HomeMy WebLinkAboutSOG 502.01 REVISED 6-2012-EMD• � f
502.01 — Emergency Medical Dispatch
Effective: 4/5/2009
Revised: 6/20/2012
Replaces: SOG 502.02 (Re -numbered)
BEMS Reference: OPS -08016
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I. Guiding Philosophy
Providing quality, consistent emergency medical services requires knowledgeable, skilled
service providers who respond in a caring and compassionate manner. To best serve our
customers, the response organizations that make up our local system strive to provide seamless
emergency medical services from the moment of the initial call for service through the arrival
and transfer of the patient at the hospital.
II. Purpose
The purpose of this policy is to provide guidance for BFRS Fire/EMS Dispatchers and all
emergency medical field personnel relative to the standard dispatch procedures to be utilized in
the City of Beaumont response system, which includes Beaumont Emergency Medical Services
Advanced Life Support (BEMS ALS) capabilities, Beaumont Fire/Rescue Services Basic Life
Support (BFRS BLS) capabilities, and is supplemented by private ambulance providers and other
local First Responders organizations.
III. Goals
The goals of this policy are to:
A. Communicate the applicability and terms of revision of this policy.
B. Detail general and "no patient" emergency medical dispatch guidelines.
C. Provide dispatch priorities based on standard response determinants according to
call type.
D. Detail dispatch procedures for utilization of private ambulance providers.
E. Communicate BEMS posting procedures.
F. Provide the Quality Assurance and Improvement (QA/QI) methodology to be
employed.
IV. Policy
A. All personnel who provide out-of-hospital care under the auspices of Beaumont
EMS, including Beaumont Fire/Rescue members, will comply with this guideline.
Endorsements:
DAA" MD _6/20/2012_
Daridush Kavouspour, MD Date Signed
Medical Director BEMS/BFRS
B. This policy will be in effect until revised jointly by the Public Health Medical
Director, the Public Health Director and the Fire Chief.
C. All dispatch criteria as shown in the following attachments will be followed by both
Fire/EMS dispatchers and BEMSBFRS Medical personnel.
V. Emergency Medical Dispatch Guidelines
A. General EMD Guidelines
1. BEMS Shift Commander (Supervisor) will be dispatched or informed of:
a. Incidents requiring two (2) or more EMS units.
b. Any incident in which an "outside" ambulance service is utilized.
C. Rescues (i.e., entrapment, water rescue, high -angle rescue, etc.)
d. Cardiac or respiratory arrests
e. Incidents in which the on -scene EMS personnel have assigned a "Priority
1 or Priority 2" signal code
f. If requested by a Med Unit
g. All active seizures
h. All hazmat events
2. Regardless of chief complaint, First Responders will be dispatched to:
a. Severe respiratory distress
b. Unconscious
C. Forcible entry required
d. Possible strokes
Multiple medic units
a. May be dispatched immediately (as part of initial assignment) if call
information strongly indicates more than two (2) patients.
4. Cancellation, Downgrading and/or Diverting
a. An EMS unit may be cancelled prior to arrival at an incident to which it
has been dispatched if the following criteria are met:
1) Another BEMS unit (including ALS units) is on the scene and
advises that the unit can cancel, OR
2) The unit is responding on a mutual aid request for another EMS or
public safety agency, and the requesting agency requests that the
unit be cancelled (For example, Orange County), OR
3) Where "no patient" is found at the dispatched location.
4) Fire/EMS dispatch will not cancel an EMS unit in any other
circumstances unless approved by the on -duty supervisor.
b. Should the original (first or second party) caller, or other responders (on
the scene) request that EMS unit to be cancelled:
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SOG 502.01 - Emergency Medical Dispatch Page 2 of 20
1) The EMS unit will be "downgraded" to a non -emergency response.
2) The EMS unit will continue to respond.
Fire/EMS dispatcher is authorized to "downgrade" responding units any
time they receive information which they believe warrants reducing the
unit's response mode (i.e., the patient has been reported to have left the
scene).
d. At the discretion of the Fire/EMS dispatcher, an EMS unit may be
diverted in the following situation:
1) Where an EMS unit becomes available and is closer to the call, or
2) A higher priority 911 call received after an EMS unit has been
dispatched to a lower priority 911 call and has not arrived on scene.
5. Obvious death criteria
a. Unquestionable evidence of the following situations:
1) Decapitation
2) Decomposition
3) Submersion of > 24 hours
4) Non -recent traumatic or expected death
5) Incineration
6) Hospice patient, and hospice nurse or physician is on scene
6. Out of City responses
a. First Responders:
1) When an EMS unit dispatched to a Priority 1 call outside the City,
the Fire/EMS dispatcher shall ensure that the local first responders
for that area are also sent.
2) Not required to on Priority 2 or Priority 3 calls, unless requested by
the responding medic crew.
3) Should also be dispatched to calls if so requested by that First
Responder organization. (i.e., Bevil Oaks VFD wishes to be notified
of all calls in their district).
b. EMS Supervisor ("501"):
1) If no First Responders are available (i.e., Cheek VFD), the
Fire/EMS Dispatcher shall send the on -duty EMS Supervisor
("501") to assist the medic unit.
