San Francisco EMS Protocols
Update Summaries
- May 2, 2022
- April 1, 2022
- March 18, 2022
- February 23, 2022
- January 11, 2022
- January 7, 2022
- January 3, 2022
- December 17, 2021
- December 1, 2021
- October 27, 2021
- October 1, 2021
- September 21, 2021
- August 25, 2021
- August 10, 2021
- July 1, 2021
- June 30, 2021
- June 14, 2021
- May 19, 2021
- May 1, 2021
- April 15, 2021
EMS Alert Info
EMS Memos
- Base Physician in the Field Program
- D10W Medication Shortage
- 2-23-22 Epi Dilution
- EMS System Response Modifications
- EMS Alert Memo
- Policy 5010 & 5020
- 10-27-21 Binax Testing
- 9-21-21 BLS Authorization
- 8-25-21 BLS Authorization
- 8-10-21 BLS Authorization
- 8-10-21 ReddiNet
- 8-10-21 Special Events
- 6-30-21 CADDiE Update
- 6-30-21 UCSF MB Parking
- 6-14-21 Protocol 7.01 Update
- 05-11-21 EMS Agency Office Move
- 05-1-21 BLS Extension
- 03-16-21 EMT COVID-19 Vaccine Administration Guidance
- 01-20-21 COVID-19 Augmentation of Policy 5000.1 for CPMC-Bernal (Obstetrics)
- 01-13-21 CADDiE and Behavioral Health Patients
- 11-10-20 Airway, Needle Thoracostomy and Allergic Reaction Protocols and the Advisory Committee Policy Revisions
- 07-08-20 Policy 7010 Emergency Medical Services at Special Events - Temporary Administrative Update
- 07-02-20 CADDiE Project Augmentation – CADDiE Hospital Direction Now Mandatory
- 06-26-20 COVID-19 Testing of Decedents in the Field
- 06-12-20 Activation of Protocol 11.06 Special Circumstances - Respiratory Pandemic & Guidance for LUCAS CPR Device Transition Between EMS and Hospitals
- 05-08-20 Approval for Use of Medications Beyond Expiration Date when Replacements are Unavailable
- 04-24-20 Ambulance Positing Modification
- 4-08-20 Alternate Destination Sites
- 04-01-20 EMT Certification & Paramedic Accreditation
- 04-01-20 PPE Doffing
- 03-23-20 Suspension of Special Event Plans
- 03-20-20 Hospital Destination Memo
- 03-18-20 Passengers in Ambulance
- 03-10-20 Use of Nebulizers
- 03-07-20 Personal Protective Equipment (PPE)
- 03-06-20 COVID-19 Ambulance Request Flowchart
General
COVID-19 Memos
COVID-19 Information
- OME Info Pamphlet
- 2.11 Respiratory Distress: Bronchospasm
- Albuterol (Ventolin or Proventil)
- Metered Dose Inhaler (MDI) Training Guide
Alternate Care Sites
Metered Dose Inhaler
Assess & Refer
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
- 2.17. Hyperkalemia
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 (iGel)
- 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
- 7.17. COVID-19 Point of Contact Testing
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
- 2080. Standards for EMS Physicians Providing EMS Oversight
- 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
- 5000.1. San Francisco Hospital Designations
- 5000.2. 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
- 6050. Documentation of Prehospital Care
- 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
Policy Section 1. System Organization and Management
Policy Section 2. Personnel & Training
Policy Section 3. Communication
Policy Section 4. Response and Transportation
Policy Section 5. Hospitals and Critical Care Centers
Policy Section 6. Data Collection and Evaluation
Policy Section 7. Public Information and Education
Policy Section 8. Disaster Response
8000. MCI Policy and Plan
Standard Operating Procedures
Background and Training
Operations
Appendix A: Medical Group / Branch Job Sheets, Organization Charts, and Field Layout
Last updated: 2022-05-02