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HomeMy WebLinkAboutEMS Medical Director AgreementL// ./ __./ B {trEvrllE Medical Director Agreement The service and the Contractor desire to enter into an agreement for the provision of professional services forthe Contractorto assist the Service as an Emergency MedicalSeNices Medical Director {EMSMD), for Bonneville loint School District No. 93 and; WHEREAS, the Service is duly authorized and empowered to enter into such an atreement, and the Contradors duly authorized and empowered to enter into such an agreement on behalf ofService; NOW THEREFORE, in consideration ofthe above recitals, the agreements, covenants, conditions and mutual promises herein set fonh, it is hereby agreed as follows: L. Agree that the contractor shall provide services as an EMSMD as directed by the ldaho EMs Physicians Commission; and have responsibility of both on-line and off-line medical direction. 2. The Contractor shalloversee the medicalaspects EMS team asthe EMSMD authority and responsibilities will include those established in the rules ofthe ldaho EMS rules and over site And operations both dired and indirect. 3. Term ofAtreement. The term of this agreement shall before the period betinning on the effective date 09/02/2021 hereof a nd ending by either party may terminate this atreement without cause before the end ofthe term by providing thirty (30) days'written notice ofsuch termination to the othea party. Buy must remain on unil a replacement is found. 4 Compensation. S€rvice is voluntary with the Eonneville Joint School District No. 93 5. This instrument constitutes and bodies the entire atreement between parties to utilize services. This atreement may be altered, amended, modified or revoked only by written instrument duly executed by the parties hereto. 6. Representations. Contractor agrees and warrants that in entering into this agreement, it has relied upon no representations, express or implied, of Service, its contractors or agents or of the Board that are not expressly stated herein. D stnct RN Dr. Scott Woolstenhu lme Su perintendent Dr. Aaron Gardner, MD, / -//,_--f(r/) *_-r/ B NNEVILLE Medical Supervision Plan Role of the System Medical Director EMS personnel provide medical care under the direction of the System Medical Director. The Medical Director is responsible for development of the medical supervision plan, treatment guidelines, provider credentialing, and quality assurance. The Medical Director's authority and responsibilities will be consistent with IDAPA 16.02.02 ldaho Code "Rules of the ldaho EMS Physician Commission." System Medical Director will have a field presence and respond to calls to provide direct medical direction and observe personnel performance when needed. System Design Our "EMS System" is comprised of a Private Service, all with multiple individuals with varying roles, experience, operational responsibilities and credentials. This includes a diverse group of healthcare professionals including Communications, First Responders. Together, this "System" provides the basis for seamless delivery of care to acutely ill or injured patients in our school district. The district depends on our EMS services and all healthcare providers will provide quality and competent care in a timely and compassionate way. EMS System services utilize a collaborative approach to maximize the potential for a positive outcome for the patients we are entrusted to serve. Beginning with emergency communications, pre-arrival guidance can be provided to transport services alerting them for better outcomes, treatments for critical and time sensitive emergencies. Air Medical Support availability ensures that rapid treatment and transport of critical patients is possible, even in the most locations in our school district. We have a System that maximizes the opportunity to deliver appropriate care to our patients as defined by a unified set of EMS Treatment Guidelines. Guidance Accordance All medical care within the district should be provided according to the current guidelines and within the scope of practice set forth by the State of ldaho. These guidelines will be reviewed and updated at least every 2 years. Changes to guidelines or 4 May 2O2f , 、 information ofimportance between updates will be disseminated using Medical Directives. Each agency must have access to On-Line MedicalControl (OLMC). This can wili be accomplished via radio or cell phone. OIMC must be from a physician unless a physician extender (PA, NP) is the highest level of provider at the receiving facility. OLMC is available from the Emergency Department at Eastern ldaho Regional Medical Center or ldaho Falls Community Hospital. All individuals providing medical care as part ofthe EMS System will be credentialed according to the requirements