1. 2016 EMS “ADMINISTRATIVE POLICY” REVISIONS EFFECTIVE APRIL 1, 2016 Contra Costa County EMS Agency

2. WHAT IS CHANGING  Updated formatting, look and feel  Indexing for quick reference  Content changes  Polices moved to “treatment guidelines”  Retirement of outdated policies and implementation of new policies  Hyperlinks embedded into policies

3.  Important to retain the traditional ‘golden rod’ feel  Uniform look and feel  Boldly labeled and numbered for quick identification Visual Appearance

4.  Traditional sequential numbering sequence replaced with updated indexing  Policies are bundled into broad categories, consistent with County EMS Plan  All policies have been renumbered to accommodate index numbering Indexing

5.  Written with one common and direct voice  Definitions removed from policies and more appropriately placed in definition list  Passive educational tips removed  Designed to expedite identification of information needed by providers at any time  Hyperlinks to other policies and external sites added Content

6.  Policy 7 – Paramedic Evaluator retired.  Policy 13 – Trauma Treatment and Triage moved. Triage guidelines are now a Treatment Guideline  Policy 17 – Paramedic Non-Transport Units retired.  Policy 31 – Management of Pre-existing Patient Medical Devices / Equipment moved. Information moved to Treatment Guidelines.  Policy 37 – Stroke Triage and Destination retired. Stroke Treatment Guideline updated to include Primary Stroke Centers. Stroke destination direction added to Policy 4002 (Old Destination Determination Policy 9) Policies Retired / Moved

7.  Policy 2005 – Paramedic Preceptor Authorization added.  Policy 2006– Paramedic Intern Authorization added.  Policy 3002 – EMD: Medical Oversight, Dispatch Quality and Operation Standards added.  Policy 3003 – Dispatch Requirements for 9-1-1 Resources added.  Policy 3004 – Base Hospital and Receiving Center Reports added. Policy Additions

8.  2016 policies may be implemented prior to April 1, 2016, if provider agency has completed training with all active employees.  Training and implementation of these policies must be completed no later than April 1, 2016 Effective Date

9. Administrative PoliciesSection Number System Organization, Management and Operations 1000 Staff and Training2000 Communications3000 Response and Transportation4000 Facilities5000 Data Collection and System Evaluation6000 Policy Index Categories

10. POLICY REVISION SUMMARY

11.  A comprehensive list of definitions removed from policies and those not previously or formally identified added  Definitions immediately follow Policy Index and precede Policy 1001 Definitions

12.  Policy 1001  Policy 1008  Policy 1009  Policy 1010  Policy 5001  Policy 5002  Policy 5003  Policy 5004  Policy 5005 Policies with no significant changes  Former Policy 12  Former Policy 30  Former Policy 35  Former Policy 4  Former Policy 29  Former Policy 24  Former Policy 26  Former Policy 38  Former Policy 14

13.  Policy 1003  Policy 1006  Policy 2004  Policy 4001  Policy 4006  Policy 4007 Policies with references removed or resources added  Former Policy 20  Former Policy 34  Former Policy 5  Former Policy 18  Former Policy 39  Former Policy 10

14. Former Policy 16  Purposes A and B combined  Scope of Direction and Oversight divided into two sections:  III. Continuum of Patient Care  IV. Turnover of Patient Care Authority Prehospital Transfer of Care Policy 1002

15. Former Policy 16  III. Continuum of Patient Care  First responder paramedics, when first on scene should transfer patient care authority and provide verbal turnover report to transport paramedics as soon as feasibly possible.  Transport paramedic reports should ensure the continuum of patient care.  The non-transport paramedic shall complete a PCR for each patient encounter. If the PCR cannot be sent with the patient to the hospital, it must be sent to the receiving ED as soon as feasibly possible.  The paramedic has ultimate responsibility for all patient assessment and care. Prehospital Transfer of Care Policy 1002

16. Former Policy 16  IV. Turn Over of Patient Care Authority  A paramedic may transfer patient care authority to a BLS transport unit, when all of the following circumstances exist:  BLS unit is available within a reasonable time.  ALS care has not been initiated.  It has been determined that ALS care is unneeded during transport. Prehospital Transfer of Care Policy 1002

17. Former Policy 16  IV. Turn Over of Patient Care Authority  Paramedics may transfer care of stable patients to BLS transport units within the following guidelines:  Patients must be stable with BLS medical complaints.  Patient’s airway must be maintained without assistance or adjuncts.  Patient must be hemodynamically stable.  Patient must be of their normal mental status and not impaired by alcohol or drugs. Prehospital Transfer of Care Policy 1002

18. Former Policy 16  IV. Turn Over of Patient Care Authority  Paramedics may transfer care of stable patients to BLS transport units within the following guidelines:  No mechanism of injury that would warrant a trauma alert or activation.  No cardiac, respiratory or neurological complaints that may warrant ALS intervention.  Except during an MCI or when no other ALS transport alternative exists, patient meeting trauma criteria will be considered ALS patients and treated accordingly. Prehospital Transfer of Care Policy 1002

19. Former Policy 16  IV. Turn Over of Patient Care Authority  Paramedics may transfer care of stable patients to BLS transport units within the following guidelines:  The transport EMT must be comfortable with the patient’s condition  Flight nurses may turn over patients to paramedics. These patients must not have or require any medications or therapies that are outside the paramedics scope of practice Prehospital Transfer of Care Policy 1002

