specified or an appeal is made.








Signature


3. REMSA shall notify the State EMS Authority of the findings of the investigation and the certification

action taken, and shall enter said information into the state’s Central Registry.

TEMPORARY SUSPENSION ORDER 1. REMSA may temporarily suspend a certificate prior to a hearing if:

1.1 The certificate holder was engaged in acts or omissions that constitute grounds for denial or revocation, AND,

1.2 permitting the certificate holder to continue to engage in certified activity would pose an imminent threat to the public health and safety.

2. Prior to, or concurrent with, initiation of a temporary suspension order, REMSA shall notify and consult

with the relevant employer (if one is present) of the certificate holder. 3. A notice of temporary suspension pending hearing shall be served by certified mail or by personal service to the certificate holder immediately, but no longer than three (3) working days from making the decision to issue the temporary suspension. 3.1 The notice shall include the allegations that allowing the certificate holder to continue to engage in certified activities would pose an imminent threat to the public health and safety. 4. Within three (3) working days of the initiation of the temporary suspension, REMSA and the relevant employer (if one is present) shall jointly investigate the allegation in order that REMSA make a determination of the continuation of the temporary suspension. 4.1 All investigatory information, not otherwise protected by the law, held by REMSA and the

relevant employer shall be shared between the parties via facsimile transmission or overnight mail relative to the decision to temporarily suspend.

5. Within fifteen (15) calendar days of the initiation of the suspension, REMSA will file an Accusation pursuant to Chapter 5 (commencing with Section 11500) of Part 1 of Division 3 of Title 2 of the Government Code (Administrative Procedure Act).

5.1 If the certificate holder files a Notice of Defense in response to the Accusation, a hearing before an Administrative Law Judge (ALJ) will be held within thirty (30) calendar days of REMSA’s receipt of this Notice of Defense. 5.2 The temporary suspension order shall be deemed vacated if REMSA 5.2.1 Fails to serve the Accusation within fifteen (15) calendar days, OR 5.2.2 Fails to make a final determination within fifteen (15) calendar days after receiving a proposed decision from the Administrative Law Judge.








Signature


PROBATION 1. REMSA may place a certificate holder on probation any time an infraction or performance deficiency occurs that indicates a need to monitor the certificate holder’s conduct in the EMS system, in order to protect the public health and safety. 1.1 The term of the probation and any conditions shall be in accordance with the MDOs and its appendices. 1.2 The period of probation shall run only when the certificate holder is actively practicing as an EMT/AEMT within California.

2. An EMT/AEMT whose certification is placed on probation by REMSA must complete the probationary requirements through REMSA.

2.1 If the probation period runs past the expiration date of the certificate, the certificate holder is required to renew the certificate with REMSA prior to its expiration date.

3. Certification shall be fully restored upon successful completion of all terms and conditions of probation. 4. REMSA may revoke or suspend certification if the certificate holder fails to successfully complete the terms of probation. SUSPENSION 1. REMSA may suspend an individual's EMT / AEMT certificate for a specified period of time for

disciplinary cause in order to protect the public health and safety. 2. The term of the suspension and any conditions for reinstatement shall be in accordance with the MDOs. 3. When the term of suspension is completed, the certificate shall be reinstated only if all conditions

for reinstatement have been met. The suspension period will be continued until all conditions have been met.

4. If the suspension period runs past the expiration date of the certificate, the certificate holder is

required to renew the certificate with REMSA prior to its expiration date.








Signature


DENIAL OR REVOCATION 1. REMSA is required by Title 22, Section 100214.3, of the California Code of Regulations (CCR). to deny or revoke for disciplinary cause any EMT/AEMT certificate that has been investigated and verified as having met the any one of the criteria below: 1.1 Has committed any sexually related offense specified under Section 290 of the Penal Code. 1.2 Has been convicted of murder, attempted murder, or murder for hire. 1.3 Has been convicted of two (2) or more felonies* 1.4 Is on parole or probation for any felony*. 1.5 Has been convicted and released from incarceration for said offense during the preceding fifteen (15) years for the crime of manslaughter or involuntary manslaughter. 1.6 Has been convicted and released from incarceration for said offense during the preceding ten (10) years for any offense punishable as a felony.* 1.7 Has been convicted of two (2) or more misdemeanors within the preceding five (5) years for any offense relating to the use, sale, possession, or transportation of narcotics or addictive or dangerous drugs. 1.8 Has been convicted of two (2) or more misdemeanors within the preceding five (5) years for any offense relating to force, threat, violence, or intimidation. 1.9 Has been convicted within the preceding five (5) years of any theft related misdemeanor. * “felony” or “offense punishable as a felony” refers to an offense for which the law prescribes imprisonment in the state prison as either an alternative or the sole penalty, regardless of the sentence the particular defendant received. 2. REMSA may deny or revoke an EMT/AEMT certificate if any of the following apply to its holder: 2.1 Has committed any act involving fraud or intentional dishonesty for personal gain within the preceding seven (7) years. 2.2 Is required to register pursuant to Section 11590 of the Health and Safety Code.

3. Items 1 and 2 above: 3.1 Apply only to convictions where the applicant/certificate holder was prosecuted as an adult. 3.2 Do not apply to convictions that have been pardoned by the Governor. 3.3 Do not apply to the convictions of EMTs/AEMTs who obtained their certificates before July 1,

2010, unless they: 3.3.1 Committed any sexually related offense specified under Penal Code Section 290.

3.3.2 Failed to disclose prior convictions when completing the application for (re)certification. 3.3.3 Are convicted of any misdemeanor or felony after July 1, 2010.








Signature


APPEAL PROCESSES 1. An applicant or certificate holder has the right to appeal a disciplinary decision by requesting a review hearing be scheduled before an administrative law judge (ALJ) from the state Office of Administrative Hearings (OAH). 1.1 Barring unique circumstances, hearings are scheduled at the convenience of the OAH at their court sites in either downtown San Diego or downtown Los Angeles. 1.2 Based on the testimony and evidence presented at the hearing, the ALJ will render an opinion on the disciplinary actions proposed by REMSA. This is an advisory opinion only. 1.3 The REMSA medical director will review the ALJ’s opinion and render the final decision in the matter. NOTIFICATION OF FINAL DECISION 1. The REMSA medical director shall notify the applicant/certificate holder and his/her relevant employer(s) of the final decision on certification action within ten (10) working days after making that determination. 2. The notification of final decision shall be served by certified mail or personal service and shall include the following information:

• The specific allegations or evidence which resulted in the certification action; • The certification action(s) to be taken, and the effective date(s) of the certification action(s), including the duration of the action(s); • Which certificate(s) the certification action applies to in cases of holders of multiple certificates; • A statement that the certificate holder must report the certification action within ten (10) working days to any other LEMSA and relevant employer in whose jurisdiction s/he uses the certificate.