ofthe EMS System. Specific medicalcare in the System will be delivered by appropriately credentialed and qualified individuals. lndividuals holding current qualifications may deliver specialty care as detined by the SOP5 and Clinical Guidelines when appropriate equipment and conditions exist. All individuals providing medicalcare as part ofthe EMS System will be currently certified by the ldaho EMS Bureau. Allortanizations providing medicalcare as part ofthe EMS System willcomply with ldaho EMS Bureau requirements forAgency Licensure and Provider Certification. All 911 requests for care will be managed by communications according to the requirements of the currently adopted Medical Priority Dispatch System. This includes call triage, pre-arrival instructions, post-dispatch instructions and response determinants. Levelof care and number of providers forStandby orSpecial Events will be determined based on specific needs. 0uring unusual or extreme conditions or circumstances, the above criteria may be modified to best meet the needs ofthe EMS System. CJedentials Every Provider that delivers medical care within the System must be credentialed to practice in addition to holding a current State of ldaho Certification. The goal is to ensure continuous competency of certified EMS personnel. Credentials All credentialed providers within the EMS System are allowed to provide care under the S May 2021 Emergency Medical Technician (EMT) Advanced Emergency Medical Technician (AEMT) direction of the Medical Director. Credentialing is the final approval of the Medical Director that ensures an individual's competency to care for patients as part ofthe Emergency MedicalServices System. An individual is "credentialed to Practice" when he or she successfully meets and maintains the defined credentialing requirements. The levels of credentialinE are: Every Provider within the System must obtain and maintain their credentials in order to continue providing care at their desiSnated level. Qualifications Qualifications are added competencies in specialty areas such as Training, USAR, Ha?ardous Materials Medicine, Tactical Medicine, etc. The Qualifications available may change based on the needs ofthe EMS System. The requirements for all qualifications are in addition to credentialing requlrements. Certifi ed EMS Personnel Credentialing ln order foran EMS providerto be reco8nized and allowed to perform within the EMS System, they must initially complete the following: Eme,gency Medical Technician . Certification at EMT level or above by ldaho EMS Bureau . Agency Orientation . CPR . Skills verificatio n . Completion of Field Training Program Maintenance of credentials: . Continuous Certifi cation(s) . Good standing with agency . Participation in atency in-services . Annualskills review Advanced Emergency Medical Technician . Certification at Advanced EMT level or above by Idaho EMS Bureau . Agency Orientation . CPR . Skills Verification . Completion of Field T.aining Program Maintenance of credentials: . Continuous Certilication(s) . Good Standing with Agency . AnnualSkills Review . Participation and Compliance with Agency QA Program Suspension or Revocation of Credentials It is important for individual providers and the School District to focus on providing care that is appropriate forthe patients we serve. We will always be accountable for our actions and we willfocus on a non-disciplinary approach to support and re-educate providers in the System. On occasion, circumstances arise that may lead to a change in Credential statut such as suspension or revocation. There are actionsthat are deemed unacceptable for any provider involved in the care of patients. If substantiated through a process ofappropriate investigation and peer review, any provider found to be involved in the following actions could lose credentials within the System. . Falsification of a patient care document . lntentionally withholding care from a patient . lntentionally harming a patient . Providing care while impaired by alcohol or drugs . Failure to remediate and/or participate in required education and/or review Additionally, a provider may be credentialed at a lower level than his current state certification. Under state rule, any change in credential status will be reported to the tdaho EMS Bureau. Skills/lnterventions Authorized by credential Level Each Credential level builds on all previous Credential levels. All skills are subject to change based upon the current State of ldaho EMS scope of practice and should be adjusted to be consistent with their current list. The following skills/interventions are authorized by Credential Levelwithin our System: Emergency Medical Te.hni.ian (EMT) Credentials All EMR skills/inteNentions plus: . Medication administration: Assist with patient prescribed nitroglycerin, EpiPen and inhaled beta agonist, Slucagon. EpiPen . Pulse-Oximetry . Nasopharynteal/Oral airway . Glucometer . 