2) Not required to on Priority 2 or Priority 3 calls, unless requested by
the responding medic crew.
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SOG 502.01 - Emergency Medical Dispatch Page 3 of 20
7. Air Medical Transport Service:
a. The helicopter ambulance shall be placed on "standby" status for:
1) Any Priority 1 calls outside the City.
2) Any calls with moderate to severe burns.
3) At the request of medic crew.
b. The closest air medical transport service will be utilized whenever
possible.
The on -scene Unified Command will authorized a "launch" status for the
aircraft and will be held accountable.
d. Upon a "launch" status, Beaumont Fire & Rescue (or the appropriate
First Responder organization) will implement the LZ procedure which
includes:
1) Provide adequate and safe landing zone.
2) Provide direct communication with the approaching aircraft.
3) Implement safety precautions regarding aircraft safety.
8. Dispatch Priority Codes
Priority
Response
Dispatched
Patient's
On Scene
Transport
Mode
Condition
Unit Needed
Condition
1
Emergency
EMS & BFR
Urgent
IU,BFR,
MICU, BFR,
501*
Lights/Siren
2
Emergency
EMS Only
Prompt
MICU, BFR
Optional
3
Emergency
EMS Only
Routine
MICU
LightNo
9. Radio Channel Designation on 911 emergency response
a. Main is used to initially dispatch medical unit(s). It should include the
following information:
1) Responding unit(s)
2) Dispatch nature
3) Location — physical address, highway names/alias, directions, and
specific landmarks if applicable.
b. TAC 2 is generally defaulted when BEMS and BFRS are dispatched
together.
TAC 3 is generally defaulted when ONLY EMS responds.
d. TAC 4 is generally defaulted for structure fires.
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Date _6/20/2012_
SOG 502.01 — Emergency Medical Dispatch Page 4 of 20
TAC 5 is generally defaulted for long term events.
10. Overview of the Dispatch Process'
a. The Emergency Medical Dispatcher conducts an INITIAL SURVEY.
b. Goes to appropriate TAB (Based on the information obtained in the
initial survey).
C. Asks KEY QUESTIONS.
d. DISPATCHES resources (Based on the information obtained from the
initial survey and key questions).
e. Gives PRE -ARRIVAL INSTRUCTIONS, if indicated.
f. RELAYS important information to responders.
B. No Patient Incident
An individual may be considered a "no patient" if the following criteria are met:
a. The individual is a competent adult capable of self-evaluation, AND
b. The individual expressly denies any complaint of illness or injury upon
direct questioning by EMS, AND
C. The examining EMS personnel can see no evidence of illness or injury
on exam, AND
d. The examining EMS personnel see no reason to doubt the patient's
ability to assess him/herself (i.e., heavy intoxication, bizarre behavior,
etc.)
2. Procedures
a. EMS crew
1) Notify Fire/EMS Dispatcher of a "no patient" disposition.
2) Document a synopsis of the event in the NOTES section of the
Event Screen, to include but not limited to:
i. Exact location of the incident.
ii. Observation of the findings.
iii. Reasons for a "no patient" disposition.
iv. Actions taken after determination of a "no patient" disposition.
Examples of No Patient Incidents.
a. Minor MVC on Eastex Freeway
1) EMS Crew
i. "Dispatch, Med-l"
ii. "Disposition No -Patient"
iii. "MVC on the frontage road, Eastex freeway, northbound.
Triage completed, 2 vehicles — minor damages, 4 occupants
I Adopted from PowerPhone — Dispatcher's Medical, Desk Reference Manual, fourth edition, Version 4.2 Rev 01/06.
Medical Director's Initials P. k1
Date _6/20/2012_
SOG 502.01 - Emergency Medical Dispatch Page 5 of 20
with no injuries and no complaints. All declined EMS
services. Release scene to Beaumont PD."
b. Lifeline call at 1234 College
1) EMS Crew
i. "Dispatch, Med-2"
ii. "Disposition No -Patient"
iii. "1234 College, 360 inspection of the residence completed with
no response or activity, neighbor advised no one's home,
owner left with family a week ago."
C. Trauma Alert Criteria
1. In the adult trauma patients greater than 13 years of age, any of the following
clinical findings indicate activation of the Trauma Team and rapid transport to
the designated trauma center:
a. Revised Trauma Score (RTS) < 11
b. Glasgow Coma Score (GCS) 13 or less
C. Systolic blood pressure < 90 mmHg with evidence of hypo -perfusion or
compensated shock: (not all inclusive)
i. "Tachycardia"
ii. "Pallor"
iii. "Diaphoresis"
iv. "Altered mentation"
V. "Prolonged capillary refill"
d. Any intubated trauma patient (including surgical airway)
e. Amputated proximal to knee or elbow
f. Penetrating injuries to head, neck, and/or torso
2. In pediatric critical trauma patients less than 14 years of age, the following
clinical findings indicate activation of the Trauma Team and rapid transport to
the designated Center:
a. Revised Trauma Score (RTS) < 9
b. Glasgow Coma Score (GCS) 13 or less
c. Persistent tachycardia with evidence of hypo -perfusion or compensated
shock
d. Systolic Blood Pressure:
i. "< 80 mmHg" "ages 6 — 13"
ii. "< 70 mmHg" "ages 1 — 6"
iii. " < 60 mmHg" "ages birth — F
iv.
e. Bradycardia with significant mechanism of injury
f. Any intubated trauma patient (including surgical airway)
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SOG 502.01 - Emergency Medical Dispatch Page 6 of 20
g. Amputation proximal to knee or elbow
h. Penetrating injuries to head, neck, and/or torso
D. Trauma Alert Notifications:
1. If a surgical airway is performed on a non-traumatic patient, the Trauma
Surgeon requests that they be notified.
a. Paramedic will notify the receiving facility via AHERN radio
b. Notification of the Trauma Surgeon will be accomplished by the
Emergency Department staff.