GENERAL PRINCIPLES OF DISCIPLINARY ACTIONS 1. Disciplinary actions taken by REMSA, or any other certifying entity, are valid statewide and will be honored by all other certifying entities for a period of at least twelve (12) months from the effective date of the certification action. 2. An EMT/AEMT whose application was denied or whose certification was revoked is not be eligible to (re)apply, and his/her application will not be honored by any (other) certifying entity for a period of at least twelve (12) months from the effective date of the certification action.








Signature


3. Failure to pass a certification examination or to meet any other requirements for certification or continuation of certification shall be sufficient grounds for denial of a certificate or denial of the renewal of a certificate without prejudice, and without completing the certificate review process.




EMT Certification Approval: REMSA Medical Director


Applies To EMTs


Signature

REMSA – Certification Page 2 of 5

2. Applicant must present a current and valid American Heart Association, American Red Cross, or

California‐approved BCLS/CPR card (“professional” level). 2.1 Information must be typed. 3. Applicant must submit proof of completion of fingerprinting for a California Department of Justice

(DOJ) and FBI criminal offender record information search with subsequent arrest notification. Use of the preprinted Riverside County EMS Agency fingerprint form is mandatory.

4. Applicant must present a completed and signed application disclosing ALL disciplinary actions (denial, revocation, suspension, probation) against any EMS certification/license and/or any health‐related certification/license from this state, another state, or other issuing entity, including any active investigation(s).

5. Applicant must show proof of meeting all of the criteria in one of the following categories: 5.1 Applicant with no prior EMS certifications The applicant must possess:

5.1.1 A valid course completion record from an approved California EMT training program OR from an out‐of‐state (OOS) program utilizing the DOT EMT‐B National Standard Curriculum / National Education Standards and which is approved by that state’s EMS approving authority (proof of such must be supplied by the OOS applicant). Course completion must be within two (2) years of the submission of a completed application packet.

5.1.2 Certificate from the National Registry of EMTs (NREMT) showing successful completion of the written and skills examinations for EMT/ EMT‐B after completion of the above course. 5.1.2.1 In order to be eligible to sit the NREMT written exam, successful completion of

the NREMT skills examination must have been accomplished less than one (1) year prior to the written test date.

5.2 Applicant holding a current, valid California AEMT, EMT‐II or EMT‐P certificate/license 5.2.1 The applicant must possess proof of current California certification/licensure that is in good standing . 5.3 Applicant holding an expired California AEMT, EMT‐II or EMT‐P certificate/license The applicant must possess: 5.3.1 Proof of California certification/licensure that was in good standing at expiration.

Expiration date must be shown/noted. 5.3.2 Proof of continuing education, dependent upon length of expiration. Expired less than 6 months: Submit proof of completion of 24 hours of approved continuing education, OR an approved EMT Refresher course.

Submit an original, completed skills competency verification form, EMSA‐SCV. Expired 6 months or more, but less than 12 months:

Submit proof of completion of 36 hours of approved continuing education (CE), OR a combination of EMT Refresher and CE.

Submit an original, completed skills competency verification form, EMSA‐SCV.






Applies To EMTs


Signature


Expired 12 months or more, but less than 24 months:

Submit proof of completion of 48 hours of approved continuing education (CE), OR a combination of EMT Refresher and CE.

Submit an original, completed skills competency verification form, EMSA‐SCV. Submit proof from the National Registry of EMTs (NREMT) of having passed the written and skills examinations for EMT / EMT‐B within the preceding 12

months. Expired 24 months or more: Continuing education is not acceptable. The applicant must successfully

complete an approved EMT basic training program and meet the requirements of section 5.1 above.

5.3.3 All CE or Refresher course completion certificates, and skills competency verification/test forms submitted to meet the requirements of certification must be dated within two (2) years of the submission date of the completed application packet.

5.4 Applicant holding a current but suspended California AEMT, EMT‐II, or EMT‐P license/certificate The applicant must: 5.4.1 Possess proof of current California certification/licensure with current suspension. 5.4.2 Pass a review board and be approved for certification by the EMS Agency Medical Director. The applicant will be required to submit certain documents for review by the Medical Director and the review board. 5.5 Applicant possessing a current, valid out‐of‐state EMT certification The applicant must possess:

5.5.1 Proof of current out‐of‐state (OOS) certification. 5.5.2 Proof from their OOS certifying agency that their certification is in good standing. 5.5.3 Certificate from the National Registry of EMTs (NREMT) showing successful completion

of the written and skills examinations for EMT/ EMT‐B within the preceding 24 months. 5.5.3.1 In order to be eligible to sit the NREMT written exam, successful completion of

the NREMT skills examination must have been completed less than one (1) year from the written test date.

5.6 Applicants new to California possessing a current, valid National Registry (NR) EMT/EMT‐Basic, AEMT/EMT‐Intermediate, EMT‐P OR a current out‐of state (OOS) AEMT/EMT‐Intermediate or EMT‐P The applicant must possess: 5.6.1 Certificate from the National Registry of EMTs (NREMT) showing successful completion

of that level of written and skills examinations OR proof of current out‐of‐state (OOS) certification.

5.6.2 Proof from the NR or their OOS certifying agency that their certification is in good standing.






Applies To EMTs


Signature


5.7 There may be some instances in which an applicant qualifies for California certification but does

not meet the requirements to sit the National Registry examination. In such cases, an approved alternate exam, testing process, and application process will be provided to the applicant.

6. Applicant shall pay the required fee by submitting payment in the following manner:

6.1 A cashier’s check or money order made payable to EMT Certification Fund, for the State’s portion of the certification fee, currently $75, and

6.2 Cash, or a cashier’s check or money order made payable to REMSA, for the Agency’s portion of the certification fee, currently $25.

7. All applications must be done in person. 7.1 If extenuating circumstances prohibit in‐person submission, a notarized statement (use the

appropriate EMS Agency form) verifying identification shall be submitted with photocopies ‐‐ front and back ‐‐ of items 1 and 2 above along with completion of all other steps. Photocopies must be distinct, and legal ID photo must clearly show the individual.

8. Incomplete application packets will be returned to the applicant with a notice describing what is missing. Those persons required by the EMS Agency to submit materials in addition to those outlined above will have not longer than thirty (30) calendar days to deliver them to the EMS office. EFFECTIVE and EXPIRATION DATES of CERTIFICATION 1. Certification shall be for not greater than two (2) years. 2. The effective date of certification for all applicants shall be that date the individual satisfactorily

completes all certification requirements and submits a completed application to the EMS Agency. 3. The certification expiration date for applicants 3.1 Required to take and pass the written and skills certifying exams, shall be the final day of the

final month of the two (2) year period following their date of passing of the written exam. 3.2 Holding a current California AEMT, EMT‐II, or EMT‐P certificate/license, either valid or

suspended, shall be the expiration date of that certification or license. 3.3 Holding a California AEMT, EMT‐II or EMT‐P certificate/license expired less than twelve (12)

months, shall be two years from the date of submission of a completed application packet. 3.4 Holding a current out‐of state (OOS) AEMT/EMT‐Intermediate or EMT‐P certificate/license, shall

be the expiration date as stated on their OOS certification, but in no case shall it exceed two (2) years from the date of their completed application packet.

