MEDICAL DIRECTOR MESSAGE

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They are not exhaustive or all inclusive. Where no guideline exists it is incumbent on the EMT to utilize their training and experience within their Scope of Practice to make clinical decisions. On-line medical control is a resource that should be utilized when appropriate. Guidelines provide detail where memory is likely to be inadequate to make decisions about interventions such as drug doses. In that regard they should be readily available for reference while on a medical or traumatic call.\u003cbr\u003e\n\u003cbr\u003e\nThese guidelines carry the patient from initial encounter through transport and turnover to the next provider. An EMT’s job is not simple and not easy. You are called upon to make assessments and treatment decisions often in hostile or troubled environments with patients sometimes similarly hostile or troubled. Impaired patients can be common.\u003cbr\u003e\n\u003cbr\u003e\nLCFD is a transporting rescue service now and LCFD personnel are often called upon to assist in the ambulance for transport to appropriate facilities for definitive care.\u003cbr\u003e\n\u003cbr\u003e\nIt is incumbent on EMTs to establish the safety of a scene before entering it.\u003cbr\u003e\n\u003cbr\u003e\nIn-route to a call the EMTs should be assigning roles in the management of the patient and the scene. This is called ‘Pit Crew’ practice and it is especially important in manpower intensive cases such as ‘CPR in progress’.\u003cbr\u003e\n\u003cbr\u003e\nAll patients should have a complete assessment to the degree that the patient will allow it and time allows. This assessment should include but no be limited to:\u003cbr\u003e\n\u003cbr\u003e\n\tDispatch information that was given prior to arrival.\u003cbr\u003e\n\u003cbr\u003e\n\tThe patient’s Chief Complaint(s) and relevant immediate history.\u003cbr\u003e\n\t\u003cbr\u003e\n\tAn assessment of immediate life and limb threatening problems and appropriate\u003cbr\u003e\n\tinterventions.\u003cbr\u003e\n\u003cbr\u003e\n\tThe patients immediate and past medical history including allergies and\u003cbr\u003e\n\tmedications. Here “SAMPLE” and “PQRST” are appropriate.\u003cbr\u003e\n\u003cbr\u003e\n\tA secondary head to toe assessment of the patient for other occult problems.\u003cbr\u003e\n\u003cbr\u003e\n\tA diagnostic summary of the clinical problems present.\u003cbr\u003e\n\u003cbr\u003e\n\tAppropriate treatment decisions and their implementation.\u003cbr\u003e\n\u003cbr\u003e\n\tProper turnover of the patient with report and time. Proper radio reporting may be\u003cbr\u003e\n\tnecessary with the receiving facility.\u003cbr\u003e\n\u003cbr\u003e\nAfter initiation of interventions the patient needs to be monitored for response to care and possible deterioration of condition until turnover.\u003cbr\u003e\n\u003cbr\u003e\nDetails of medication administration are worth mention. The EMT should prepare and draw up their own medications to ensure that the proper medication is delivered to the correct patient at the appropriate time in the correct dose and by the proper route. The drug reference section contains more detail than the protocols do concerning medications and procedures. For example, IO Lidocaine is not specified in protocol, it is standard practice in conscious patients, but is detailed in the drug section.\u003cbr\u003e\n\u003cbr\u003e\nAll aspects of the patient encounter will be recorded in an organized fashion on an approved ‘PCR’ by the end of the EMT’s shift. The DCHART method is preferred but the SOAP method is acceptable. This includes dispatch information; the mechanism of injury if appropriate, the patient’s chief complaint(s) and immediate history, the detailed past medical history, the primary problems and interventions, the secondary survey, the overall treatment of the patient and transport decisions and the proper turnover of the patient. All times should be recorded.\u003cbr\u003e\n\u003cbr\u003e\nRefusal of patient care requires the same level of documentation with clear documentation of efforts to encourage treatment especially where serious conditions may exist. Impaired patients may not sign refusal forms and a decision needs to be made if involuntary transport is necessary.\u003cbr\u003e\n\u003cbr\u003e\nControlled substances will be handled carefully and properly and use well documented. Proper reporting of use and wastage and restocking is essential.\u003cbr\u003e\n\u003cbr\u003e\nErrors in care will be appropriately documented and reported along the proper chain of command to the Battalion Chief for EMS. No EMT is perfect and errors will occur.\u003cbr\u003e\n\u003cbr\u003e\nI wish the best for each EMT in the practice of medicine in the streets.\u003cbr\u003e\n\u003cbr\u003e\n\u003cbr\u003e\nBenjamin Diven, M.D.\u003cbr\u003e\nLCFD Medical Director","adBanner":{"ad_banner_enable":0,"banner":"","redirect_url":""},"mapThirdParty":"0","MapThirdParty":"0","reviewRating":1,"attributesForList":[],"directoryInfo":[],"formIdentifier":"default","formType":"custom","widgetInfo":{"widget_enable":0,"widget_label":"Widget Label","widget_code":""},"listOwner":"","claimStatus":null,"pwaUrl":"https://www.lcfdapp.com/services_1582148118880_5/2112236/2112239/10009966"},{"listId":10009967,"catId":2112239,"dirPageId":"services_1582148118880_5","distance":"","chatUrl":"","chatType":"","header":"REVISION PAGE FOR 2018 PROTOCOLS","summary":"","detail":"REVISIONS TO 2018 CLINICAL GUIDELINES\u003cbr\u003e\n\u003cbr\u003e\n1.\tChanged name from “Protocols” to “Guidelines”\u003cbr\u003e\n2.\tDo Not Resuscitate DNR. 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