12-lead EKG Acquisition . EPI lnjection (lM) . Aspirin, Zofran, Benadryl, Tylenol, lbuprofen, Nasal Narcan . Peripheral lV initiation and isotonic infusion administration (Optlonal Module) . Taser Barb Removal (Optional Module) Advan.ed EmerBen.y Medlcal Techni.ian (AEMT) Credentials All EMR and EMT skills/inteNentions plus: . Medication administration: all medications and routes as outlined in EMT and AEMT tevel Patient Care Guidelines . Peripheral intravenous access Patient Care Reporting Requirements Guiding P nciples of Documentotion At a minimum, all patient care documentation by any Credentialed Provider in the System shall: . Be truthful, accurate, objective, pertinent, legible, and complete with appropriate spelling, abbreviations and grammar. . Reflect the patient's chiefcomplaint and a complete history and sequence of events. . Document the rationale behind your assessment ofthe patient. . Report physicalfindings, a complete set ofvitalsigns, any abnormalfindings, and sitnificant changes pertinent to patient care. . Summarize allassessments, interventions and the results ofthe interventions with appropriate details. . lnclude explanationsfor why an otheawise appropriate assessment, and/or intervention(s), did not occur. . Clearly describe details and circumstances surroundinE any unusualsituations. . Ensure appropriate patient hand offoccurs. . Protect patient confidentiality in accordance with HIPPA regulations. Minimol Ooto Elements Required lot PotientCore Repoft Documentotion . Date and time of incident . location of incident . Responders and incident number . Patient name (John Doelane Doe if unknown) . Gender . Chiefcomplaint . Patient assessment . Available witness account of ihcident . Patient treatment provider . Transporting unit and location oftransport . Refusa I of treatment EMS Providers are strongly encourated to utilize the ldaho IGEMS-PCR for documentation purposes. This allows standardized reporting within the System. lt also allows for immediate chart review for Ol purposes. Medical Dircctor ovejsight and Chart Reviews Feedback should be viewed as a critical part ofthe educational process for EMS providers. The Medical Director should provide feedback to the EMT's in a timely manner. All high acuity calls will be review by the Medical Director- Each agency should have an individual responsible forchart reviews and provide the Medical Director if necessary for chart review. Clinical Erro6 and Reporting Our collective desire is to foster an environment where the self-reporting of medical concerns and incidents is not only encouraged, but expected. ln orderto improve as a System, be a responsible member ofthe medical community, and be accountable to the students and staff we serve, it ls essentialthat these incidents be promptly and thoroughly reviewed. The purpose ofthe review is to determine why the erroroccurred and attempt to make chan8es within the system to prevent errors in the future. All Credentialed Providers are expected to report clinical errors throu8h the appropriate organizational channels. All providers should be committed to an educational {non- punitive) approach in reviewing errors and evaluating care. The process i5 structured to be fair and objective with an emphasis on education as a means to improve personal and collective performance. Clinical Review Process The Clinical Review Process is designed to investigate questions regarding clinical care. The process ensures awareness ofthe EMS Medical Directorand administrator in order to address issues as they arise and provide timelyfeedback, education and monitor clinicalperformance. Circumstances should be reported directly reported to the EMS Administrator, District RN and Superintendent for investigation and followed !p with the Medical Director. Determination of Magnitude Action or care appears appropriate or minor deviation from acceptable. lf it is determined, after review by the Medical Director and District MedicalTeam that the provider,s actions were appropriate or a minor deviation occurred, appropriate feedback will be delivered and documented accordingly. Action or care appears to deviate significantly from expectations lfthe outcome ofthe review reveals a Provider has deficiencies in an area, an education plan may be created to assure the deficient areas are appropriately addressed. When developmentofan education plan is appropriate the EMS Administrator willadministerthe plan. lf a Provider is unsuccessful or fails to participate with the education plan to overcome deficiencies, the individual may lose credentialing. what isthe Detinition ofa "Patient'' Anyone that fits the definition of a patient must be properly evaluated and/or appropriate