C. The Trauma Team will be activated by the Trauma Surgeon at his/her
discretion.
2. During a multi -casualty incident (MCI) or if the incident command system (ICS)
is in place, the paramedic will request the Trauma Alert via the following chain
of command:
a. The Triage Officer
b. The Medical Command Officer
C. The Incident Commander
The designated personnel; Triage Officer, Medical Command, or the Incident
Commander, will contact Fire/EMS Dispatcher and transmit the following
information:
a. Estimated age of the patient
b. Sex of the patient
C. All applicable trauma alert criteria
d. Mechanism of injury
e. ETA to the facility
4. Fire/EMS Dispatch will contact Christus Hospital—St. Elizabeth Transfer Center
and relay the following information:
a. Estimated age of the patient
b. Sex of the patient
C. All applicable Trauma Alert criteria
d. Mechanism of injury
e. ETA to the facility
In the event that the patient deteriorates en route to the hospital And meets
Trauma Alert criteria:
a. The attending Paramedic will activate the Trauma Alert via Fire/EMS
Dispatch to transmit the Trauma Alert information.
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SOG 502.01 - Emergency Medical Dispatch Page 7 of 20
E. Cancellation of* Trauma Alert
1. Beaumont EMS Paramedic:
a. Proper chain of command must be utilized
b. Cancellation must go through Fire/EMS Dispatch
C. Can Only be cancelled while on scene.
2. Hospital Staff
a. At the discretion of the Emergency Room physician or charge nurse.
F. Documentation
1. All trauma Alerts including cancellation must be documented in the Patient
Care Reporting (PCR).
2. Trauma Alert documentation is located under the Intervention section of the
ResearchNet Patient Care Reporting.
VI. Disoatchina Priorities Accordina to EMD Svstem Response Determinants
A. Dispatching priorities for BEMS units:
1. Advanced Life Support units — Single paramedic unit without transport
capability.
a. Fox units (FX1 and FX2) and 505
1) Should be dispatched according to the EMS Response Determinants.
2) Should be dispatched initially when Med Unit (MU) is not available
in the system.
3) Should be dispatched for "posting" when there's no medical
coverage in the specific Med district.
i) Can be dispatched in place of BEMS Shift Commander (SC)
when appropriate or at the request of 501.
b. Supervisory units (501)
1. Should be dispatched according to the EMS Response
Determinants where SC is denoted.
2. Should be dispatched when MU and FX units are not available.
2. Mobile Intensive Care Units (MICU) — Double medics unit, able to transport 2
supine patients.
a. Med 1— 6
1. Should be dispatched according to the EMS Response
Determinants.
2. The closest available MU should be dispatched.
Medical Director's Initials P. k1
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SOG 502.01 - Emergency Medical Dispatch Page 8 of 20
t5. Beaumont P -mi) ,
Key:
FR First Responder
FS Fire Suppression Equipment
SC Shift Commander
veternunants
RS Fire Rescue MU Medic Unit
PD Police Department FX Medic Fox -Truck or :50:5
Priority 1 = emergency response, with first responders
Priority 2 = emergency response, NO first responders
3 = non
- Urgent
- Prompt
- Routine
Animal Bites / Attacks
4
History of severe allergic reactions.
Consider dispatch of animal control
and/or PD
Unknown situation (3 party caller) 2 MU
Abdominal Pain /Problems
2
Fainting OR chest pain, dizzy, sweaty or
ale
Feeling of tightness in throat or chest.
1
FR, MU
FR, MU
Males over 35
2
2
MU
Rape without serious injuries
Females over 12
3
2
MU
2
Blunt trauma or recent surgery without
priority symptoms
2
MU
Minor trauma, nausea with no other
symptoms
2
3
MU
Rash OR other symptoms; Alert, no
Animal Bites / Attacks
4
History of severe allergic reactions.
Consider dispatch of animal control
and/or PD
Unknown situation (3 party caller) 2 MU
Poisonous snake 2 MU, PD
Allergies / Reactions /
3
Feeling of tightness in throat or chest.
