Potential Procedures Potential Procedures for Response to EMS for Response to EMS Agency Request for Agency Request for

Paramedic Paramedic

Vermont EMS District 3Vermont EMS District 3October 2009October 2009

OverviewOverview

Providing paramedic care Providing paramedic care requires a significant commitment requires a significant commitment of resources by an EMS agencyof resources by an EMS agency

Need to clarify expectations and Need to clarify expectations and procedures between agencies procedures between agencies receiving and providing receiving and providing paramedic careparamedic care

OverviewOverview

Goal of system: provide timely Goal of system: provide timely paramedic care to patients in paramedic care to patients in District 3 who would benefit from itDistrict 3 who would benefit from it– by building on existing foundation of by building on existing foundation of

cooperation and assistancecooperation and assistance– through education of EMS providers through education of EMS providers

and community leaders on which pts and community leaders on which pts are most likely to benefit from are most likely to benefit from paramedic careparamedic care

OverviewOverview

Most important principle: Most important principle:

Do what is best for the Do what is best for the patientpatient

AssumptionsAssumptions

The “radio room” has evolved into The “radio room” has evolved into a true Communications Center a true Communications Center

EMS agencies and Comm Ctr will EMS agencies and Comm Ctr will have list of conditions and have list of conditions and situations that may merit situations that may merit immediate call for paramedic immediate call for paramedic responseresponse

AssumptionsAssumptions

EMS crew chief can request paramedic EMS crew chief can request paramedic when may be helpful (first responders when may be helpful (first responders go through crew chief)go through crew chief)

EMS crew chief can cancel paramedic EMS crew chief can cancel paramedic after suitable evaluation of scene or pt after suitable evaluation of scene or pt

On-line medical direction is a resource On-line medical direction is a resource for determining whether to cancelfor determining whether to cancel

AssumptionsAssumptions

INITIALLY, these services are INITIALLY, these services are planning to provide paramedic planning to provide paramedic care: care: – Essex RescueEssex Rescue– Colchester RescueColchester Rescue– South Burlington Fire DeptSouth Burlington Fire Dept

Coverage will increase as more Coverage will increase as more agencies come on lineagencies come on line

What would happen when an EMS What would happen when an EMS agency requests paramedic agency requests paramedic service in District 3?service in District 3?

Assume the non-paramedic Assume the non-paramedic service and a neighboring service and a neighboring paramedic service have signed an paramedic service have signed an agreement for paramedic agreement for paramedic interceptsintercepts

Comm Center Role: Comm Center Role: – coordinate and communicate with coordinate and communicate with

paramedic servicesparamedic services– NOT command and control – full NOT command and control – full

authority remains with the servicesauthority remains with the services– take daily roll call to determine take daily roll call to determine

which paramedic services availablewhich paramedic services available

Scenario Scenario

High speed MVC with pt High speed MVC with pt ejected in town without ejected in town without paramedic serviceparamedic service

Crew chief requests Crew chief requests paramedic dispatchparamedic dispatch

Comm Ctr coordinates Comm Ctr coordinates dispatching of first dispatching of first available paramedicavailable paramedic

Scenario Scenario

If paramedic available, responds in If paramedic available, responds in response vehicleresponse vehicle

Crew treats and packages pt for Crew treats and packages pt for transporttransport– If paramedic arrives before ambulance If paramedic arrives before ambulance

leaves scene, gets in ambulanceleaves scene, gets in ambulance– If ambulance has left, crew chief and If ambulance has left, crew chief and

paramedic coordinate rendezvous if paramedic coordinate rendezvous if feasiblefeasible

Scenario Scenario

If ambulance and paramedic If ambulance and paramedic rendezvous, paramedic gets in rendezvous, paramedic gets in ambulance and works with crew ambulance and works with crew treating pt during transporttreating pt during transport

If no rendezvous, paramedic If no rendezvous, paramedic cancels response and ambulance cancels response and ambulance continues transport continues transport

Scenario Scenario

If paramedic not initially If paramedic not initially available, Comm Ctr coordinates available, Comm Ctr coordinates dispatch of closest paramedic dispatch of closest paramedic

Scenario Scenario

ResultResult– the only time transport the only time transport maymay be be

delayed is in unusual circumstance delayed is in unusual circumstance when the ambulance and paramedic when the ambulance and paramedic agree (with medical direction agree (with medical direction consult, when appropriate) that consult, when appropriate) that paramedic interventions justify paramedic interventions justify delaydelay

Scenario Scenario

ResultsResults– If no ambulance crew member able If no ambulance crew member able

to drive paramedic vehicle to to drive paramedic vehicle to hospital, ambulance returns hospital, ambulance returns paramedic to vehicle after callparamedic to vehicle after call

– Ambulance bills for treatment and Ambulance bills for treatment and transporttransport

– Cost of paramedic response Cost of paramedic response determined beforehanddetermined beforehand

Crew chief requests dispatch of Crew chief requests dispatch of paramedicparamedicClosest paramedic available?Closest paramedic available?

YES

NOParamedic respondsParamedic respondsArrive before ambulance leaves Arrive before ambulance leaves scene?scene?

YESAmbulance transports Ambulance transports

with paramedic on with paramedic on boardboard

NOAmbulance & paramedic Ambulance & paramedic conferconferIs rendezvous feasible?Is rendezvous feasible?

YES

NO

Ambulance & paramedic Ambulance & paramedic meetmeet

Paramedic cancels and Paramedic cancels and ambulance transports without ambulance transports without paramedic paramedic

Dispatcher consults back-up listDispatcher consults back-up listIf no other paramedic available, If no other paramedic available, ambulance treats & transports ambulance treats & transports alonealone

Algorithm for Dispatch of Algorithm for Dispatch of ParamedicParamedic

Determination of Determination of CriteriaCriteria Adopted criteria based on Adopted criteria based on

nationwide priority dispatch as well nationwide priority dispatch as well as models currently being used in as models currently being used in the state of VT and New Englandthe state of VT and New England– Regional Ambulance (Rutland) Regional Ambulance (Rutland) – CALEX Ambulance CALEX Ambulance – Rescue IncRescue Inc– Southern MaineSouthern Maine

Criteria for Paramedic Criteria for Paramedic DispatchDispatch Cardiac: chest pain, chest pressure, Cardiac: chest pain, chest pressure,

dysrhythmias, cardiac arrestdysrhythmias, cardiac arrest Respiratory: dyspnea, apnea, Respiratory: dyspnea, apnea,

asthma, COPD exacerbationasthma, COPD exacerbation Unconscious/unresponsiveUnconscious/unresponsive CVA/StrokeCVA/Stroke Overdose/poisoningOverdose/poisoning Gunshot wound/stabbingGunshot wound/stabbing

CriteriaCriteria

Allergic reaction/symptomatic insect Allergic reaction/symptomatic insect stings/anaphylaxisstings/anaphylaxis

MVC with: multiple patients, car vs. MVC with: multiple patients, car vs. pedestrian/bicycle/motorcyclepedestrian/bicycle/motorcycle

Obvious major mechanisms of Obvious major mechanisms of trauma: fall >15 feet, crush injuries, trauma: fall >15 feet, crush injuries, injury involving machinery/power injury involving machinery/power toolstools

Pain management as requiredPain management as required

CriteriaCriteria

Pediatric patients meeting any of Pediatric patients meeting any of previous criteriaprevious criteria

Future criterion:Future criterion:– Request by trained personnel on Request by trained personnel on

scenescene