20. Former Policy 19  Definitions removed  Title changed to Determination of Death  Section VII – Emergency Medical Dispatch removed  Section VI – Coroner Investigation content reduced  Section IX – Discontinuing CPR clarified such that only ALS personnel may discontinue CPR Determination of Death Policy 1004

21. Former Policy 21  Sections II(C) and (D) added  II(C) – If the physician on scene desires option 1, the Base Hospital will retain medical control if Base Hospital contact was established.  II(D) – If the physician on scene desires options 2 or 3, the paramedics will:  Verify physician’s State of California medical license.  Immediately contact Base Hospital and speak with a Base Hospital Physician. Physician On Scene Policy 1005

22. Former Policy 23  Section II amended to clarify reporting responsibilities  EMTs and paramedics are mandated reporters.  If reasonable suspicion of abuse or neglect exists, EMTs and paramedics are required to report to APS or CPS even if reported to law enforcement or hospital staff.  Reporting to any party other than APS or CPS does not absolve one’s responsibility of reporting requirement.  Section III amended to include current contact information for reporting agencies.  Resources added Abuse / Assault Reporting Policy 1007

23. Former Policy 1  Changes to Section II – Prerequisite to EMT Certification  Provide documentation of successfully passing NREMT written and skills exam and have either:  A valid EMT course completion record from an approved U.S. DOT EMT training program dated within the last two (2) years; or  Documentation of successful completion of an approved out-of-state initial U.S. DOT approved EMT training course within the last two (2) years. EMT Certification Policy 2001

24. Former Policy 1  CPR requirement amended to reflect training to American Heart Association standards.  Recertification After Lapse in Certification amended to remove all duplicate language and requirements; consolidated and referenced Sections II and IV.  Section VII – Continuing Education Hours amended to include the addition of audits for Continuing Education. EMT Certification Policy 2001

25. Former Policy 2  CPR and ACLS requirements added  Verification of infrequent skills competency requirement every two years added  Application requirement for continuous accreditation added  Please review policy in its entirety Paramedic Accreditation Policy 2002

26. Former Policy 3  ALS ride-along requirement clarified  Addition of a Contra Costa County EMS Agency protocol examination added  Reauthorization requirements amended  Denial, suspension, probation or revocation criteria added MICN Authorization Policy 2003

27. New Policy  Establishes the requirements for Paramedic Preceptor authorization  Please review policy in its entirety Paramedic Preceptor Authorization Policy 2005

28. New Policy  Establishes the requirements for Paramedic Intern authorization  Please review policy in its entirety Paramedic Intern Authorization Policy 2006

29. Former Policy 41  Former Section II(B) removed  Scheduling off-cycle EMT Orientation classes removed. EMT Orientation and Registration for Non- Emergency Ambulance Providers Policy 2007

30. Former Policy 6  Section II additions:  A(4) – recordkeeping  A(6) – application fee  A(7) – submission timeline  B – notification of approval or denial  E – record availability Prehospital Continuing Education Provider Policy 2008

31. Former Policy 11  Section III(C) added:  EMS Event reporting requirements for disrupted Base Hospital communication Base Hospital Communications Policy 3001

32. New Policy  Establishes the minimum standards for Emergency Medical Dispatch centers.  Please review policy in its entirety. EMD: Medical Oversight, Dispatch Quality and Operation Standards Policy 3002

33. New Policy  Establishes the minimum response and mode assignments used by Emergency Medical Dispatch centers in Contra Costa County.  Please review policy in its entirety. Dispatch Requirements for 9-1-1 Resources Policy 3003

34. New Policy  Establishes the framework for approved reporting formats for Base Hospital and receiving center verbal reports.  Please review policy in its entirety. Base Hospital and Receiving Center Reports Policy 3004

35. Former Policy 9  Receiving hospitals moved to Policy 4003 – Approved Receiving Hospitals  Added Section X – STEMI/Acute Stroke, which provides destination direction for these patients Patient Destination Determination Policy 4002

36. New Policy  Outlines the approved receiving hospitals for patients transported by 9-1-1 ground ambulance.  Please review policy in its entirety. Approved Receiving Hospitals Policy 4003

37. Former Policies 33 A/B  Policies 33 A and 33B combined into a single policy  Removed former Section II - Authority EMS Aircraft Classification and Authorization Policy 4004

38. Former Policy 33C  Removed former Section II - Authority EMS Aircraft Utilization and Field Operations Policy 4005

39. Former Policy 22  Removed Authority language  Removed former Section II(A) – Prehospital Personnel Exposure Risk Reduction  Removed former Section II(B) – Provider Agencies Exposure Risk Reduction  Resources added Infectious Disease Precautions and Exposure Management for EMS Personnel Policy 4008

40. Former Policy 25  Definitions removed  Former Section V – STEMI Alert/ Patient report information removed  Section IV – Transfer of Care Report information added STEMI Triage and Destination Policy 4009

41. Former Policy 40  Definitions removed  Removed former Section III – Authority EMS – ED Transfer of Care Standards Policy 4010

42. Former Policy 15  Section II – Transport Options For Acute Interfacility Transfer matrix changed Hospital Guidelines for Acute Care Interfacility Transfer Policy 5006

43. Former Policy 27  General changes to documentation requirements  Please review policy in its entirety Documentation of the Patient Care Report Policy 6001

44. Former Policy 32  Removed former Section II – Authority  General changes to reporting requirements  Resources added  Please review policy in its entirety EMS Event Reporting Policy 6002

45. Former Policy 8  General changes to requirements  Please review policy in its entirety EMS Quality Improvement Plan (EQIP) Policy 6003

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