2
1
FR, MU
Stings
2
Sweaty, anxious, lightheaded. Feeling
may still be in the area, instruct
Rape without serious injuries
3
1 MU, PD
weak or faint
2
MU
Trauma over 12 hours old
Unknown situation (3 party caller)
2
MU
Unknown situation (3 party caller)
Rash OR other symptoms; Alert, no
2
3
MU
Non-traumatic OR non -recent traumatic
respiratory distress
3
FX
Animal Bites / Attacks
4
Poisonous snake bite with signs of 1 FR, MU, PD
envenomation. Weak or lightheaded
Consider dispatch of animal control
and/or PD
Unknown situation (3 party caller) 2 MU
Poisonous snake 2 MU, PD
Others 3 FX
Assault / Rape
5
Dangerous* injuries OR respiratory
distress OR serious bleeding OR altered
mental status
1
FR, MU, PD,
FX
If there is any possibility "actor"
Possible dangerous* injuries
without previous history of chronic back
2
MU, PD, FX
Unknown situation
2
FX, PD
may still be in the area, instruct
Rape without serious injuries
3
1 MU, PD
EMS to stage and awaits PD.
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Date _6/20/2012_
SOG 502.01 - Emergency Medical Dispatch Page 9 of 20
Altered mental status. Age over 50
Back Pain (non-trauma)
6
without previous history of chronic back
1
FR, MU
pain.
Fainting OR dizziness OR chest pain.
2
MU
Trauma over 12 hours old
Unknown situation (3 party caller)
2
MU
Non-traumatic OR non -recent traumatic
3
FX
back pain
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SOG 502.01 - Emergency Medical Dispatch Page 9 of 20
11 Breathing Problems 1 9 1 Any I Alert SC I 1 I FR, MU
Burns / Explosion
10
Dangerous (neck, rectal, vomiting blood,
Alert SC
1
FR, MU
Bleeding
8
pregnancy, groin). Lightheaded, weak,
Alert SC
1
FR, MU
Anything still burning
Headache or nausea
dizzy or sweaty
2
1 FX
Electrical and/or Electrical Hazard
Guidelines)
Unknown situation (3party caller)
FR, MU, SC
1
FR, MU
Possibly dangerous (face, arms, legs,
Alert SC
1
FR, MU
If airway or breathing problems,
then dispatch as DANGEROUS.
vaginal, coughing up)
Under age of 35 without priority
Unknown situation (3 d party caller)
Not dangerous (hands, fingers, toes, feet,
1
2
MU
2
mouth trauma, nose scalp, urinating)
Cocaine use
Small OR minor burns
2
11 Breathing Problems 1 9 1 Any I Alert SC I 1 I FR, MU
Burns / Explosion
10
Multiple victims OR explosion. Facial,
genital, hands, feet > 10% body surface
Alert SC
1
FR, MU
Inhalation
Victim smoldering/burning
lightheaded, dizzy, fire, or hazmat
Alert SC
1
FR, MU
Anything still burning
Headache or nausea
history OR sweating/changing colors,
2
1 FX
Electrical and/or Electrical Hazard
Guidelines)
1
FR, MU, SC
Chemical
Unknown situation (3 Id party caller)
Hazmat
MU
Under age of 35 without priority
Unknown situation (3 d party caller)
MU
1
FR, MU, SC
Burn < 10% of body surface
2
MU
Cocaine use
Small OR minor burns
2
3
FX
Alert, normal breathing, no cocaine use,
Carbon Monoxide /
11Multiple
victims, hoarse voice, coughing,
Alert SC
1
FR, MU
Inhalation
15
lightheaded, dizzy, fire, or hazmat
Alert SC
1
FR, MU
If appropriate, send utility company4
Headache or nausea
history OR sweating/changing colors,
2
1 FX
Cardiac / Respiratory
12
Suspected cardiac OR respiratory arrest
Alert SC
1
FR, MU, SC
Arrest
15
status, penetrating or open wound
Alert SC
1
FR, MU
Obvious death (per "General Dispatching
history OR sweating/changing colors,
3
FX, PD
Closed injury without priority symptoms
Guidelines)
2
MU
Chest Injuries
14
Difficulty breathing OR altered mental
Alert SC
1
FR, MU
Chest Pain
15
status, penetrating or open wound
Alert SC
1
FR, MU
Unknown situation (3 Id party caller)
history OR sweating/changing colors,
1
FR, MU
Closed injury without priority symptoms
2
MU
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Date _6/20/2012_
SOG 502.01 — Emergency Medical Dispatch Page 10 of 20
Altered mental status OR
Chest Pain
15
abnormal/difficult breathing OR cardiac
Alert SC
1
FR, MU
history OR sweating/changing colors,
over the age of 35.
Unknown situation (3 Id party caller)
2
MU
Under age of 35 without priority
2
MU
symptoms
Send PD if cocaine/drug use
Cocaine use
2
MU
Alert, normal breathing, no cocaine use,
3
MU
age < 35 years
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SOG 502.01 — Emergency Medical Dispatch Page 10 of 20
Childbirth / Obstetrics 16
Imminent birth OR delivery
Choking now OR abnormal breathing OR
1
FR, MU
FR, MU
3 Id trimester bleeding OR bleeding
23
altered mental status, child, or infant
Alert SC
1
associated with feeling faint/fainting.