treatment options taken (including an informed refusal ifthe competent patient absolutely does not wish medical care or transport despite our su8Sestions that they do). Similarly, anyone that does not fit the definition of a patient as defined by our System does not require an evaluation or completion of a Patient Care Record. lfthere is ever any doubt, an individualshould be deemed a patient and appropriate evaluation should take place. It is important to remember that the deflnition of a patient requires the input ofboth the individual and the Provider, and an assessment ofthe circumstances that led to the 911 call. The definition of a patient is a separate question from whether or not the patientgets evaluated or treated. The definition of a patient is any human being that: . Has a complaint suggestive of potential illness or injury . Requests evaluation for potential illness or injury . Has evidenceofan obvious illnessor injury . Has experienced an acute event that could lead to illness or injury . ls in a circumstance or situation that could lead to illness or injury All individuals meeting any ofthe above criteria are considered "patients" in the System. lfthere are any questions or doubts, the individualshould be considered a patient- Patient Consent and Refusal The United States Supreme Court has recognized that a "person has a constitutionally protected liberty inteaest in refusing unwanted medical treatment" even if refusal could result in death. Although courts protect a patient's rights to refuse care, "preseNation of life, prevention ofsuicide, maintenance ofthe ethical integrity ofthe medical profession, and protection of innocent third parties" may also be considered when evaluating a patient's wish to refuse treatment. Each case must be examined individually. ln providing medicalcare, the universalgoal is to act in the best interest ofthe patient. Thisgoal is based on the principle ofautonomy, which allows patients to decide what is best forthem. A patient,s best interest may be served by providing leading-edge medical treatment, or it may be served simply by honoring a patient's refusalofcare. Although complicated issues can arise when providers and patient5 disagree, the best policy is to provide adequate information to the patient, allow time for ample discussion, and document the medical record meticulously. With certain exceptions (see tmplied Consent), all adult patients, and select minoa patients, have a right to consent to medicalevaluation a nd/o r treatment, or to refuse medicalevaluation and/ortreatment if they have the legal competency and present mental capacity to do so. There are three specific forms of consentthat apply to EMS: lnformed Consent, lmplied Consent, and Substituted Consent. lnformed Consent lnformed consent is more than legality- lt is a moral responsibility on the part ofthe Provider, based in the recognition of individual autonomy, dignity, and the present mental capacity for self-determinatjon. With informed consent, the patient is aware of, and understands, the risk(s) of any care provided, procedures performed, medications administered, and the consequences of refusing treatment and/or transport. They should also be aware ofthe options available to them ifthey choose not to accept our evaluation and/or treatment. lmplied Consent ln potentially life-threatening emergeocy situations, consent fortreatment is not required. The law presumes that ifthe individual with a realor potential life- threatening injury or illness were conscious and able to communicate, he/she would consent to emergency treatme nt. ln life-threatening emergency situations, consent for emertency care is not required ifthe individualis: . Unable to communicate because ofan injury, accident, illness, or unconsciousness and suffering from what reasonably appears to be a life-threatening injury or illness OR . Suffering from impaired present mental capacity OR . A minor who is suffering from what appears to be a life- threatening injury or illness and whose parents, manaSinS or possessory conservator, oa guardian is not present Substituted Consent This is the situation in which another person consentsfor the patient, as in minors, incapacitated patients, incarcerated patients, and those determined by courts to be legally incompetent. The fundamental issue in informed, substituted consent for minors is a question of how decisions should be made forthose who are not fully competent to decide forthemselves. parents or guardians are entitled to provide permission because they have the legal responsibility, and in the absence ofabuse or neglect, are assumed to act ih the best interests ofthe child. However, there is a moraland ethical ,,need to respect the rights and autonomy ofevery individual. regardless ofage." Provide6 must walk a fine