3.5 New to California possessing a current, valid National Registry (NR) EMT/EMT‐Basic, AEMT/EMT‐Intermediate, or EMT‐P certificate, shall be two (2) years from the date of their

passing of the NR exam or submission of a complete application packet, whichever is soonest. 4. Certification expires on the final day of the final month of the prescribed period.






Applies To EMTs


Signature


The RESPONSIBILITIES of CERTIFICATION / PRACTICE in RIVERSIDE COUNTY Duly certified applicants practicing within the jurisdiction of Riverside County EMS Agency (REMSA) shall: 1. Maintain knowledge of and adhere to all Riverside County policies, procedures, and protocols. 2. Project a professional demeanor, exemplifying the mission and values of this Agency (refer to policy #1000). 3. Adhere to the requirements and stipulations of the REMSA county‐wide Continuous Quality Improvement Program (CQIP). 4. Comply with all requests for information from REMSA in connection with medical CQI, incident review, arrest inquiry, and disciplinary investigation/review. 5. Complete all mandatory in‐service/skills training sessions as designated by REMSA, including protocol updates and Performance Improvement Plans. 6. Report, in writing, changes of address, telephone contact information, and/or employment to REMSA within thirty (30) days of the change. Written notification shall include both the old and new information, effective date of the change, and the EMT’s certification number.




EMT Recertification Approval: REMSA Medical Director


Applies To EMTs


Signature

REMSA –Recertification Page 2 of 5

The APPLICATION PROCESS Prior to expiration, applicants for recertification must submit a completed reapplication packet which contains the following documents and materials. It is strongly urged that applicants for recertification submit all such materials a minimum of thirty (30) days prior to their expiration date. 1. A current California EMT card or one expired less than two (2) years, OR a current California AEMT, EMT‐II, or EMT‐P certification/license. 2. A current and valid legal photo I.D. ‐‐ i.e., state driver’s license, state I.D. card, military I.D. card, or passport. 2.1 Temporary driver’s licenses without a picture and military IDs where the applicant is not the primary issuant will not be accepted. 3. A current and valid American Heart Association, American Red Cross, or California‐approved BCLS/CPR card (“professional” level). 3.1 Information must be typed. 4. If the recertification applicant is new to Riverside County, formerly certified with Riverside County but expired over one (1) year, or continuously certified with Riverside County since before 2004, (s)he must submit proof of completion of fingerprinting for a California Department of Justice (DOJ) and FBI criminal offender record information search with subsequent arrest notification. Riverside County EMS Agency must be listed as the recipient of this information. 5. A completed and signed application disclosing ALL disciplinary actions (denial, revocation, suspension,

probation) against any EMS certification/license and/or any health‐related certification/license from this state, another state, or other issuing entity, including any active investigation(s).

6. Proof of meeting all of the criteria in one of the following categories: 6.1 Applicant with a current EMT certification or an EMT certification expired less than six (6) months: 6.1.1 Successful completion of twenty‐four (24) hours of approved EMS continuing education (CE) OR an EMT Refresher from an approved EMT training program. 6.1.2 Submission of an original Skills Competency Verification (SCV) form, EMSA‐SCV (07/03), completed by an approved verifier in accordance with policy #4130, Skills Competency Verification. 6.2 Applicant with an EMT certification expired six (6) months or more, but less than twelve (12) months: 6.2.1 Successful completion of thirty‐six (36) hours of approved EMS continuing education (CE). An EMT Refresher course from an approved EMT training program may substitute for an equivalent amount of CE credits. 6.2.2 Submission of an original Skills Competency Verification (SCV) form, EMSA‐SCV (07/03), completed by an approved verifier in accordance with policy #4130, Skills Competency Verification.






Applies To EMTs


Signature


6.3 Applicant with an EMT certification expired twelve (12) months or more, but less than twenty‐four (24) months: 6.3.1 Successful completion of forty‐eight (48) hours of approved EMS continuing education (CE). An EMT Refresher course from an approved EMT training program may substitute for an equivalent amount of CE credits. (see 6.3.2.1 below)

6.3.2 Certificate from the National Registry of EMTs (NREMT) showing successful completion of the written and skills examinations for EMT/ EMT‐B after completion of the above course. (Skills examination is not SCV)

6.3.2.1 In order to be eligible to sit the NREMT written exam, successful completion of • An approved EMT Refresher course must be documented. • The NREMT skills examination must have been accomplished less than

one (1) year prior to the written test date. 7. Applicant shall pay the required fee by submitting payment in the following manner:

7.1 A cashier’s check or money order made payable to EMT Certification Fund, for the State’s portion of the certification fee.

7.1.1 For those applicants not needing to Livescan, the current State fee is $37. 7.1.2 For those applicants required to Livescan, the State recertification fee is $75.

7.2 Cash, or a cashier’s check or money order made payable to REMSA, for the Agency’s portion of the certification fee, currently $25.

7.3 If expired, the REMSA payment must include an additional $10 late fee, for a total of $35.

8. Applicants new to Riverside County must apply in person. 8.1 If extenuating circumstances prohibit in‐person submission, a notarized statement (use the appropriate EMS Agency form) verifying identification shall be submitted with photocopies ‐‐ front and back ‐‐ of items 1, 2, and 3 above along with completion of all other steps. Photocopies must be distinct, and legal ID photo must clearly show the individual. 9. Incomplete application packets will be returned to the applicant with a notice describing what is missing. Those persons required by the EMS Agency to submit materials in addition to those outlined above will have not longer than thirty (30) calendar days to deliver them to the EMS office.






Applies To EMTs


Signature


EFFECTIVE and EXPIRATION DATES of CERTIFICATION 1. Recertification will be for a period of not greater than two (2) years. 2. If recertification requirements are met within six (6) months prior to expiration of the current certification period, the effective date of the new certification will be the day following expiration of the current certification. (Example: Current certification expires 9/30, recertification effective 10/1.) 3. If the recertification requirements are met greater than six months prior to expiration of the current certification period, the effective date of the new certification will be the date the applicant satisfactorily completes all recertification requirements. (Example: Current certification expires 9/3/12, requirements met 2/7/12, recertification effective 2/7/12 to expire 1/31/14.) 4. The effective date of certification for expired applicants applying for recertification shall be the submission date of a completed application packet. 5. Certification expires on the final day of the final month of the prescribed period.