Unknown situation (3r party caller)
status
1
Pain less than 5 minutes apart
1
FR, MU
3
Delivery or post -partum
MU
respiratory distress
or small areas (frostbite)
Unknown situation (3 Id party caller)
Any abnormal presentation
1
FR, MU
Altered mental status OR respiratory
Not actively seizing now AND breathing
Previous complications
2
MU
distress
Unknown pregnancy problem
2
MU
Other complaint (awake/alert, not in
Other bleeding OR cramps OR labor
MU
2
MU
(non -imminent delivery)
Illness during pregnancy WITHOUT
3
MU
priority symptoms
Choking
17
Choking now OR abnormal breathing OR
1
FR, MU
Cold Incidents
23
altered mental status, child, or infant
Alert SC
1
FR, MU
Unknown situation (3r party caller)
status
1
FR, FX
Not choking now; awake/alert, no
Injury limited to fingers, toes, ears, nose
3
FX
MU
respiratory distress
or small areas (frostbite)
Unknown situation (3 Id party caller)
Diabetic Problems
26
Cold injuries with respiratory problems
Unknown situation (3 Id party caller) 2 MU
Conscious but not alert 1 MU
Cold Incidents
23
OR cardiac problems OR altered mental
Alert SC
1
FR, MU
status
Injury limited to fingers, toes, ears, nose
pregnant, or cardiac history
2
MU
or small areas (frostbite)
Unknown situation (3 Id party caller)
1
Diabetic Problems
26
Actively seizing now OR breathing not
Unknown situation (3 Id party caller) 2 MU
Conscious but not alert 1 MU
Convulsions/Seizures
24
physically verified by caller, bizarre
Alert SC
1
FR, MU
behavior, multiple seizures, diabetic,
Unknown situation (3party caller)
pregnant, or cardiac history
I
FR, MU, SC,
Unknown situation (3 Id party caller)
1
FR, MU
Altered mental status OR respiratory
Not actively seizing now AND breathing
1
2
MU
distress
physically verified by caller
Diabetic Problems
26
Unconscious OR abnormal breathing, 1 FR, MU
diabetic history, bizarre behavior
Unknown situation (3 Id party caller) 2 MU
Conscious but not alert 1 MU
Conscious and alert 2 FX
Diving or Drowning
Still in water, shallow water diving
FR, MU, SC,
Incidents''
27
accident or pool.
Alert SC
1
RC
SCUBA
Unknown situation (3party caller)
I
FR, MU, SC,
RC
Altered mental status OR respiratory
Alert SC
1
FR, MU
distress
Other complaint (awake/alert, not in
3
MU
water)
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Date _6/20/2012_
SOG 502.01 — Emergency Medical Dispatch Page 11 of 20
Drug Overdose
28
Unconscious OR respiratory distress,
vomiting or seizures
Alert SC
1
FR, MU, PD
Electrocution
Conscious, no respiratory distress, not
disconnected OR breathing problems OR
2
MU PD
FS, MU
violent
2
fall > 6 feet.
HEMS to respond non -emergency
Violent or dangerous activities, bizarre
Other fractures
Downed wires, electrical hazards
until PD arrives and secures scene.
behavior
3�
MU, PD, SC
PD may then request emergency
1
FS, MU
Alert, breathing normal, not in contact
response if warranted.
2
MU
with power
Eye Problems / Injuries 1 30 Severe or moderate eye injury, chemicals 1 FR, MU
Minor eye problem or injury 3 FX
Any situation other than below
Altered mental status OR victim not
1
FR, MU
Electrocution
29
disconnected OR breathing problems OR
Alert SC
1
FS, MU
2
fall > 6 feet.
normal mental status
Other fractures
Downed wires, electrical hazards
2
MU
without above symptoms
Unknown situation (3r party caller)
2
1
FS, MU
Alert, breathing normal, not in contact
1 FX
2
MU
with power
2
MU
Eye Problems / Injuries 1 30 Severe or moderate eye injury, chemicals 1 FR, MU
Minor eye problem or injury 3 FX
Head / Neck / Spine Injury
Any situation other than below
Long fall (>6 feet) OR altered mental
1
FR, MU
Falls
31
status OR respiratory distress OR serious
Alert SC
1
FR, MU
2
bleeding, neck pain or paralysis, fracture
normal mental status
Other fractures
with expose bone
2
MU
without above symptoms
Fall < 6 feet with controlled bleeding OR
2
MU
All others
other problems, no altered mental status,
1 FX
no breathing problems, ground level fall
2
MU
with fracture, chest pain, abdominal pain
or facial injuries.
