Sarasota County EMS - HANDBOOK for COMMUNITY PROTOCOLS

Protocols and the Policy and Procedure Manual, are required reading for rescue
personnel. Each EMT and Paramedic employed by a Sarasota County EMS
Provider will have the opportunity to familiarize himself/herself with this material prior
to implementation.

An updated version of the Hazardous Materials Protocols will be released concurrent
with the Community Protocols. Although Toxmedics and HazMat Medics will be
responsible for the entire contents of these protocols, Emergency Medical
Technicians and Paramedics should have a working familiarity with them. There will
be no examination questions the Hazardous Materials Protocols. All exam questions
will be from the Community Protocols, Handbook and Policy Procedure Manual
themselves.

Quality EMS requires quality medical direction. The Medical Director writes protocols
and policies, investigates complaints and oversees training programs; this is called
"off-line medical control". However, for the hour-to-hour clinical control of the system,
the Medical Director appoints "on-line medical control" (OLMC) physicians. These
are the emergency department (ED) staff physicians of Sarasota, Charlotte and
Manatee Counties (Resource Hospitals) and are called "Supervising Physicians".
Radio and telephone systems allow communication between rescue crews in the
?eld and their supervising physicians.

Another source of OLMC in Sarasota County is the ability of a medic in the ?eld to
contact an on-call Medical Director 24/7 by cellular telephone. The 2017 Policy and
Procedure Manual directs you to call either Dr. Johnson or on our cell phones.
Depending upon the command structure of your respective department, you may
need to contact an on-duty administrative of?cer (EMS Captain, for example). If the
of?cer agrees that direct access is warranted, the Charge Paramedic is authorized to
call the on-call Medical Director by cell phone. The Medical Director and Charge
Paramedic consult, and a resolution is reached. Should recorded documentation by
desired, the Medical Director and crew can meet on Med All (Delta 12), which is
recorded and archived by PSCC.

Often, protocols alone are suf?cient to guide patient care. When the clinical
presentation is complicated or confusing, OLMC serves as a resource to EMS
personnel. Orders issued by OLMC take precedence over orders issued by an on-
scene healthcare provider. We continue to require that _o_n y on-scene physicians
may assume OLMC with the permission of the Supervising Physician. On-scene
healthcare professionals such as physician assistants, nurses, advanced registered
nurse practitioners and respiratory therapists may assist with at the discretion of the
Charge Paramedic, but cannot assume medical control.

Licensed midwives attending childbirths at birthing centers or private residences are
not healthcare professionals. These individuals may or may not have limited input
on-scene at the sole discretion of the Charge Paramedic. If there is a birthing center
in your area, make sure you read and understand the policy covering response to

 

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Sarasota County EMS HANDBOOK for COMMUNITY PROTOCOLS

out-of-hospital childbirths attended by midwives. Sarasota County EMS takes a no-
nonsense approach to this particular scenario. Respond, assess, stabilize and
transport the mother and/or newborn to an appropriate Resource Hospital. Staging
at the birthing center and engaging in discussions with the midwife are not
authorized. Again, respond, assess, stabilize and transport.

When OLMC is obtained, the physician giving orders becomes responsible for the
care of the patient during the prehospital phase of care. It is his/her right to modify
the treatment in the protocols if the best interest of the patient is thereby served.
However, EMS personnel have an obligation to the Medical Director to employ good
clinical judgment. They also have an obligation to their employer to follow
appropriate guidelines and directives. Therefore, any modi?cation of treatment
ordered by a Supervising Physician must be based upon sound medical judgment
and must be in accordance with the current standard of practice in prehospital care.

In medicine, "gray areas" are a fact of life. As your Medical Director, I cannot predict
all the gray areas you will encounter during the life expectancy of these protocols.
Having served as your Medical Director for many years, I have con?dence that you
are properly trained and approach your work with compassion and common sense.

The American Heart Association Guidelines for CPR and ECC is the national
standard of care in the United States for EMS organizations. To access the 2015
Guidelines, navigate to Any ACLS class taught in
the last year has been based on the 2015 Guidelines. It is not the intention of this
Handbook to reiterate the information contained in the Guidelines.

The issue of consent is an important one. Our birthright as Americans is the right to
choose what is (and what is not done) to our bodies by healthcare providers. The
law considers healthcare providers to possess medical expertise, and requires them
to "inform" patients of proposed medical interventions prior to obtaining permission to
carry them out (informed consent). We might not like the decisions our patients
make, but we sometimes must be resigned to honor them. As Albert Einstein said,
?Two things are in?nite: the universe and human stupidity; and I'm not sure about
the universe."

However, not every patient encountered by EMS personnel has the legal right to give
or withhold consent. Minors and incapacitated adults (intoxication, disease states,
head trauma, illness) are unable to legally give or withhold 
do not have the capaciy to do so. In these patients, consent for treatment by EMS
personnel is implied.

By the same token, someone may not refuse needed medical attention unless they
have capacity to do so. Eighty percent of lawsuits against EMS organizations are
brought by patients who were not transported to a hospital. Many patients who
refuse needed medical care are high risk. The only way to decide whether or not
someone has capacity to refuse care is to assess the patient, paying particular

 

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