San Francisco EMS Protocols

Prehospital Care Vision and Ethics Statement

Updates and Memoranda

• Summary of Protocol Revisions
• Summary of Policy Revisions
• 2018-01: Epinephrine Use as Alternative Medication for Use During Dopamine Shortage
• 2018-02: Dosage Correction for Dextrose 10%

Section 1: Assessment

• 1.01. Patient Assessment - Primary Survey
• 1.02. Patient Assessment - Secondary Survey

Section 2: Medical

• 2.01. Abdominal Discomfort
• 2.02. Allergic Reaction
• 2.03. Altered Mental Status
• 2.04. Cardiac Arrest
• 2.05. Adult Post-Cardiac Arrest or Return of Spontaneous Circulation
• 2.06. Chest Pain / Acute Coronary Syndrome
• 2.07. Dysrhythmias: Symptomatic Bradycardia
• 2.08. Dysrhythmias: Tachycardia
• 2.09. Pain Control
• 2.10. Poisoning and Overdose
• 2.11. Respiratory Distress: Bronchospasm
• 2.12. Respiratory Distress: Acute Pulmonary Edema
• 2.13. Adult Seizure
• 2.14. Stroke
• 2.15. Suspected Sepsis
• 2.16. Shock

Section 3: Environmental

• 3.01. Bites, Stings and Envenomation
• 3.02. Decompression Injury
• 3.03. (Near) Drowning
• 3.04. Hazardous Materials
• 3.05. Heat Injury / Hyperthermia
• 3.06. Cold Injury / Hypothermia

Section 4: Trauma & Burns

• 4.01. General Trauma Evaluation and Overview
• 4.02. Traumatic Cardiac Arrest
• 4.03. Head, Neck and Facial Trauma
• 4.04. Chest, Abdominal and Pelvic Trauma
• 4.05. Extremity Trauma
• 4.06. Burns

Section 5: Obstetrics & Gynecological

• 5.01. Gynecological and Obstetrical Emergencies

Section 6: Behavioral

• 6.01. Agitated / Violent Patient

Section 7: Procedures

• 7.01. Airway Management
• 7.02. Oral Endotracheal Intubation
• 7.03. Supraglottic Airway
• 7.04. Nasotracheal Intubation
• 7.05. Needle Cricothyrotomy
• 7.06. Needle Thoracostomy
• 7.07. Continuous Positive Airway Pressure
• 7.08. Pulse Oximetry
• 7.09. Carboxyhemoglobin Monitoring
• 7.10. 12-Lead Electrocardiogram Procedure
• 7.11. Spinal Motion Restriction
• 7.12. Vascular Access with IO Device
• 7.13. Vascular Access with Pre-Existing Vascular Access Device
• 7.14. Reporting Assault / Abuse
• 7.15. Splinting

Section 8: Pediatric Medical

• 13.IV. Normal Pediatric Vital Signs
• 8.01. Pediatric Allergic Reaction / Anaphylaxis
• 8.02. Pediatric Altered Mental Status
• 8.03. Pediatric Dysrhythmia: Bradycardia
• 8.04. Pediatric Dysrhythmia: Tachycardia
• 8.05. Pediatric Cardiac Arrest: Neonatal Resuscitation
• 8.06. Pediatric Cardiac Arrest: Bradyasystole and PEA
• 8.07. Pediatric Cardiac Arrest: VF / Pulseless VT
• 8.08. Pediatric Poisoning and Overdose
• 8.09. Pediatric Respiratory Distress
• 8.10. Pediatric Seizure
• 8.11. Pediatric Shock & Hypotension
• 8.12. Pediatric Pain Control

Section 9: Pediatric Trauma & Burns

• 13.IV. Normal Pediatric Vital Signs
• 9.01. Pediatric Trauma
• 9.02. Pediatric Burn

Section 10: Pediatric Behavioral

• 13.IV. Normal Pediatric Vital Signs
• 10.01. Pediatric Agitated / Violent Patient

Section 11: Special Circumstances

• 11.01. Austere Care
• 11.02. Crush Syndrome
• 11.03. Chemical & Radiological Agents
• 11.04. Field Amputation
• 11.05. Blast Injury

Section 12: Critical Care Transport Paramedic

• 12.01. Intravenous Infusion of Nitroglycerin
• 12.02. Intravenous Infusion of Heparin
• 12.03. Intravenous Infusion of Potassium Chloride
• 12.04. Intravenous Infusion of Amiodarone Hydrochloride
• 12.05. Monitoring of Thoracostomy Tube
• 12.06. Stoma and Tracheostomy Care
• 12.07. Chemical Sedation for Vent Dependent and Agitated Patients
• 12.08. Automatic Transport Ventilators
• 12.09. Intravenous Infusion of Blood / Blood Products
• 12.10. IV Infusion of Glycoprotein IIb / IIIa Receptor Inhibitors
• 12.11. Intravenous Infusion of Total Parenteral Nutrition
• 12.12. Intravenous Infusion of Morphine Sulfate
• 12.13. Intravenous Infusion of Midazolam

Section 13: References

13.I. Medication List

• Adenosine
• Albuterol
• Amiodarone
• Aspirin
• Atropine Sulfate
• Calcium Chloride
• Cetacaine Spray
• Charcoal (Activated)
• Dextrose 10%
• Diphenhydramine
• Dopamine (with Epinephrine Infusion Alternative per Memo 2018-01)
• Epinephrine
• Fentanyl Citrate
• Glucagon
• Glucose
• Hydroxocobalamin
• Ibuprofen
• Ketorolac Injection
• Lidocaine
• Magnesium Sulfate
• Midazolam
• Morphine Sulfate
• Naloxone
• Nitroglycerin
• Normal Saline
• Ondansetron
• Oxygen
• Pralidoxime
• Sodium Bicarbonate
• 13.II. Abbreviations
• 13.III. Pediatric Dosage Chart
• 13.IV. Normal Pediatric Vital Signs