Ground level fall, no altered mental status,
no breathing problems, no or minor
3
FX
bleeding
Head / Neck / Spine Injury
Any situation other than below
Fractures with severe bleeding OR
1
FR, MU
Fractures'
32
associated with other significant trauma
MU
1
FR, MU
2
OR spinal injuries
normal mental status
Other fractures
2
MU
Head / Neck / Spine Injury
Any situation other than below
Altered mental status OR sudden onset
1
FR, MU
Headache
33
and severe pain OR speech/motor/sensory
MU
2
MU
2
problems
normal mental status
Unknown situation, recent head injuries
without above symptoms
2
MU
All others
3
1 FX
Head / Neck / Spine Injury
Any situation other than below
1
FR, MU
Unknown situation (3Iparty caller)
2
MU
Head laceration or contusion ONLY,
2
MU
normal mental status
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SOG 502.01 — Emergency Medical Dispatch Page 12 of 20
Heat Incidents
36
Altered mental status OR respiratory
Alert SC 1
FR, MU
FR, MU
Heart Problems
35
distress OR sweating or change in color
Unknown situation (3" party caller) 2
1
FR, MU
FX
37
OR firing of implanted defibrillator
1
1
FR, MU, SC
Unknown situation (3Iparty caller)
trauma, penetrating wounds, amputation
1
FR, MU
Send PD if cocaine/drug use
Chest pain only, age > 35 OR cocaine use,
2
MU
history with none of the above
Entrapment, Unknown situation (3 party
Alert SC
1
Chest pain only, age < 35 (no cocaine use)
1
3
1 MU
Heat Incidents
36
Altered mental status, high body
temperature, bizarre behavior, vomiting
Alert SC 1
FR, MU
FR, MU
Cardiac history, cramps or nausea
2
MU
Unknown situation (3" party caller) 2
MU
Conscious with normal body temperature 3
FX
Non-specific Diagnosis /
38
Severe bleeding OR injury to
Unknown situation (3r party caller) 1 FR, MU, SC
1
FR, MU
Machinery / Industrial
39
head/chest/abdomen OR altered mental
Alert SC
1
FR, MU, PD
Injuries
37
status OR respiratory distress, major
1
1
FR, MU, SC
2
trauma, penetrating wounds, amputation
2
MU, PD
symptoms
of arm or leg.
Entrapment, Unknown situation (3 party
Alert SC
1
FR, MU, RC
caller)
Chest or abdomen without priority
symptoms, obvious fractures without loss
of sensations or circulation.
Alert SC
1
FR, MU
Head/neck/spine without paralysis or
numbness.
Amputations of fingers or toes
Other
3
MU
Non-specific Diagnosis /
38
Specific symptom, Cardiac History,
Unknown situation (3r party caller) 1 FR, MU, SC
1
FR, MU
Illness
39
Pediatric
Alert SC
1
FR, MU, PD
Unknown situation (3 party caller)
and alert but under the age of 1.
1
FR, MU
"Sick" WITHOUT specific priority
2
MU
2
MU, PD
symptoms
Psychiatric / Behavioral.
44
Altered mental status OR respiratory
Unknown situation (3r party caller) 1 FR, MU, SC
1
MU, PD, SC
Poisoning',
39
distress, vomiting or seizures, conscious
Alert SC
1
FR, MU, PD
Other
and alert but under the age of 1.
2
MU, PD
Extremities below the elbow/knee
Conscious and alert
MU, PD
2
MU, PD
Psychiatric / Behavioral.
44
Violent or suicidal, overdose, bizarre
Unknown situation (3r party caller) 1 FR, MU, SC
1
MU, PD, SC
Stab / GSW
41
behavior, Weapons
I
SC
Other
Alert SC
2
MU, PD
Stroke / CUA 42
All 1 FR, MU, SC
Multiple wounds or victims,
Unknown situation (3r party caller) 1 FR, MU, SC
Alert and breathing normally Alert SC 3 1 MU
FR, MU, PD,
Stab / GSW
41
head/neck/trunk wounds
I
SC
Extremities above the elbow/knee
Alert SC
2
MU, PD
Extremities below the elbow/knee
3
MU, PD
Stroke / CUA 42
All 1 FR, MU, SC
Unknown situation (3r party caller) 1 FR, MU, SC
Alert and breathing normally Alert SC 3 1 MU
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Date _6/20/2012_
SOG 502.01 — Emergency Medical Dispatch Page 13 of 20
Suicide
43
Violent aggressive behavior to self and
others. Continues to threaten suicide,
serious injuries
Alert SC
3
MU, PD, SC
Traumatic Injuries
45
OR severe bleeding OR respiratory
Alert SC
1
PD, FX or SC
Traffic Collisions
44
Trapped
GO TO
1
FS, MU, RC,
Traumatic Injuries
45
OR severe bleeding OR respiratory
Alert SC
1
PD, FX or SC
(specific)
Multiple victims
distress, amputation (except fingers and
1
FS, PD, SC or
Unconscious but breathing, multiple
toes)
FX
Confirmed dangerous or possibly
Alert SC
1
FR, PD, SC or
2
dangerous injuries
50 with abdominal pain, trauma
(fingers and toes)
FX
Unknown situation (3party caller)
Unknown situation (3party caller)
1
FS, MU, PD,
MU
conscious with normal breathing
Not serious* injuries
FX
1 3
Low speed accident, alert, ambulatory,
3
PD, FX
minor injuries or complaints
Unknown Problem (Man
Down)
Apparently unconscious OR life status
47 Alert SC 1 FR, MU, PD
questionable
Serious injuries* OR alerted mental status
GO TO
Standing, sitting up, moving, or talking 3 FX
Traumatic Injuries
45
OR severe bleeding OR respiratory
Alert SC
1
FR, MU
(specific)
distress, amputation (except fingers and
CARD
Unconscious but breathing, multiple
toes)
episodes, cardiac history, female age 12-
Possibly serious* injuries, amputation
1
2
MU
50 with abdominal pain, trauma
(fingers and toes)
Now conscious but abnormal breathing,
respiratory distress, OR cardiac history
Unknown situation (3party caller)
1
2
MU
conscious with normal breathing
Not serious* injuries
1
1 3
1 FX
Unknown Problem (Man
Down)
Apparently unconscious OR life status
47 Alert SC 1 FR, MU, PD
questionable
Unconscious and NOT breathing
GO TO
Standing, sitting up, moving, or talking 3 FX
Unconscious / Fainting
46
CPR
1
FR, MU, SC
CARD
Unconscious but breathing, multiple
episodes, cardiac history, female age 12-
Alert SC
1
FR, MU
50 with abdominal pain, trauma
Now conscious but abnormal breathing,
respiratory distress, OR cardiac history
1
FR, MU
conscious with normal breathing
3
FX
Unknown Problem (Man
Down)
Apparently unconscious OR life status
47 Alert SC 1 FR, MU, PD
questionable
Unknown situation (3party caller) 1 FR, MU, PD
Send FR if forcible entry needed Medical alert notifications 2 FX
Standing, sitting up, moving, or talking 3 FX
VII. Dispatching Procedures for Utilization of Private Ambulances
A. "Rollover" Response —Emergency call, any priority, when no BEMS ambulance is
available.