line between respect for minors' autonomy, respect for parental rithts, and the law. The whole issue of when a patient may or may not be considered legally competent and possessing the present mental capacity to consent to, or refuse care, is complex and confusing jn the emergency care environment. lt is ourobligation to make sure we address each ofthe following principles: . When they can, patients mustgive us permission to evaluate and/ortreat them for any presumed or real medical condition. . We mustevaluate a nd/o r treat those patients who are unable to decide due to their illness, injuryor circumstances. . We must be able to determine whether a patient has the legal competency and present mental capacity to refuse evaluation and/or treatment. . We must inform the patient ofthe risks and potentialalternatives to refusing or accepting care and be reasonably certain they understand. . We must honor a patlent's refusa I of eva luation and/ortreatment ifthey have the legal competency and present mentalcapacity to refuse that evaluation and/or treatment. Any person, eighteen (18) years of age or older, that is deemed to have the legal competency and present mentalcapacityto consent, may consent to, or refuse evaluation, treatment, and/or transportation. That person may also sign a legal document (Patient Refusal Form). lfthe patient hasthe legalcompetency and present mentalcapacityto consent, and chooses to refuse fu rther eva luation and/or treatment, the Provider must, after assessing the patient's ability to understand, provide the patient with information re8arding the risks of refusal, the alternative options available, and whatto do ifconditions persist or worsen. A Provider may be denied access to personal property (land and home) by the property owner or patient, ifthere is no obvious immediate life threat to a patient. Legal Competency and Present Mental Capacity to Consent or Refuse Evaluation or Treatment It is our oblitation to offer evaluation and/ortreatment to anyone with evidence of illness or injury re8ardless ofwhetherthey initially choose to refuse that evaluation a nd/or treatm e nt. However, a patient must have the legal competency and present mental capacity to consent before consent is deemed to be valid. . Mental competency: there is a presumption of legal mental competency unless one has been declared mentally incompetent by a court of law. Legally competent individuals have a right to refuse medical treatment. . Presenl mental capacityi refers to one's present mental ability to understand and appreciate the nature and consequences of his/her condition and to make rational treatment decisions. While there are criteria for leBal competency and present mental capacity as defined below, there is no way to cover every potential circumstance with a written guideline. Thus, we should always determine a palient disposition that is safe and appropriate given the circumstances . 18 years ofage or older . Alert, able to communicate, and demonstrates appropriate cognitive skills forthe circumstances ofthe situation . Showing no indication of impairment by alcohol or drug use . Showing no current evidence ofsuicidal ideations, suicide attempts or any indication that they may be a danger to themselves orothers. . Showing no current evidence of bizarre/psychotic thoughts and/or behavior, or displaying behavior that is inconsistent with the circumstances ofthe situation . No physicalfinding orevidence ofillness orinjurythat may impairtheirabilityto understand and evaluate theircurrent situation {for example, a patient with a head injury and an abnormalGCS, a patient with si8nificant hypoxia or hypotension, etc.) . A patient that has NOT been declared legally incompetent by a court of law. lf a patient has been declared legally incompetent, his/her cou rt a ppointed guardian has the right to consent to, or refuse, evaluation, treatment, a n d/or tra nsportatio n forthe patient. When evaluating a patient for the ability to consent to or refuse treatment, the Provider must determine whether or not the patient possesses the present mentalcapacityto uoderstand and appreciate the nature and consequences of his/her aondition and to make rational treatment decisions. Such an evaluation must take into consideration not only the patient's orientation to person, place, time, and event, but also their memory function, their ability to engaSe in associative and abstract thinking about their condition, their ability to respond rationally to questions, and their ability to apply information Eiven to them by the Providers. A thorou8h test ofthe patient's mental status is one that assesses orientation/ registration (memory), attention, calculation, recall and lan8uage. This can be accomplished fairly rapidly. For example . Level of Consciousness (AVPU)- The use