EXTENSIONS for ACTIVE DUTY MILITARY SERVICE 1. Upon written request, an individual who is a member of the reserves and is deployed for active duty with a branch of the Armed Forces of the United States may be granted an extension of EMT certification for up to six (6) months past the date of the individual’s deactivation/release from active duty if the individual’s California EMT certificate expires(ed):

while on active duty, OR less than six (6) months from the date (s)he is deactivated/released from active duty.

The extension will be granted if the following are provided: 1.1 Documentation from the respective branch of the Armed Forces of the United States verifying the individual’s dates of activation and deactivation/release from duty. 1.2 A recertification application packet meeting the requirements of items 1 ‐ 5, 7, 8, of the Application Process section (above) and

1.2.1 If certification is current, documentation of meeting the requirements of 6.1. 1.2.2 If certification has lapsed, documentation of meeting the requirements of 6.2 or 6.3,

whichever would have applied prior to the extension. 1.3 Provide documentation showing that the CE activities submitted for the certification renewal period were taken not earlier than thirty (30) calendar days prior to the effective date of the individual’s EMT certificate that was valid when the individual was activated for duty and not later than six (6) months from the date of deactivation/release from duty. 2. For an individual whose active duty required him/her to use his/her EMT skills, credit may be given for documented training that meets the requirements of Chapter 11, EMS CE Regulations (Division 9, Title 22, California Code of Regulations) while the individual was on active duty. The documentation shall include verification from the individual’s Commanding Officer attesting to the classes attended.






Applies To EMTs


Signature


The RESPONSIBILITIES of CERTIFICATION / PRACTICE in RIVERSIDE COUNTY Duly certified applicants practicing within the jurisdiction of Riverside County EMS Agency (REMSA) shall: 1. Maintain knowledge of and adhere to all Riverside County policies, procedures, and protocols. 2. Project a professional demeanor, exemplifying the mission and values of this Agency (refer to policy #1000). 3. Adhere to the requirements and stipulations of the REMSA county‐wide Continuous Quality Improvement Program (CQIP). 4. Comply with all requests for information from REMSA in connection with medical CQI, incident review, arrest inquiry, and disciplinary investigation/review. 5. Complete all mandatory in‐service/skills training sessions as designated by REMSA, including protocol updates and Performance Improvement Plans. 6. Report, in writing, changes of address, telephone contact information, and/or employment to REMSA within thirty (30) days of the change. Written notification shall include both the old and new information, effective date of the change, and the EMT’s certification number.



December 31, 2011 Treatment Protocols

EMT Certification by Challenge Approval: REMSA Medical Director


Applies To EMTs


Signature

REMSA –Certification by Challenge Page 2 of 3

The RESPONSIBILITIES of CERTIFICATION 1. To legally practice as an EMT in the State of California, one must obtain and maintain in good standing

a certification from the State. 2. Once certified, EMTs are responsible and held accountable for the knowledge and skills delineated in the EMT scope of practice (SOP) as defined by Title 22, Section 100063, of the California Code of Regulations and by local accreditation. 2.1 Local Accreditation Local EMS Agencies (LEMSAs) may set forth additional knowledge and skills requirements or may restrict the state SOP, as defined by their Medical Director. Local accreditation imparts the responsibility and accountability for these additions/restrictions. 2.2 In addition to competence in knowledge and skills, an EMT is expected to project a professional demeanor in his appearance and attitude. This includes creating complete and appropriate documentation, maintaining composure, being respectful, being cooperative with other agencies, exemplifying high ethical standards, and being a patient advocate in addition to an empathetic listener. THE APPLICATION PROCESS The applicant must present 1. A current and valid legal photo I.D. ‐‐ i.e., state driver’s license, state I.D. card, military I.D. card,

passport. 1.1 Temporary driver’s licenses without a picture and military IDs where the applicant is not the

primary issuant will not be accepted. 2. A current and valid American Heart Association, American Red Cross, or California‐approved BCLS/CPR card (“professional” level).

2.1 Information must be typed. 3. Proof of completion of fingerprinting for a California Department of Justice (DOJ) and FBI criminal

offender record information search with subsequent arrest notification. Riverside County EMS Agency must be listed as the recipient of this information.

4. A completed and signed application disclosing ALL disciplinary actions (denial, revocation, suspension, probation) against any EMS certification/license and/or any health‐related certification/license from this state, another state, or other issuing entity, including any active investigation(s).

5. Proof of meeting the eligibility and testing requirements as stated above (see ELIGIBILITY and The CHALLENGE PROCESS).

6. Payment of the required fee by submitting payment in the following manner: 6.1 A cashier’s check or money order made payable to EMT Certification Fund, for the State’s

portion of the certification fee, currently $75, and 6.2 Cash, or a cashier’s check or money order made payable to REMSA, for the Agency’s portion of

the certification fee, currently $25.



December 31, 2011 Treatment Protocols

EMT Certification by Challenge Approval: REMSA Medical Director


Applies To EMTs


Signature

REMSA –Certification by Challenge Page 3 of 3

7. All applications must be done in person.

7.1 If extenuating circumstances prohibit in‐person submission, a notarized statement (use the appropriate EMS Agency form) verifying identification shall be submitted with photocopies ‐‐ front and back ‐‐ of items 1, 2, and 5 above along with completion of all other steps. Photocopies must be distinct, and legal ID photo must clearly show the individual.

8. Incomplete application packets will be returned to the applicant with a notice describing what is missing. Those persons required by the EMS Agency to submit materials in addition to those outlined above will have not longer than thirty (30) calendar days to deliver them to the EMS office. EFFECTIVE and EXPIRATION DATES of CERTIFICATION 1. The effective date of certification for applicants shall be that date the individual satisfactorily

completes all certification requirements and submits a completed application to the EMS Agency. 2. Certification shall expire on the final day of the final month of the two (2) year period following the

date of passing of the National Registry written exam. LOCAL PRACTICE REQUIREMENTS Duly certified applicants practicing within the jurisdiction of Riverside County EMS Agency (REMSA) shall: 1. Maintain knowledge of and adhere to all Riverside County policies, procedures, and protocols. 2. Project a professional demeanor, exemplifying the mission and values of this Agency (refer to policy #1000). 3. Adhere to the requirements and stipulations of the REMSA county‐wide Continuous Quality Improvement Program (CQIP). 4. Comply with all requests for information from REMSA in connection with medical CQI, incident review, arrest inquiry, and disciplinary investigation/review. 5. Complete all mandatory in‐service/skills training sessions as designated by REMSA, including protocol updates and Performance Improvement Plans. 6. Report, in writing, changes of address, telephone contact information, and/or employment to REMSA within thirty (30) days of the change. Written notification shall include both the old and new information, effective date of the change, and the EMT’s certification number.

