Book 35 - EMS Field Manual - LAFD Training

I 

I 

Preface 

The EMS Field Manual, LAFD Book 35, is intended to serve as a convenient 

reference for all Advanced Life Support (ALS) and Basic Life Support (BLS) 

Fire Department personnel. 

The condensed information contained herein was generated from existing 

policies and procedures that govern LAFD EMS operations. Members are 

required to maintain a thorough knowledge of Department of Health Services 

(DHS) and LAFD policies and procedures. To maintain a high standard of 

expertise, as qualified health care professionals, a periodic review of these 

writings is recommended. 

Excerpts from the (DHS) Prehospital Care Policy Manual (LAFD Book 33), 

DHS Medical Guidelines, LAFD Training Bulletins, Departmental Bulletins, 

LAFD Manual of Operation, and EMS Updates were utilized in the compilation 

of this manual. 

Book 35 is subject to periodic revisions as policy andlor procedures change. 

If field personnel identify areas that may require clarification or revision, please 

contact the Quality Improvement Section at (2 13) 485-7 153.

' 

EMS Field Manual (Book 35) 

TABLE of CONTENTS 

FIELD PROCEDURES / PROTOCOLS 

LAFD Patient Assessment Guidelines 

Simple Triage and Rapid Treatment (START) 

Acute Life Threatening Event (ALTE) 

Broselow Pediatric Emergency Tape 1 PEDS Color Code 

Patient Resolution Guide (PRG) 

PRG Principles 

Level of Consciousness 

Glasgow Coma Scale 

Revised Trauma Score 

Patient Refusal of Treatment andlor Transportation (AMA) I In Custody 

Child I Elder I Dependent Adult Abuse Reporting 

Determination of Death 

Patients Determined to be Dead 

Medical Patients in Cardiopulmonary Arrest 

Crime ScenesIAccidental DeathsISuspected Suicides 

Procedures Following Pronouncement of Death 

Documentation for Reports 

Prehospital Do-Not-Resuscitate (DNR) Orders 

Honoring Advance Health Care Directives (AHCD) 

Task Oriented EMS Standard Operating Guidelines (SOGs) [TasksIEquipment] 

Size-Ups 

SOGs for EMS Incidents (e.g., Cardiac Arrest, Trauma, Medical Complaint) 

Patient Transfer of Care from ALS to BLS 

EMT-1 Expanded Scope of Practice 

Poison Control System 

System-wide Mental Assessment Response Team (SMART) 

City Volunteer Programs 

Miscellaneous I Communications During Emergencies 

Highest Ranking Medical Authority 

Body Armor Vests 

Medical Waste Disposal 

Management of Multiple Victim Incidents I MCI Short Form 

Revised: 512005 

PAGE 1 OF 3 

SECTION 1 

1.0 

1. 1 

1.2 

1. 2a 

1.3 

1. 3a 

1.4 

1.4a 

1.4b 

1.5 

1. 6 

1.7 

1. 7a 

1. 7b 

1.7~ 

1. 7d 

1. 7e 

1. 8 

1. 8a 

1.9 

1. 9a 

1. 9b 

1.10 

1.11 

1. 12 

1.12a 

1. 13 

1. 14 

1.14a 

1.14b 

1.14~ 

1. 15

EMS Field Manual (Book 35) 


PATIENT TRANSPORTATION 1 DESTINATION 

LAFD Patient Destination Guidelines /General Principles 

Patients Transported by BLS Personnel 

Patients Transported by ALS Personnel 

Transport to Specialty Care Centers: SART Centers, Trauma Centers, Trauma 

Triage CriteriaIGuidelines, Extremis Patients 

Trauma Catchment / Boundary Areas 

Pediatric Trauma Centers 

LA County Trauma Center Maps 

Trauma Center Diversion / EDAP I PMC / PTC / Perinatal 

Burn Patients / Decompression 

Patient Destination Guidelines / EDAP / Patient Requests / Hospital Diversion 

Transporting Patients in Custody 

Hospital Refusal to Accept Rescue Ambulance Patients 

Service Area Hospitals Specialties / Exceptions 

Service Area Hospital Maps 

Los Angeles County Emergency Medical Service Receiving Facilities 

EMS and Battalion Offices 

Receiving Hospitals Sorted by EMS Battalion Captains 

Fire Station, Battalion, Division, EMS Battalion Chart 

LAFD Rescue Ambulance Locations 

APPARATUS 1 EQUIPMENT 

Apparatus Towing Apparatus Breakdown Procedures 1 Documentation 

Apparatus Maintenance 

CAV and NAV 

Obtaining a Spare Gurney 

Multi-Casualty Medical Supply Cache 

Disaster Cache Box (Amy1 Nitrite I Mark I Kit) 