EMS POLICIES

Policy Section 1. System Organization and Management

• 1000. Policy & Protocol Public Comment Process
• 1010. Advisory Committees
• 1020. Glossary

Policy Section 2. Personnel & Training

• 2000. Prehospital Personnel Standards & Scope of Practice
• 2001. Use of Standard and Special Circumstances Treatment Protocols
• 2010. Public Safety First Aid Training and Approval
• 2020. Emergency Medical Technician Program Approval
• 2030. Paramedic Program Approval
• 2040. Emergency Medical Technician Certification
• 2050. Paramedic Accreditation
• 2051. Preceptors for Paramedic Student Interns
• 2052. Paramedic Field Supervisor
• 2060. Continuing Education Approval
• 2070. Certificate/License Discipline Process for Prehospital Personnel

Policy Section 3. Communication

• 3000. Medical Dispatch Center Standards
• 3000.1. Medical Dispatcher Standards
• 3010. EMS Communications Equipment and Procedures
• 3011. Communication Drills
• 3020. Field to Hospital Communications

Policy Section 4. Response and Transportation

• 4000. Prehospital Provider Standards
• 4000.1. Ambulance Turnaround Time Standard
• 4001. Vehicle Equipment & Supply List
• 4002. Controlled Substances
• 4010. Integrated Response Plan
• 4020. Emergency Medical Services (EMS) Aircraft Utilization
• 4030. Intercounty and Bridge Response
• 4040. Procedure and Documentation for Non-Transported Patients
• 4041. Scene Management, Physician on Scene and Mass Gatherings
• 4043. EMS Use of Physical Restraints
• 4050. Death in the Field
• 4051. Do Not Resuscitate & Physician Orders for Life-Sustaining Treatment
• 4070. Critical Care Transport by Paramedic (CCT-P) Program Approval
• 4071. CCT-Paramedic Optional Scope of Practice
• 4072. Bariatric Patient Transports

Policy Section 5. Hospitals and Critical Care Centers

• 5000. Destination Policy
• 5001. Trauma Triage Criteria
• 5010. Receiving Hospital Standards
• 5011. Base Hospital Standards
• 5012. Pediatric Critical Care Standards
• 5013. Trauma Center Designation
• 5014. Level I Trauma Care Standards
• 5015. Stroke Center Standards
• 5016. STEMI and ROSC (“STAR”) Receiving Center Standards
• 5020. Diversion Policy
• 5021. Trauma Center Bypass Policy
• 5030. Interfacility Transfers
• 5040. Emergency Department Downgrade or Closure Impact Evaluation Policy

Policy Section 6. Data Collection and Evaluation

• 6000. Quality Improvement Program
• 6010. Local Emergency Medical Services Information System (LEMSIS)
• 6020. Incident Reporting
• 6030. Research Studies
• 6040. Pilot Programs

Policy Section 7. Public Information and Education

• 7010. Emergency Medical Services at Special Events

Policy Section 8. Disaster Response

8000. MCI Policy and Plan

• Entire MCI Policy and Plan
• Policy
• Revision Summary

Part 1. Standard Operating Procedures

• 1.1. Alert Levels
• 1.2. 911 Dispatch
• 1.3. Private Ambulance Dispatch
• 1.4. Field Supervisors (Medical Group)
• 1.5. Hospitals
• 1.6. DEM Duty Officer / EOC Medical - Public Health Group

Part 2. Background

• 2.1. Introduction
• 2.2. Patients
• 2.3. Medical Group Organization
• 2.4. San Francisco Alert Levels
• 2.5. Standard Operating Procedures
• 2.6. EMS Provider Agency Roles and Responsibilities
• 2.7. Interagency Coordination
• 2.8. In-County Coordination
• 2.9. Out-of-County Coordination - Medical Mutual Aid

Part 3. Operations

• 3.1. Introduction
• 3.2. Scene Management
• 3.3. Initial Set Up of the Medical Group
• 3.4. Alert Level Determination
• 3.5. EMS, 911 Dispatch and Hospitals Communications
• 3.6. Medical Branch / Group Operations
• 3.7. Modified 911 EMS Responses
• 3.8. Hospital Operations
• 3.9. Overview Patient Distribution
• 3.10. Assigned Patient Distributions
• 3.11. Managed Patient Distribution
• 3.12. Patient Distributions in a Level 4 MCI (Red) Alert
• 3.13. Alternate Care Sites
• 3.14. Mass Medical Evacuations
• 3.15. Mass Medical Evacuation Patient Tracking
• 3.16. Receipt of Out-of-County Patients
• 3.17. Medical Mutual Aid Resources
• 3.18. Initiating Medical Mutual Aid
• 3.19. Ambulance Strike Teams
• 3.20. Emergency Declarations - Invoking Austere Medical Care Standards
• 3.21. Demobilization

Appendix B. Medical Branch / Group Positions

• B.1. Common Tasks: All Field Personnel
• B.2. Medical Branch Director
• B.3. Medical Group Supervisor
• B.4. Triage Area
• B.5. Treatment Area
• B.6. Patient Transportation Area
• B.7. Medical Supply Coordinator
• B.8. Layout Diagram
• Appendix D. Abbreviations, Acronyms & Glossary
• Appendix E. Report of Hospital Patients Received from Incident
• 8050. Hazardous Materials Incident Field Policy