of appropriate "noxious stimuli" is an acceptable practice in our System to assist in determining a patient's levelof consciousness. This may be in the form of ammonia inhalants or painful stimulithrough the application of pressuae to the fingernail bed. . Awake, alert, and oriented- elicit speclfic/detailed responses when questioning your patient to determine awake, alert, and oriented status. . Registration giveyour patientthe name of3 unrelated items (dog, pencil, radio)and askthem to repeatthem and rememberthem because you willaskagain later. . Attention and calculation- ask the patient to spell a five-letter word backwards (pound, earth, space, ready, daily, etc.) or counting down by 7's starting at 100. . Recall ask the patient to rccall the 3 items identified in "registration." . Language- state a simple phrase ("no if, ands, or buts") and ask the patient to repeat. Also test the patient's ability to respond to verbal commands by asking the patient to do something with an object ("hold this piece of paper", "fold this paper in half) or identify two objects held up such as a watch or pencil. Patients with impaired present mental capacity may be treated under implied consent. lf patient does not have present mental capacity but continues to refuse treatment or is combative, law enforcement may be dispatched to the scene and participate in the evaluation and decision process. OLMC should be contacted as an additional resource. Obviously, if in the opinion of the ALs Credentialed Provider in charge, there is an immediate risk to life or significant morbidity, patient safety and care are the priority (implied consent would apply here). Finally, the Provider's findings must be documented with facts, not conclusions, and such documentation must be sufficient to demonstrate the patient's mental status and understanding of his/her condition and the consequences of refusing treatment. Consent to, or Refusalof Evaluation/Treatment for a Minor The following person(s) may consent to, or refuse, the evaluation, treatment, a nd/or tra nsportatio n of a minor: . Parent . Grandparent . Adult {> 18) brotheror sister . Adult (> 18) aunt or uncle . Educational institution in which the child is enrolled that has received written authorization to consent/refuse from a person having the right to consent/refuse. . Adult who has actual care, control, and possession ofthe child and/or has written authorization to consent/refuse from a person having the right to consent/refuse (i.e., daycare camps, soccer parents, carpools, etc.). . Adult who has actual care, control, and possession of a child under the jurisdiction of a juvenile court. . A court havin8 iurisdiction over a suit affecting the parent-child relationship ofwhich the child is the subject. . A peace offcerwho has lawfully taken custody ofthe minor, ifthe peace officer has reasonable grounds to believe the minor needs immediate medical treatment- . A managing or possessory conservator oa guardian. A Provider may be denied accessto minorchildren bya parent or guardian ifthere is no obvious immediate life threat to the patient. However, in general, parents orguardians caonot refuse life,saving therapy for a child based on religious or other grounds. When treating minors, it is important that there be an interactive process between them and the Provider. The interaction should involve developmentally appropriate disclosure about the illness/injury, the solicitation ofthe minor's willin8ness and preferences re8arding treatment, and decision options. Although the intent ofthis interaction js to involve the child in decisions, the way in which the participation is framed is important. As with any patient, minors should be treated with respect. lnitiation and Termination of Cardiopulmonary Resuscitation (CpR) Cardiopulmonary Resuscitation (CPR) is NOT tndicated lnitiation of Cardiopulmonary Resuscitation (CpR) by any credentialed provider is not indicated for pulseless, apneic patients in the presence of: . Obvious appearance of death . Decomposition . Obvious dependent lividity . Rigor mortis . Obvious mortalwounds (massive burn injuries, severe traumatic injuries with obvious signs oforgan destruction such as brain, thoracic contents, etc.) Severe extremity damage, including amputation, should not be considered an obvious mortal wound without coexistent iniury/illness. . Patient submersion ofgreater than 60 minutes from arrivalofthe first Public Safety entity untilthe patient is in a position for resuscitative effortslo be initiated. Exceptions include extreme cold-water submersions. . Operationally, on-scene rescuers should consider conversion from rescue to recovery at 60 minutes. Exceptions to this guideline include any potential for a viable patient such as a diver with an air source or a patient trapped with a