a. Dispatch First Responder if appropriate per protocol/procedure.
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b. Dispatch EMS Shift Commander (501) if appropriate per
protocol/procedure. Otherwise, simply notify the Shift Commander.
1) Shift Commander will respond at his/her discretion.
2) The Shift Commander will no longer respond to all rollover events,
but is to be notified.
C. Dispatch next rotation private ambulance service. The Fire/EMS
Dispatcher will ask if a paramedic unit is available. If so, dispatch that
unit. If not move to the next private company in rotation.
1) The private unit should communicate with Fire/EMS Dispatch via
radio on Main. At the dispatcher's discretion, the private ambulance
may be assigned to another channel. The private unit should notify
the Fire/EMS Dispatcher via radio of the following intervals:
i) Responding to call. The private unit will state from what
location they are responding.
ii) Arriving on scene.
iii) Transport priority and destination. The Fire/EMS Dispatcher
should enter this information into the CAD notes.
iv) Arrival at destination (at this point, the unit can be "cleared"
from the call).
v) If the patient is not transported; the disposition of the patient
(refusal, etc); should be entered into the CAD notes.
d. If the first service contacted does not have a unit available:
1) Dispatch the EMS Shift Commander, if not already done, and
2) Contact the next -up rotation private company.
e. Within 24 hours of the transport, the private unit will send, by fax or
hand delivery, a copy of the transport run to the Clinical Supervisor of
Beaumont EMS.
2. "Referral" Responses — BEMS unit is requesting private ambulance to transport
to alternative destination.
a. For "referral" calls, the private ambulance will respond non -emergency
(Priority 3), unless expressly requested otherwise by the on -scene EMS
personnel.
b. Ascertain if the patient has a specific preference for a private ambulance.
If so, dispatch that service.
C. If the patient does not have a preference, dispatch the next rotation
private ambulance service. The dispatcher shall ask if a paramedic unit
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is available. If so, dispatch that unit. If not, move to the next private
company in rotation.
d. If possible, the private unit will communicate with Fire/EMS Dispatch
via the radio on Main and advise Fire/EMS Dispatcher of the following
intervals:
1) Responding to call. The private unit will state from what location
they are responding.
2) Arriving on scene.
3) Transport priority and destination. The dispatcher should enter this
information into the CAD notes.
4) Arrival at destination (at this point, the unit can be "cleared" from
the call).
5) If the patient is not transported; the disposition of the patient
(refusal, etc). The dispatcher should enter this information into the
CAD notes.
6) Responding "emergency traffic" at anytime in the City limits and
their route.
Within 24 hours of the transport, the private unit will send, by fax or
hand delivery, a copy of the transport run to the Clinical Supervisor of
Beaumont EMS.
"Posting" Responses — Private ambulance is being brought into BEMS system
for coverage.
a. When the Beaumont EMS (BEMS) system is reduced to only one
available ambulance unit ("level 1"), Fire/EMS Dispatch shall contact a
private ambulance service and request that they provide a paramedic -
level ambulance for deployment into the BEMS system.
b. The private services will be contacted for this assignment based upon
geographical need and "rotation".
1) Example:
i) If the BEMS system's geographical deployment need is for a
unit for the south sector of the City, then Fire/EMS Dispatch
will contact a provider which is stationed in the south sector.
ii) This provider will be selected from among the other services
stationed in that area based upon a rotation system.
The private service will only deploy paramedic -level ambulances for
posting assignments.
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SOG 502.01 - Emergency Medical Dispatch Page 16 of 20
d. Fire/EMS Dispatch will create an `Out of Service' posting event anytime
a private ambulance service is posted for deployment into the BEMS
system.
Once placed on "post," the assigned private ambulance, if possible, shall
notify Fire/EMS Dispatch via radio on Main of their availability and
location.
1) The private ambulance may post anywhere within the given
geographical sector of the City.
2) If possible, the private ambulance shall continuously monitor the
assigned radio channel for a response assignment from Fire/EMS
Dispatch until released from post by Fire/EMS Dispatch.
