{"id":591,"date":"2020-10-11T09:33:30","date_gmt":"2020-10-11T09:33:30","guid":{"rendered":"https:\/\/dhs.lacounty.gov\/emergency-medical-services-agency\/?page_id=591"},"modified":"2020-10-11T09:41:14","modified_gmt":"2020-10-11T09:41:14","slug":"emergency-medical-services-ecg06","status":"publish","type":"page","link":"https:\/\/dhs.lacounty.gov\/emergency-medical-services-agency\/home\/ce11\/emergency-medical-services-ecg06\/","title":{"rendered":"Emergency Medical Services  ECG06"},"content":{"rendered":"<div class=\"wpb-content-wrapper\"><p>[vc_row][vc_column][vc_column_text]<\/p>\n<h2 class=\"grve-element grve-title grve-align-left grve-h2\">Emergency Medical Services (EMS) Agency<\/h2>\n<div class=\"grve-element grve-text\">\n<p><strong><em>Treatment Protocols and Policies<\/em><\/strong><\/p>\n<\/div>\n            <div class=\"qae-faqs-container qae-faqs-toggle-container\">\n\t\t\t\t\t\t\t<ul class=\"qe-faqs-filters-container\">\n\t\t\t\t<li class=\"active\"><a class=\"qe-faqs-filter all-faqs\" href=\"#\" data-filter=\"*\">All<\/a><\/li>\n\t\t\t\t<li><a class=\"qe-faqs-filter\" href=\"#treatment-protocols-and-policies\" data-filter=\".treatment-protocols-and-policies\">Treatment Protocols and Policies<\/a><\/li>\t\t\t<\/ul>\n\t\t\t\t\t<div id=\"qaef-598\" class=\"qe-faq-toggle treatment-protocols-and-policies\">\n\t\t\t<div class=\"qe-toggle-title\">\n\t\t\t\t<h4>\n\t\t\t\t\t<i class=\"fa fa-minus-circle\"><\/i> For patients resuscitated from cardiac arrest, why am I staying on scene to stabilize the patient after return of spontaneous circulation (ROSC)?\t\t\t\t<\/h4>\n\t\t\t<\/div>\n\t\t\t<div class=\"qe-toggle-content\">\n\t\t\t\t<div class=\"vc_tta-panel-heading\">\n<p class=\"vc_tta-panel-title vc_tta-controls-icon-position-left\">Re-arrest is common shortly after return of spontaneous circulation (ROSC), occurring in approximately 60% of patients who are resuscitated from out-of-hospital cardiac arrest (OHCA). &nbsp;Particularly, during the COVID-19 pandemic, avoiding CPR en route to the facility not only improves patient outcomes, but can also reduce exposure risk for EMS providers. Nearly all patients are preload dependent after cardiac arrest and most will require vasopressor support. Rapid on-scene stabilization can prevent re-arrest by initiating volume resuscitation and preparing to administer push-dose vasopressors as needed before the epinephrine administered during resuscitation wears off and the patient begins to decompensate. Once the patient has been initially stabilized with intravenous fluids and push dose epinephrine as needed, the patient can be transferred to the nearest STEMI Receiving Center. &nbsp;See <a href=\"https:\/\/file.lacounty.gov\/SDSInter\/dhs\/1040387_1210CardiacArrest2018-05-30.pdf\">Treatment Protocol 1210 Cardiac Arrest<\/a>&nbsp;and the EMS Agency memo for more information.<\/p>\n<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t<div id=\"qaef-597\" class=\"qe-faq-toggle treatment-protocols-and-policies\">\n\t\t\t<div class=\"qe-toggle-title\">\n\t\t\t\t<h4>\n\t\t\t\t\t<i class=\"fa fa-minus-circle\"><\/i> For patients without return of spontaneous circulation (ROSC), why am I consulting with the Base Physician regarding the decision to transport?\t\t\t\t<\/h4>\n\t\t\t<\/div>\n\t\t\t<div class=\"qe-toggle-content\">\n\t\t\t\t<div class=\"vc_tta-panel-heading\">\n<p class=\"vc_tta-panel-title vc_tta-controls-icon-position-left\"><a href=\"https:\/\/file.lacounty.gov\/SDSInter\/dhs\/206332_Ref.No.814,DeterminationofDeath_06-21-16.pdf\">Per Ref. 814, Determination\/Pronouncement of Death in the Field<\/a>, the Base Physician must determine the decision for transport or termination for patients who do not meet criteria for termination of resuscitation in section II.A. This is based on the physician\u2019s assessment of the patient\u2019s chances of meaningful survival. This has not changed during the COVID-19 pandemic. On-scene resuscitation to achieve ROSC prior to transport optimizes the patient\u2019s chances for a good outcome. If futility is determined by the Base Physician, the patient should not be transported to the hospital.<\/p>\n<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t<div id=\"qaef-596\" class=\"qe-faq-toggle treatment-protocols-and-policies\">\n\t\t\t<div class=\"qe-toggle-title\">\n\t\t\t\t<h4>\n\t\t\t\t\t<i class=\"fa fa-minus-circle\"><\/i> How does treat and refer work? What if the patient still wants transport?