OPERATIONS: General Policy (BLS/ALS) Policy: 5205

Date: 10/1/10

EQUIPMENT AND SUPPLIES FOR FIRST RESPONDER / EMT EMERGENCY APPARATUS

Page 1 of 3

The purpose of this policy is to define the standard of equipment and supplies which should be carried on First Responder or EMT staffed emergency apparatus operating in Riverside County. This list represents the recommended items with minimum quantities.

EQUIPMENT AND SUPPLIES - FIRST RESPONDER / EMT EMERGENCY APPARATUS

RECOMMENDED ITEMS

MIN. QUANTITY 1. AIRWAYS

a. Nasopharyngeal (Sizes 30, 32, & 34 Fr.) (EMT Only) b. Oropharyngeal (Sizes Adult, Child, & Infant)

1 Each 2 Each

2. BANDAGING MATERIALS

a. Compresses (4x4) b. ABD Pads (9x5) c. Trauma Dressing (10x30) d. Vaseline Gauze Compresses e. Roller gauze bandage (Sterile) f. Triangular bandage g. 1" Tape h. 2" Tape

25 3 2 2 6 2 2 2

3. BLANKETS (Disposable)

2

4. BLOOD PRESSURE CUFFS

a. Adult b. Adult Large / Thigh c. Pediatric

1 1 1

5. BURN KIT (Bag with 4 clean sheets and 4 liters of Sterile

Water or Normal Saline)

2 Sets

6. CERVICAL COLLARS - Rigid

(Sizes to fit all patients over one year old)

2 Each

7. COLD PACKS

2

8. HEAD IMMOBILIZATION EQUIPMENT (Soft)

(Towel rolls, foam head blocks, cardboard immobilizer or other approved equipment)

2 (1 Set)


Date: 10/1/10


Page 2 of 3

RECOMMENDED ITEMS

MIN. QUANTITY

9. OB KIT

1

10. OXYGEN ADMINISTRATION EQUIPMENT

a. Bag Valve Mask Resuscitator (With oxygen reservoir) Adult and Pediatric b. Masks (Non-rebreather), Adult and Pediatric c. Nasal Cannulas d. Pocket Masks With Check Valve (Adult) e. Portable Oxygen System

1 Each

2 Each 2 2 1

11. SAFETY EQUIPMENT

a. Eye Protection (Meets or exceeds OSHA standards) b. Disposable Filtration Masks (Meets Title 8 CCR Section 5193) c. Disposable Gloves, Non-sterile - Medium and Large

(Meets or exceeds OSHA standards) d. Hand Wash, Commercial Antimicrobial e. Disposable Shoe Covers f. Gowns g. Sharps Container (Meets or exceeds OSHA standards) h. Waste Disposal Bag (Meets or exceeds EPA standards) i. NIOSH Approved (P-100) Filter Respirator (For infection control) j. Hazardous Materials Guide (Current DOT Emergency Response

Guidebook)

1 Pair Per Crew Member 1 Per Crew Member

1 Container Each Size

1 Container 1 Pair Per Crew Member

1 Per Crew Member 1 2

1 Per Crew Member 1

12. SPINAL IMMOBILIZATION EQUIPMENT

a. Long Back Board or equivalent b. Short Back Board or equivalent (e.g., KED) c. Patient Securing System (Straps)

1 1

1 Set 13. SPLINTS (Pneumatic or rigid)

a. Leg Splints (Various sizes) b. Arm Splints (Various sizes)

2 2

14. SUCTION EQUIPMENT

a. Portable Suction Device (V-VAC type, battery or oxygen driven) b. Suction Tubing c. “Tonsil” Tip Rigid Suction Catheter d. Bulb Syringe

1 1 1 1


Date: 10/1/10


Page 3 of 3

RECOMMENDED ITEMS

MIN. QUANTITY

15. TRACTION SPLINT (For use on lower extremities)

1

16. TRIAGE KIT

(Includes Triage Tags (20), ICS 420-1 FOG, Patient Transfer & Hospital Bed Availability forms, and required ICS forms)

1

17. MISCELLANEOUS EQUIPMENT

a. Bandage Scissors b. Penlight c. Stethoscope d. Oral Glucose Paste / Gel (EMT only)

2 2 1

1 Container 18. OPTIONAL

a. Defibrillator+

b. Defibrillator Pads, Adult+ c. Defibrillator Pads, Pediatric (as recommended by manufacturer)+

d. Multilumen Airway (EMT only)+

e. A variety of pediatric nasopharyngeal airways (sizes 20, 22, 24, 26, 28) (EMT Only)

1

2 Sets 2 Sets

1 1 each

+ may only be utilized by approved providers


Date: 10/1/10

EQUIPMENT AND SUPPLIES FOR BASIC LIFE SUPPORT AMBULANCES

Page 1 of 3

The purpose of this policy is to define the standard of equipment and supplies to be carried on Basic Life Support (BLS) patient transportation units operating in Riverside County. This list represents mandatory items required by the Riverside County EMS Agency. All other applicable State and Federal equipment requirements must also be complied with for each unit in service.

EQUIPMENT AND SUPPLIES - BASIC LIFE SUPPORT AMBULANCE

REQUIRED ITEMS MIN. QUANTITY 1. AIRWAYS a. Nasopharyngeal (Sizes 30, 32, & 34 Fr.) b. Oropharyngeal (Sizes Adult, Child, & Infant)*

1 Each 1 Each

2. BANDAGING MATERIALS a. Compresses (4x4)* b. ABD Pads (9x5) c. Trauma Dressing (10x30)* d. “Vaseline”-type Gauze Compresses (3" x 3" minimum size) e. Roller gauze bandage (Sterile)* f. Triangular bandage g. 1" Tape* h. 2" Tape

25 3 2 2 6 2 2 2

3. BLOOD PRESSURE CUFFS* a. Adult b. Adult Large / Thigh c. Child d. Infant

1 1 1 1

4. BURN KIT (Bag with 4 Clean Sheets and 4 Liters of Sterile Water or Normal Saline)

2 Sets

5. CERVICAL COLLARS - Rigid

Sizes to fit all patients over one year old) 2 Each

6. COLD PACKS 6 7. HEAD IMMOBILIZATION EQUIPMENT (Soft)*

(Towel rolls, foam head blocks, cardboard immobilizer or other approved equipment)

2 (1 Set)