potential air source. Final decision for transition from rescue to recovery mode rests with on scene command in consultation with medical control as needed. . ldaho POST or Comfort One order/Out ofState DNR . Valid Out-Of'Hospital Do Not Resuscitate Written Order or Device from any (US) State . ln nursing home or assisted living, a facility DNR form or signed order for DNR. ln addition, unless a patient arrests during transport, Credentialed Providers should not transport or continue Cardiopulmonary Resuscitation (CPR) for pulseless, apneic patients suffering from blunt or penetrating trauma that do not respond followint intubation, lV fluids and bilateral needle decompression, if available and indicated. Termination of Resuscitation Efforts Without OLMC Any System Credentialed Provider, in the following circumstances, may discontinue resuscitation efforts without OLMC when: . Resuscitation efforts were inappropriately initiated . A valid advanced directive/DNR was discovered after resuscitative efforts had been initiated When a Credentialed Provider makesthe decision to not injtiate resuscitative efforts, orto terminate efforts, the following procedures should be followed by the provider(s) making that de(ision: . Canceladditional EMS units . Document per System and agency guidelines . Coordinate with law enforcement/coroner for body disposition Termination of Resuscitation Efforts Utilizing OLMC Except for the previous criteria, OtMC should be contacted any time resuscitation effons have been initiated, and termination of resuscitation efforts is being considered. . 20 minutes ofongoing resuscitation attempts without Return ofSpontaneous Circulation (ROSC) . No shock indicated by AED/Monitor . ETC02 < 20 The following cases may require transport to hospital after consultation with OLMC: . Hypothermia . Persistent ventricu la r fibrillation/ventricu la r tachyca rd ia . Persistent PEA with an electrical heart rate greaterthan 40 . Forthe intubated patient, ETC02 >20 mmHg When OLMC is involved in the decision to terminate resuscitative efforts, the following procedures should be implemented: . Resuscitative efforts must be continued while requesting a pronouncement. . Contact OLMC at EIRMC or IFCH or designated hospitalvia phone or radio. . Document per System and aSency protocols Out of Hospita I Advanced Directives Pertaining to Resuscitation Patients have a legal right to consent to, or refuse/ recommended medical procedures, lncluding resuscitative efforts. These patients require thoughtful consideration at critical times. The decision to honor or not to honor an out of hospital Do Not Resuscitate (POST/Comfort One/Medical Facility DNR) must be made quickly and accurately. Remember, it is our obligation to carry out the patient's appropriately desitnated medical choices, even when they cannot direct us in cases of cardiopulmonary arreSt. An out of hospital DNR order should NOT be honored and resuscitative efforts should be initiated in the following circumstances: . The patient or person who executed the order destroys the form and/or removes the identification device OR . The patient or person who executed the order directs someone jn their presence to destroy the form and/or removes the identification device OR . The patient or person who executed the order tells the EMS providers or attendinE physician that it is his/her intent to revoke the order OR . The attending Physician or physician's desi8nee, if present at the time of revocation, has recorded in the patient's medicalrecord thetime, date, and place ofthe revocation and enters "VOlD" on each page of the DNR order ln the event that there is a question as whether to honor or not honor an out of hospital DNR, contact OLMC as needed. lmportant Points to Remember: . lt is appropriate to transport patients to the hospital who have arrested for pronouncement if, in the assessment ofthe providers, the circumstances mandate such an action (for example, death in a public place). . Always rule out a non-traumatic etiology for what may be perceived as a traumatic arrest (for example, primary Ventricular Fibrillation resultint in a minorcar crash). . Anytime a DNR is not honored, the reason must be documented in the Patient Care Record (PCR). . An Advanced Directive does not imply that a patient refuses palliative and/or supportive care. Care intended for the comfort ofthe patient should not be withheld based on a Medical Power ofAttorney. . When in doubt, always initiate resuscitative efforts. tater te rm ination can be implemented if appropriate. . Refer to the POST/Comfort One/DNR Guideline. Provision of Care While Off-Duty ln orderto benefit patientsand utilize allavailable resources in the System, when a Credentialed Provider finds the need to provide care while off-duty, the following procedure will be