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
• 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

• 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 (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

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

• 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. 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

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

13.I. Medication List

• 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

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
• 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
• 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
• 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

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

Standard Operating Procedures

• Alert Levels
• 911 Dispatch
• Private Ambulance Dispatch
• Field Supervisors (or Medical Group)
• Hospitals
• DEM Duty Officer / EOC Medical - Public Health Group

Background and Training

• 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

Operations

• 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

Appendix A: Medical Group / Branch Job Sheets, Organization Charts, and Field Layout

• 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