8. IRRIGATING SOLUTIONS a. Irrigating Saline (1,000cc Container) b. Sterile Water (1,000cc Container)

2 2


Date: 10/1/10


Page 2 of 3

REQUIRED ITEMS

MIN. QUANTITY

9. OB KIT*

1

10. OXYGEN ADMINISTRATION EQUIPMENT* a. Bag Valve Clear Mask Resuscitator (With Oxygen Reservoir)

Adult, Pediatric, and Infant b. Masks, clear (Non-rebreather) Adult, Child, and Infant

c. Nasal Cannulas Adult and Child

d. Pocket Masks With Check Valve (Adult) e. Portable Oxygen System

1 Each

2 Each

2 Each

2 1

11. SAFETY EQUIPMENT a. Eye Protection (Meets or exceeds OSHA standards) b. Disposable Filtration Masks (Meets Title 8 CCR Section 5193) c. Disposable Gloves, Non-sterile - Medium and Large (Meets or exceeds OSHA standards)

d. Hand Wash, Commercial Antimicrobial e. Disposable Shoe Covers f. Gowns g. Sharps Containers (Meets or exceeds OSHA standards) h. Waste Disposal Bag (Meets or exceeds EPA standards) i. NIOSH Approved (P100) Filter Respirator (For infection control) j. Hazardous Materials Guide (Current DOT Emergency Response Guidebook)

1 Pair Per Crew Member

1 Per Crew Member 1 Container Each Size

2 Containers

1 Pair Per Crew Member 1 Per Crew Member

1 1

1 Per Crew Member 1

12. SPINAL IMMOBILIZATION EQUIPMENT* a. Long Back Board or equivalent b. Short Back Board or equivalent (e.g., KED) c. Patient Securing System (Straps)

1 1

1 Set 13. SPLINTS (Pneumatic or Rigid)* a. Arm Splints (Various Sizes) b. Leg Splints (Various Sizes)

2 Each 2 Each

14. SUCTION EQUIPMENT* a. Portable Suction Device (V-VAC type, Battery or Oxygen Driven) b. Suction Tubing c. ‘Tonsil’ Tip Rigid Suction Catheter d. Bulb Syringe

1 1 1 1


Date: 10/1/10


Page 3 of 3

REQUIRED ITEMS

MIN. QUANTITY

15. TRACTION SPLINT (For Use on Lower Extremities)* 1 Set 16. TRIAGE KIT

(Includes Triage Tags (20), ICS 420-1 FOG, Patient Transfer and Tracking, and Hospital Bed Availability Forms)

1

17. MISCELLANEOUS EQUIPMENT a. Flashlight b. Penlight c. Tongue Depressors d. Towels e. Glucose Paste f. Ambulance cot and collapsible stretcher; or two stretchers, one of

which is collapsible* g. Straps to secure the patient to the stretcher or ambulance cot, and

means of securing the stretcher or ambulance cot in the vehicle*

h. Ankle and Wrist Restraints (Soft ties are acceptable)* i. Sheets, pillow cases, blankets, and towels for each stretcher or

ambulance cot, and two pillows for each ambulance* j. Bandage Scissors* k. Bandage Scissors, Sterile (if no appropriate instrument in OB kit) l. Emesis Basin* m. One Gallon of Potable Water* n. Bed Pan* o. Urinal* p. Stethoscope

2 2 6 4

1 Container As Specified

1 Set

1 Set As Specified

1 Pair 1 Pair

1 As Specified

1 1 2

* Items required by the California Highway Patrol, CHP 299 (Revised 4-98)

OPTIONAL EQUIPMENT MIN. QUANTITY

18. a. Defibrillator+ b. Defibrillator Pads, Adult+ c. Defibrillator Pads, Pediatric (as recommended by manufacturer)+

d. Multilumen Airways+ e. A variety of pediatric nasopharyngeal airways (sizes 20, 22, 24, 26, 28)

1 2 sets 2 sets 1 each 1 each

+ may only be utilized by approved providers

Page 1 of 2 OPERATIONS: General Policy (BLS/ALS) Policy: 5225

Date: 10/1/10

PERSONAL PROTECTIVE EQUIPMENT (PPE) FOR AMBULANCES The purpose of this policy is to define the standard for personal protective equipment (PPE) to be carried on Advanced Life Support (ALS) and Basic Life Support (BLS) patient transportation units operating within Riverside County. This list represents mandatory items required by the Riverside County EMS Agency. All other applicable State and Federal equipment requirements must also be complied with for each unit in service. PPE carried must meet or exceed the performance requirements set down by the referenced Standard(s).

PERSONAL PROTECTIVE EQUIPMENT - AMBULANCE

REQUIRED ITEMS

MIN. QUANTITY

1. Eye Protection NFPA 1999 EMS Standards ANSI Z87.1 -- e.g., glasses, face shield, or work goggles, or mask with side protection and splash resistance for infection control. Fit over glasses and sunglasses preferred.

2 sets

2. Hearing Protection - ear plugs or other NFPA 1999 EMS Standards

2 sets

3. Hard Hat - Work Helmet (blue preferred) NFPA 1951 ANSI Z89.1-1986 (Class B) OSHA: 29 CFR 1910.135 & 29 CFR 1926.100(b) CSA Z94.1-M1992 (Class G) or equivalent

2

4. a) Garment - Multiple Use NFPA 1999 EMS Standards -- i.e., full-body - shirt & pants, or jumpsuit/coveralls with barrier protection b) Garment - Single Use NFPA 1999 EMS Standards -- i.e., barrier garment made of high density polyethylene fibers, e.g., Tyvek

2 sets

2 sets

5. a) Footwear - Multiple Use NFPA 1999 EMS Standards: Height: minimum 4” Cut, puncture, & abrasion resistant Toe safety Barrier protection ANSI Z41-1991 - if determined by entry job description, or incident response zone

OSHA: Safety toe & shank Chemical resistant b) Footwear covers - Single Use NFPA 1999 EMS Standards OSHA: Chemical resistant

2 pairs

2 pairs

Page 2 of 2 OPERATIONS: General Policy (BLS/ALS) Policy: 5225

Date: 10/1/10

PERSONAL PROTECTIVE EQUIPMENT (PPE) FOR AMBULANCES

REQUIRED ITEMS

MIN. QUANTITY

6. a) Gloves - Work, Multiple Use NFPA 1999 EMS Standards: Physical protection (cut resistant -- leather or other) Barrier protection b) Gloves - Medical, Single Use 21 CFR 880, Class 2 Body substance isolation Nitrile-type or equivalent; latex may be used for exams

2 sets

7. Safety Vest / Jacket High visibility, break-away, with reflective material, class 2 or 3 23 CFR 634 ANSI / ISEA 107 (2004) (Note: ANSI 207 (2006) cannot be substituted as it does not meet the 23 CFR 634 statement)

2

8. a) Respiratory Protection -- P-100 per 8 CCR 5199 To include: Written respiratory program policies Health questionnaire Fit testing Training on selection, use, and storage NIOSH Respirator Selection Logic 2004 OSHA: 42 CFR 84 (breathing apparatus standards) 8 CCR 5144 (use of respirators, including those for TB) Firescope California Standardized Hazardous Materials Equip List, 2004 Ed., p. 7-10 as noted above NOTE: follow NIOSH standards, when finalized.

