San Francisco EMS Protocols
COVID-19 Information
- Alternate Destination Sites
- Ambulance Positing Modification
- BLS Authorization & Mutual Aid
- CADDiE Project Augmentation – CADDiE Hospital Direction Now Mandatory
- COVID-19 Ambulance Request Flowchart
- COVID-19 Units, BLS in 911 & Corporate Resources
- EMT Certification & Paramedic Accreditation
- Extension of Emergency Release of Policy 4060 - Assess & Refer
- Hospital Destination Memo
- Passengers in Ambulance
- Personal Protective Equipment (PPE)
- PPE Doffing
- Suspension of Special Event Plans
- Use of Nebulizers
- 2.11 Respiratory Distress: Bronchospasm
- Albuterol (Ventolin or Proventil)
- Metered Dose Inhaler (MDI) Training Guide
COVID-19 Memos
Alternate Care Sites
Metered Dose Inhaler
Assess & Refer
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
- 1.03. Patient Assessment - Critical Patient Offload 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 (ROSC)
- 2.06. Chest Pain / Acute Coronary Syndrome
- 2.07. Dysrhythmia: Symptomatic Bradycardia
- 2.08. Dysrhythmia: 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
Section 6: Behavioral
Section 7: Procedures
- 7.01. Airway Management
- 7.02. Oral Endotracheal Intubation
- 7.03. Supraglottic Airway
- 7.05. Needle Cricothyrotomy
- 7.06. Needle Thoracostomy
- 7.07. Continuous Positive Airway Pressure (CPAP)
- 7.08. Pulse Oximetry
- 7.09. Carboxyhemoglobin Monitoring
- 7.10. 12-Lead Electrocardiogram Procedure
- 7.11. Spinal Motion Restriction
- 7.12. Vascular Access with Intraosseous (IO) Device
- 7.13. Vascular Access with Pre-Existing Vascular Access Device (PVAD)
- 7.14. Reporting Assault / Abuse
- 7.15. Splinting
- 7.16. Mechanical CPR Device
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: Ventricular Fibrillation / Pulseless Ventricular Tachycardia
- 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
Section 10: Pediatric Behavioral
Section 11: Special Circumstances
- 11.01. Special Circumstances: Austere Care
- 11.02. Special Circumstances: Crush Syndrome
- 11.03. Special Circumstances: Chemical & Radiological Agents
- 11.04. Special Circumstances: Field Amputation
- 11.05. Special Circumstances: Blast Injury
- 11.06. Special Circumstances: Respiratory Pandemic
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 Ventilator-Dependent and Agitated Patients
- 12.08. Automatic Transport Ventilators
- 12.09. Intravenous Infusion of Blood / Blood Products
- 12.10. Intravenous Infusion of Glycoprotein IIb / IIIa Receptor Inhibitors
- 12.11. Intravenous Infusion of Total Parenteral Nutrition (TPN)
- 12.12. Intravenous Infusion of Morphine Sulfate
- 12.13. Intravenous Infusion of Midazolam
Section 13: References
- Adenosine (Adenocard)
- Albuterol (Ventolin or Proventil)
- Amiodarone
- Aspirin (ASA)
- Atropine Sulfate
- Calcium Chloride (CaCl)
- Charcoal (Activated) [Actidose with Sorbitol)
- Dextrose 10% (D10W)
- Diphenhydramine (Benadryl)
- Dopamine (with Epinephrine Infusion Alternative per Memo 2018-01)
- Epinephrine (Adrenaline)
- Fentanyl Citrate (Sublimaze)
- Glucagon
- Glucose (Glucose)
- Hydroxocobalamin
- Ibuprofen
- Ketorolac Injection
- Lidocaine (Xylocaine)
- Magnesium Sulfate
- Midazolam (Versed)
- Morphine Sulfate
- Naloxone (Narcan)
- Nitroglycerin (Nitrolingual)
- Normal Saline
- Ondansetron (Zofran)
- Oxygen (02)
- Pralidoxime (2-PAM Chloride)
- Sodium Bicarbonate
- 13.II. Abbreviations
- 13.III. Pediatric Dosage Chart
- 13.IV. Normal Pediatric Vital Signs
13.I. Medication List
EMS POLICIES
- 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
- 3000. Medical Dispatch Center Standards
- 3000.1. Medical Dispatcher Standards
- 3010. EMS Communications Equipment and Procedures
- 3011. Communication Drills
- 3020. Field to Hospital Communications
- 4000. Prehospital Provider Standards
- 4000.1. Ambulance Turnaround Time Standard
- 4001. Vehicle Equipment & Supply List
- 4001a. Minimum Equipment Requirements for First Response and Ambulances
- 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
- 4060. Assess & Refer
- 4070. Critical Care Transport by Paramedic (CCT-P) Program Approval
- 4071. CCT-Paramedic Optional Scope of Practice
- 4072. Bariatric Patient Transports
- 5000. Destination Policy
- 50000.1. San Francisco Hospital Designations
- 50000.2. Psychiatric Patient Destination
- 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
- 6000. Quality Improvement Program
- 6010. Local Emergency Medical Services Information System (LEMSIS)
- 6020. Incident Reporting
- 6030. Research Studies
- 6040. Pilot Programs
- Entire MCI Policy and Plan
- Policy
- Alert Levels
- 911 Dispatch
- Private Ambulance Dispatch
- Field Supervisors (or Medical Group)
- Hospitals
- DEM Duty Officer / EOC Medical - Public Health Group
- Introduction
- Patients
- Medical Group Organization
- San Francisco Alert Levels
- Standard Operating Procedures
- EMS Provider Agency Roles and Responsibilities
- Interagency Coordination
- In-County Coordination
- Out-of-County Coordination - Medical Mutual Aid
- Introduction
- Scene Management
- Initial Set Up of the Medical Group
- Alert Level Determination
- Communications
- Medical Branch / Group Operations
- Modified 911 EMS Responses
- Hospital Operations
- Overview Patient Distribution
- Assigned Patient Distributions
- Managed Patient Distribution
- Patient Distributions in a Level 4 MCI (Red) Alert
- Alternate Care Sites
- Mass Medical Evacuations
- Mass Medical Evacuation Patient Tracking
- Receipt of Out-of-County Patients
- Medical Mutual Aid Resources
- Initiating Medical Mutual Aid
- Ambulance Strike Teams
- Emergency Declarations - Invoking Austere Medical Care Standards
- Demobilization
- First Tasks When Arriving On-Scene
- Medical Branch Director
- Medical Group Supervisor
- Triage Area Unit Leader
- Triage Personnel
- Morgue Manager
- Treatment Area Unit Leader
- Immediate (Red) Treatment Manager
- Delayed (Yellow) Treatment Manager
- Minor (Green) Treatment Manager
- Patient Loading Coordinator
- Transportation Area Unit Leader
- Medical Communications Coordinator
- Ground Ambulance (Staging) Coordinator
- Air Ambulance Coordinator
- Medical Supply Coordinator
- MCI Organization Chart First Five Minutes Medical Group Response
- MCI Organization Chart Full Medical Branch Activation
- Layout Diagram
- Appendix B: Battalion Control During Catastrophic Incidents
- Appendix C: MCI Field Documentation Algorithm
- Appendix D: Ambulance Mutual Aid Escalation
- Appendix E: Abbreviations, Acronyms & Glossary
- Glossary
- 8050. Hazardous Materials Incident Field Policy
- 8050a. Hazardous Materials Incident Control Zones