followed: . The Credentialed Provider will identify himself/herself and the level of credentialing . Levelofcare provided will not exceed the System scope of practice for the credentialed provider . System Treatment Guidelines will be followed Physician on-scene EMS personnelwork underthe direction ofthe Medical Director through written treatment guidelines and receive medical direction from the medical control physician. There will be times though that a physician will be on-scene and wish to provide or direct patient care. During these situations the following guidelines will apply: Medical Director/ Designee . When the Medical Director/designee is on scene, they may choose to provide medical direction. Patient's Personal Physician: . A physician with a prior physician/patient relationship may request deviation from treatment guidelines, but al no time maythe credentialed provider perform outside the scope of pradice. lntervening Physician: . A physician with no prior patient relationship may request deviation from treatment guidelines only if physiciao is accepting responsibility forthe patient, including accompanying the patient to the hospital. . Physician should be known to the provider or present official state identification as an MD or DO. . At no time willthe credentialed provider perform outside the scope oftheir practice. . Personnel shall request the intervenint physician contact on-line medical control physician for consultation. Oispatch of resources should be limited tothe following components: Bonneville Joint School District No.93 is not a 911 EMS service and only a Private service forthe school district and willcall9ll for (ldaho Falls Fire Department) Fortransport services. Notifications for resources will be done by radio and cellphone. Disaster/Multi-Patlent Mass Casualty lncidents that overwhelm the resources ofthe System pose a particularly difficult challenge. plannihg for such incidents should be formalized and drilled retularly. During these sltuations, the following will apply: . Credentialed personnel will follow System guidelines and not exceed their respective scope of practice . NIMS and ICS principles will be followed . Triage using the START method, and triage tags . Documentation ofcare is still required. However, a triage tag willseNe as appropriate documentation as long as it includes patient identification and inteNentions. . Requirement for OLMC may be suspended fortreatment guidelines that previously required OtMC priorto intervention. OI,MC should stilt be established at the first available opportunity. lntroduction of New Equipment or Technology lf new technology or equipment is introduced into the System, the following will apply: . All technology or equipment changes must be approved by the Medical Director . All items must be within the scope of practice of the provider. . ltem wlll be reviewed for clinical and cost-effectiveness. . Standardized training will be developed including objectives, education content, and evaluation tool to ensure competency. . Each Credentialed provider will receive standardized training and show competency. . New item may be added to periodic skill review at the discretion of the Medical Director. Safe Haven Act The ldaho Safe Haven Act is intended to provide a safe alternative for parents who otherwise might abandon their infant. A safe haven is authorized by law to accept a baby less than 30 days of age directly from a parent without identifying the parent. The parent is not required to provide any information to the safe haven. However, the parent may volunteer medical or other information. The parent may remain anonymous and will not be prosecuted for child neglect or abandonment. Emergency medical personnel may respond to a 911 call requesting Safe Haven or be presented with an infant under 30 days old at a Transport or Non-Transport EMS agency. When contacted by a custodial parent with a request for Safe Haven, proceed with the following steps: . Determine if the parent is requesting Safe Haven and is expressing an intent not to reclaim the child. . Provide aid to protect and preserve the physical health and safety of the infant. . lf law enforcement is not en -route or present on scene, request law enforcement to place child in protective custody. . Do not ask for the identity of the parent. lf known, keep parental identity confidential. . Accept voluntary information given by the parent regarding the health history of the parent or infant. . Transport child to the hospital in a child safety seat if possible. . Report any voluntary information to the hospital personnel while keeping the identity of the parent and child confidential. ' Record encounter on Patient Care Report or run report and document type of call as "Other" with Safe Haven listed on the line below "Other".