2

OPTIONAL ITEM Min. Quantity 1. Respiratory Protection -- Escape Hoods or Closed Respiratory System (ex. – SCBA, APR)

2

Ambulance Service Providers are responsible for assuring their personnel are trained in the carrying, proper use, and maintenance of the above equipment in compliance with OSHA 1910.132(f)

OOppeerraattiioonnaall PPoolliiccyy 5310 Effective

October 1, 2010 Review Date

December 31, 2012 Operational Policies

Ambulance Diversion Approval: REMSA Medical Director


Applies To EMD, EMR, EMT, AEMT, PM, MICN, BHP


Signature

REMSA – Ambulance Diversion Page 2 of 2

3. The hospital must obtain authorization from all of the following people prior to instituting diversion: a. Emergency Department supervisor/house supervisor/designee b. Emergency Department physician director/designee c. Administrator on‐call. d. Trauma Surgeon on duty DIVERSION NOTIFICATION Once the decision to institute diversion is made as permitted by hospital policy, the following steps should then be taken: 1. Using ReddiNet, the charge nurse/designee will update the local ambulance dispatch center, and all local hospitals when going on and off diversion: a. Names of authorizing personnel will be entered on ReddiNet. b. Diversion rationale will be entered on ReddiNet, i.e. Both surgeons occupied, Operating Rooms at maximum capacity, CT inoperable. 2. Hospitals shall make every effort to re‐open as soon as possible. The EMS Agency will have an EMS Specialist on‐call at all times in case of emergency. DIVERSION EVALUATION 1. Any problems associated with patient care for diverted patients will be submitted to the EMS

Agency on an Unusual Occurrence Report Form within 72 hours. 2. A diversion report will be compiled by the EMS Agency for the purpose of evaluating

opportunities for continuous quality improvement. 3. Diversion records shall become part of the Continuous Quality Improvement process within each

hospital and the EMS Agency. 4. The EMS Agency may perform periodic, unannounced site visits of hospitals instituting

ambulance diversion to ensure compliance with all guidelines. Frequency of site visits will be at the discretion of the EMS Agency.

5. All incidents of trauma diversion will be reviewed internally at each trauma center for appropriateness and reported to the Trauma Audit Committee for review.


October 1, 2010 Review Date December 31, 2012

Operational Policy Continuation of Trauma Care

Approval: REMSA Medical Director Humberto Ochoa, MD

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Applies To EMD, EMR, EMT, AEMT, PM, MICN, BHP


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REMSA –Continuation of Trauma Care Page 2 of 2

Procedure for continuation of trauma care transport:

For Critical Trauma Patient: For Trauma Patient:

The patient should be resuscitated and attempts made to stabilize for transport.

A. Referring Physician:

1. The physician initiating Continuation of Care transport should call the local ALS ambulance provider. When continuation of care has been initiated the ambulance provider will respond immediately to requesting facility code 3.

OR request the patient’s current EMS crew to stand‐by on premises for immediate transport of the patient to a trauma center. The stand‐by of the EMS crew should not last longer than 20 minutes.

2. Notify directly the ED physician at the receiving Trauma Center. (see #4 for script.)

3. Coordinate diagnostics and interventions w/ receiving ED physician.

4. Suggested script, “This is Dr.____at ____hospital. I want to speak to the ED physician regarding a critical trauma patient for higher level of care.” (Do not use the word “transfer.”)

B. Information to Transporting Personnel:

Information concerning the patient’s condition and needs during transport should be communicated to transporting personnel.

C. Documentation: DO NOT Delay Transport

1. All documents are sent including: problem, treatments, status at time of transfer, lab values, Xrays, personal belongings, and EMTLA higher level of care paperwork.

A. Referring Physician:

Contact Closest Trauma Center, speak to accepting Trauma Surgeon.

(per hosp policy or ED to ED)

B. Information to Transporting Personnel:

Information concerning the patient’s condition and needs during transport should be communicated to transporting personnel.

C. Documentation:

All documents are sent including, problem, treatments, status at time of transfer, lab values, Xrays, personal belongings and EMTLA Higher level of care paperwork.

D. Prior to Transfer:

The patient should be resuscitated and attempts made to stabilize in respect to ABCDE’s.

E. Management during Transport.

Determine if patient needs CCT, ALS or BLS transport.

During transport, continued management of vital functions and continuous re‐evaluation are essential.

Reference: American College of Surgeons; Rural Trauma Team Development Course



September 30, 2012 Treatment Protocols

STEMI Receiving Centers Approval: REMSA Medical Director


Applies To EMS System


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REMSA – STEMI Receiving Centers Page 2 of 4

Personnel The hospital shall have the following designated positions filled: a. Medical Director – the hospital shall designate a medical director for the SRC program who shall be a

physician who is board‐certified in Emergency Medicine or in Cardiology. b. Nursing Director – There shall be a designated SRC nursing director. c. Physician Consultants – A daily roster of the following on‐call physician consultants who must be promptly available within 30 minutes of notification: i. Cardiologist with primary PCI privileges ii. Cardiovascular surgeon, if cardiovascular surgical services are offered.*

*If cardiovascular surgical services are not available in house the facility must have a rapid transfer agreement in place with a facility that provides this service. Additionally, the facility must have a rapid transport agreement in place with a Riverside County permitted transport provider.

d. Additional personnel who must be promptly available within 30 minutes of notification: i. Intra‐aortic balloon pump nurse or technologist ii. Cardiac catheterization laboratory team Policies Internal policies shall be developed for the following: a. Fibrinolytic therapy protocol to be used only in unforeseen circumstances when PCI of a STEMI patient is not possible. b. Diversion of STEMI patients only during times of Internal Disaster Designation (see EMS Policy #5310, “Ambulance Diversion”) Data Collection The following data shall be collected on an on‐going basis and available for review by the Riverside County EMS Agency: a. Number of field identified STEMI patients transported for emergency care b. Number of above patients who received primary PCI c. For EMS‐transported patients with STEMI, door‐to‐infusion times for fibrinolysis, and door‐to‐dilation times for primary PCI. d. Total number of myocardial infarction admissions/year (all patients, not just EMS) e. Total number of PCI procedures/year for those cardiologists/cardiac surgeons treating EMS‐ transported patients. f. Total number of EMS STEMI patients that bypass the closest, most accessible receiving hospital (not approved as a SRC) and are transported to a SRC.