When needed for a response assignment and the private ambulance is not
posting on BEMS Main: Fire/EMS Dispatch will notify the private
ambulance by phoning the posted unit's main dispatch office. After the
phone notification, tone out the call using tone 2 on BEMS Main.
g. If the private ambulance is posting on BEMS Main, tone out the call
using tone 2 and be sure to get an acknowledgement from the posting
unit.
h. Should the private service need the posted private ambulance for a
"private call" or transfer, the private service or the private unit will
notify Fire/EMS Dispatch of their need to leave post. Unless Fire/EMS
Dispatch has an impending response assignment for that unit, the unit
will be released from post for the "private call" or transfer.
Once dispatched to a response assignment, the private ambulance will
adhere to all policies and procedures as implemented for other
"Rollover" Responses.
Private ambulance units, on a rotation basis among the companies
operating within the sector of interest, will continue to be utilized to
maintain the BEMS system at "level 2" until two BEMS units become
available. Once two BEMS units are available, the private ambulance(s)
can be released from post.
4. Rotation
a. As of January 1, 2012, the following companies will be on rotation to
respond to Rollovers and Referrals:
1) Acadian
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SOG 502.01 - Emergency Medical Dispatch Page 17 of 20
2) Priority One Ambulance
b. This list is subject to change at the discretion of the Public Health
Director.
Private ambulance responses will be rotated among these agencies in
turn. If an agency is contacted but cannot respond, that agency will go to
the bottom of the rotation.
VIII. Beaumont EMS Posting Procedure
A. FOX Units
When a FOX unit is available for service, it will be utilized for posting based on
the following criteria:
a. To maintain a minimum of Level 3, which includes the following
medical districts to be covered either by MICU or FOX Unit(s):
1) Med-1/5
2) Med-2/3
3) Med-4
b. To maintain a minimum of Level 2, which includes the following
medical districts to be covered either by MICU or FOX Unit(s):
1) Med-1/5
2) Med-2
C. To maintain a minimum of Level 1, which include the following
location:
1) EMS -HQ
d. At the discretion by the on -duty BEMS Shift Commander.
2. MICU Units
a. When only 1 MICU unit is available and no private ambulance is
available for posting.
1) MICU will be dispatched to posting, centrally, such as EMS -HQ.
b. At the discretion by the on -duty BEMS Shift Commander
IX. Notification of Available EMS Resources -General Guidelines
A. When the number of medical requests reduces BEMS transport units to one (1)
and/or exceeds the number of available EMS resources, the Fire/EMS Dispatcher
will initiate the following options:
1. Level 0
a. When no BEMS transport units, Supervisor units, Fox units or private
EMS units are available in the system.
b. When the system reaches Level 0, the Fire/EMS Dispatcher will email
notification of status to 500, 501, 505, 550, and the Public Health Director.
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SOG 502.01 - Emergency Medical Dispatch Page 18 of 20
2. MICU -1
a. When only one (1) BEMS transport unit is available in the system.
b. When the system reaches MICU -1 level, the Fire/EMS Dispatcher will
email notification of status to 501, and 505.
3. Level I
a. When only one EMS resource is available in the system at the time.
b. When the system reaches Level 1, the Fire/EMS Dispatcher will email
notification of status to 500, 501, 505, 550, and the Public Health Director.
X. Quality Assurance and Improvement Methodology
A. The EMS Quality Assurance/Quality Improvement Liaison Officer (EQLO) will be
responsible for conducting follow-ups, review of calls, data collection and
identifying areas where training or guidance is needed to maintain, support, mitigate
risk management and improve the EMS system.
1. The EQLO will report to the Clinical Coordinator as it relates to data collection
and analysis; recommended training and improvement; and review of calls.
2. The EQLO will report to the EMS Manager as it relates to the conflict between
departmental policies and procedures, and complaints.
3. The EQLO will work in conjunction with the BFRS Chief Communications
Officer, who is ultimately responsible for QA/QI for EMD dispatchers.
B. EQLO Duties and Responsibilities:
1. Weekly QA/QI Control
a. Query and review all "No Patient" calls for accuracy and
appropriateness.
b. Query all EMS calls and review for accuracy and appropriateness in
accordance with the case review template form.
C. Field -to -Dispatch Feedback Mechanism
1. On -duty BEMS Shift Commander
a. All reports generated should be carefully tracked through the system,
investigated and evaluated.
b. All reports should be written as a request for clarification and should
avoid any and all accusatory "non-colleagueal" tones.
C. Forward all written documentation to the EQLO.
2. EQLO will review and clarify any discrepancies prior to filing the report with
the Clinical Coordinator and EMS Manager.
3. EQLO and the Clinical Coordinator will provide recommendations for Dispatch
Continuing Education (DCE) training through the Beaumont Fire/Rescue Chief
Communications Officer and/or his/her Assistant.
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SOG 502.01 - Emergency Medical Dispatch Page 19 of 20
D. Fundamental EMD Performance
1. Accurately query the caller.
2. Select appropriate method of response and resource(s).
3. Provide pertinent and accurate information to responders (MCT and radio).
4. Give appropriate aid and direction for patients through the caller.
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SOG 502.01 - Emergency Medical Dispatch Page 20 of 20