\t\t\t\t<\/h4>\n\t\t\t<\/div>\n\t\t\t<div class=\"qe-toggle-content\">\n\t\t\t\t<div class=\"vc_tta-panel-heading\">\n<p class=\"vc_tta-panel-title vc_tta-controls-icon-position-left\"><a href=\"https:\/\/file.lacounty.gov\/SDSInter\/dhs\/1069965_834.1-Covid19.pdf\">Reference 834.1 Treat and Refer for Ill Patients During the COVID-19 Outbreak<\/a>\u00a0is a policy that was created for EMS personnel to identify low acuity patients with COVID-19 related complaints that do not need immediate transport to the Emergency Department. Use\u00a0<a href=\"https:\/\/file.lacounty.gov\/SDSInter\/dhs\/1071088_834.2-COVID-19LowRiskScreeningTool.pdf\">Reference 834.2 Low Risk COVID-19 Screening Tool<\/a>\u00a0to determine if the patient meets low risk criteria. Patients must have normal vital signs and pulse oximetry 94% or greater to be treated and referred.<\/p>\n<p>If the patient or legal guardian still requests transport after reassurance by EMS personnel, then the patient\u00a0<strong>must\u00a0<\/strong>be taken to the Most Accessible Receiving facility (MAR) for adults or Emergency Department Approved for Pediatrics (EDAP) for children<\/p>\n<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t<div id=\"qaef-587\" class=\"qe-faq-toggle treatment-protocols-and-policies\">\n\t\t\t<div class=\"qe-toggle-title\">\n\t\t\t\t<h4>\n\t\t\t\t\t<i class=\"fa fa-minus-circle\"><\/i> If there is a disagreement between TP 1245 and the treatment protocol corresponding with the provider impression, which protocol should be followed?\t\t\t\t<\/h4>\n\t\t\t<\/div>\n\t\t\t<div class=\"qe-toggle-content\">\n\t\t\t\t<div class=\"vc_tta-panel-heading\">\n<p class=\"vc_tta-panel-title vc_tta-controls-icon-position-left\">During the COVID-19 pandemic, direction under <a href=\"https:\/\/file.lacounty.gov\/SDSInter\/dhs\/1070073_1245PotentialCOVID-19Patients.pdf\">TP1245<\/a>\u00a0will supersede any direction that is outlined in the other treatment protocols.<\/p>\n<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t<div id=\"qaef-586\" class=\"qe-faq-toggle treatment-protocols-and-policies\">\n\t\t\t<div class=\"qe-toggle-title\">\n\t\t\t\t<h4>\n\t\t\t\t\t<i class=\"fa fa-minus-circle\"><\/i> \u00a0Is there a treatment protocol for COVID-19 patients?\t\t\t\t<\/h4>\n\t\t\t<\/div>\n\t\t\t<div class=\"qe-toggle-content\">\n\t\t\t\t<div class=\"vc_tta-panel-heading\">\n<p class=\"vc_tta-panel-title vc_tta-controls-icon-position-left\"><a href=\"https:\/\/file.lacounty.gov\/SDSInter\/dhs\/1070073_1245PotentialCOVID-19Patients.pdf\">TP 1245 Potential COVID-19 Patients<\/a>, is a newly created protocol that is a direct response to the COVID-19 pandemic. This protocol is intended to be used in conjunction with the treatment protocol(s) that correspond to the provider impression(s). &nbsp;The guidance therein supersedes guidance in the other treatment protocols during the COVID-19 pandemic.&nbsp; This protocol was developed to outline practices that ensure quality prehospital care, while maximizing provider safety and minimizing exposures in the field.<\/p>\n<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t            <\/div>\n\t\t\n<p><em><a href=\"https:\/\/dhs.lacounty.gov\/emergency-medical-services-agency\/ce11\/\">COVID \u2013 19 RESOURCES AND UPDATES<\/a><\/em>[\/vc_column_text][\/vc_column][\/vc_row]<\/p>\n<\/div>","protected":false},"excerpt":{"rendered":"<p>[vc_row][vc_column][vc_column_text] Emergency Medical Services (EMS) Agency Treatment Protocols and Policies COVID \u2013 19 RESOURCES AND UPDATES[\/vc_column_text][\/vc_column][\/vc_row]<\/p>\n","protected":false},"author":3,"featured_media":0,"parent":56,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"page-templates\/template-faq-page.php","meta":{"_oasis_is_in_workflow":0,"_oasis_original":0,"_monsterinsights_skip_tracking":false,"_monsterinsights_sitenote_active":false,"_monsterinsights_sitenote_note":"","_monsterinsights_sitenote_category":0,"footnotes":"","_links_to":"","_links_to_target":""},"categories":[],"tags":[],"class_list":["post-591","page","type-page","status-publish","hentry"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.8 - 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