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Continuous Quality Improvement An in‐house CQI program which monitors, at minimum, the following: a. Death rate (within 30 days, related to procedure regardless of the mechanism) b. Emergency CABG rate (result of procedure failure or procedure complication) c. Vascular complications (PCI access site complication, hematoma large enough to require transfusion, or operative intervention required) d. Cerebrovascular accident rate (peri‐procedure) e. Post‐procedure nephrotoxicity (increase in serum creatinine of >0.5) f. Tracking of door‐to‐dilation times g. Active participation in Riverside County EMS Agency CQI activities/committees is required. Performance Standard a. A primary door‐to‐dilation time goal of 90 minutes or less shall be met 90% of the time. Designation a. The SRC shall be designated after satisfactory review of written documentation and an initial site survey by Riverside County EMS Agency personnel/designees. i. Documentation of current accreditation from The Society of Chest Pain Centers as a “Chest Pain Center with PCI” shall be accepted in lieu of a formal site visit/documentation review by the EMS Agency. b. Initial designation as a SRC shall be for a period of two (2) years. Thereafter, redesignation shall occur every four (4) years, contingent upon satisfactory review. c. Failure to comply with the criteria outlined in this policy will result in disciplinary action up to and including suspension or rescission of SRC designation. Reporting Requirements a. Door‐to‐dilation times will be reported to the EMS Agency every three (3) months. i. If the goal of door‐to‐dilation times of 90 minutes or less is not met 90% of the time, an improvement plan must be submitted to the EMS Agency addressing the deficiency (ies) with steps being taken to improve the times. b. Prehospital personnel shall complete the first section of the Suspected ST‐Elevation MI (STEMI) Report and submit it to the SRC for completion. c. SRC shall complete the Suspected ST‐Elevation MI (STEMI) Report and submit it with the Patient Care Report and a copy of the prehospital ECG(s) to the EMS Agency on a monthly basis. i. Suspected ST‐Elevation MI (STEMI) Report shall be completed for all patients identified in the prehospital environment as being STEMI patients, regardless of whether or not the patient was subsequently identified as suffering from a ST‐Elevation MI.








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Triage Criteria A designated SRC should be considered as the destination of choice if all of the following criteria are met: a. The patient’s 12‐Lead ECG shows a STEMI based on machine interpretation of field 12 Lead ECG, verified by paramedic and approved by a STEMI Base Hospital physician. b. ETA to the STEMI Receiving Center is 30 minutes or less from the scene. i. The STEMI Base Hospital physician may override this requirement and authorize transport to the SRC with transport time of greater than thirty (30) minutes. c. The STEMI Base Hospital confirms a SRC as the destination; STEMI Base Hospital contact is mandatory for all patients identified as possible STEMI patients. d. The STEMI base hospital, if different from the SRC, will notify the SRC of patient’s pending arrival as soon as possible, to allow timely activation of cardiac catheterization laboratory team at the SRC.

Destination Decision The following factors, in conjunction with a suspected STEMI, should be taken into consideration when making the destination decision: a. Malignant dysrhythmias; ventricular fibrillation/tachycardia and second/third degree atrioventricular block b. Contraindications to thrombolytics c. Duration of symptoms d. Hemodynamic instability (shock) e. Patients with uncontrollable airways or in cardiopulmonary arrest shall be transported to the closest receiving center. The only exception is if the hospital is closed due to Internal Disaster, per policy #5310.

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OPERATIONS: General Policy (BLS/ALS) Policy: 5910 Date: 10/1/10

SELF-APPLICATION (PROTECTION) with an EMERGENCY ESCAPE HOOD

1. Use of the NIOSH approved Emergency Escape Hood shall be for self-application or

application to an emergency response team member only, in the event of exposure or suspected exposure (based on symptomology and/or environmental cues) to chemical, biological and/or radiological agents.

2. Escape hoods only provide protection to known chemical warfare agents and particulates for

a minimal amount of time (maximum of 15 minutes) and cannot be re-used. The hood is designed to provide respiratory protection and protect the head and eyes from exposure during escape from chemical, biological and radiological warfare agents (P-100 masks DO NOT provide protection against any warfare agent.) Note: This device is only designed for an emergency escape and does not provide protection for or allow for any responder to work in a contaminated environment, nor is it designed to escape a fire or smoke related to fire. The escape hood provides NO protection against oxygen deficiency. 2.1 Emergency Escape Hoods may be issued to and used by EMT-P’s, EMTs and first

responders. 2.2 Emergency Escape Hoods are not to be issued for use on the general population.

3. Only prehospital personnel who have successfully completed training specific to the use of

an Emergency Escape Hood are authorized to use this equipment under this protocol. 3.1 Knowledge and skills shall be maintained through annual review training.

4. Upon identifying a scene involving a suspected or known release of any chemical, biological

or radiological agent, 4.1 Don (put on) your escape hood (make sure hair and clothing do not obstruct seal). 4.2 Immediately remove yourself and other personnel from the contaminated area and notify

the IC at the scene. 4.3 Isolate / cordon off the area. 4.4 Do Not remove hood in contaminated atmosphere. Once removed, DO NOT re-use;

treat equipment as contaminated. 5. Once personnel are removed from the contaminated area and until the unknown substance is identified as hazardous/non-hazardous

5.1 Observe for any abnormal signs and symptoms. 5.2 Ensure continuous medical monitoring of any personnel who donned protective equipment or who responded to the event and were in the suspected contaminated area for any abnormal signs and symptoms. 5.3 Provide for proper decontamination of potentially exposed personnel. 5.4 Never leave the scene until properly decontaminated and dismissed by the appropriate staff member of the incident command structure on-scene. 5.5 Once properly decontaminated, response personnel should be transported to closest most appropriate receiving center for further evaluation. Note: DO NOT transport contaminated clothes or equipment.

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OPERATIONS: General Policy (BLS/ALS) Policy: 5910 Date: 10/1/10

SELF-APPLICATION (PROTECTION) with an EMERGENCY ESCAPE HOOD

6. Emergency Escape Hoods are a one-time-use device, post-event the hood must be discarded following standard procedures for contaminated equipment/materials. 6.1 Once removed, the escape hood should be red bagged and left on scene with all other contaminated clothes, equipment and trash generated at the scene of the incident. All disposable personal protective equipment will be bagged as hazardous waste. The red bag containing potential HAZMAT material should be left at a designated point in the decontamination area. This designated point will be established by the appropriate HAZMAT personnel on scene of the incident following coordination with the IC. 6.2 The escape hood must not be transported to the receiving hospital. 7. If you believe you or your team members have been exposed to a nerve agent:

REFER TO POLICY # 5900.

8. Any Emergency Escape Hood use must be reported to the EMS Agency on the appropriate form(s).

Documents

TO: ALS and BLS Ambulance Providers Base and Receiving