Base Hospital Hailing and Working Channel Assignments 

Revised: 512005 PAGE 2 OF 3 

SECTION 2 

SECTION 3

Records and Documentation 

The Journal (F-2) 

EMS Field ~ akal (Book 35) 


RECORDS / DOCUMENTATION 

Hazardous Substance Exposure Report (F-3) 

Stores Requisition (F-80) 

Rescue Equipment Loan Slip (F-215M) 

EMS Report (F-902M) 

Controlled Medication Inventory (F-903) 

LAFD Situation Report (F-904) 

The Health Insurance Portability and Accountability Act (HIPAA) 

CAL I OSHA and FED I OSHA Notifications 

Communicable Disease Exposure (Contaminated Needle Puncture) 

Procedures I Exposure Categories 

, Communicable Disease Exposure and Notification Report (F-420) 

1 

' Communicable Disease Decontamination 

Suspected Child AbuseINeglect Reporting Guidelines 

Suspected Elder and Dependent Adult Abuse Reporting Guidelines 

Communication Failure Protocol 

Mnemonics 

Abbreviations 

Bibliography 

Record of Revisions 


SECTION 4 

4. 0

\ 

Section 1: Field Procedures 1 Protocols 

LAFD PATIENT ASSESSMENT GUIDELINES 

^ SCENE 

Â Safety (BSI PrccautionsJPPE) 

+ Environment 

Â Mechanism of Injury 

+ Number of Patients 

^ GENERAL IMPRESSION 

+ What you see! 

^ AIRWAY 

4 P U LS E (Rate, Rhythm, Quality) 

4 RESPIRATION (Rate, Rhythm, TV) 

4 B P (Systolic/Diastolic) [Orthostatic's PRN] 

^ BREATHING (AssistfOxygen) 

^ CIRCULATION (RadialICarotid) 

+ Pulses 

+ Capillary Refill 

+ Control Severe Bleeding (PRN) 

- j COMPLETE BODY CHECK 

/ SKIN SIGNS 

+ Color 

+ Temperature 

+ Moisture 

^ CHIEF COMPLAINT 

(SignsISymptoms) 

+ Objective Observation 

+ Subjective Findings 

(What they say!) 

FIRST- PERFORM FOCUSED BODY CHECK 

(Determined by LOG, Chief Complaint, and History) 

Glasgow Coma Scale (GCS) 

ASSESS BILATERAL BREATH SOUNDS 

for patients with chest injuries, difficulty 

breathing, and I or signs of shock 

LO 0 K for Tissue Damage, Scars, Deformities, Abnormal Behavior I Motion, Fluids 

F E EL for Tenderness, Instability, Crepitus 

4 HEAD 4 BREATHSOUNDS 4 NEUROLOGICAL 

4 NECK 4 ABDOMENIPELVIS 4 BACK 

4 CHEST 4 EXTREMITIES (UpperILower) 4 MEDICAL TAGS, 

TRACKS, TRAUMA 

DEFORMITY BURNS 

CONTUSION TENDERNESS 

ABRASION LACERATIONS 

PUNCTURE1 SWELLING 

PENETRATING 

PULSES 

MOTOR 

SENSORY 

Revised: 121200 1

Section I: Field Procedures 1 Protocols 

LAFD PATIENT ASSESSMENT GUIDELINES 

S SignsISymptoms 

A Allergies 

M Medications 

P Past History 

L Last AteIDrank 

E Events Preceding 

FOCUSED HISTORY 

0 Onset 

P Provokes 

Q Quality 

RegionIRadiationl 

Recurrence 

S Severity 

T Time 

Alcohol1 Apneal 

A Anaphylaxis1 

E EpilepsyIEnvironment 

/ Insulin 

0 Overdose 

U Uremialunderdose 

T Trauma 

1 Infection 

StrokeIShockl 

Seizure 

C Cardiovascular 

AIRWAY (OIP, Mask) SPINAL PRECAUTION 

BREATHING (Position I BVM 102) GLUCOSE 

CIRCULATION (Direct Pressure I Position Patient) OB ASSISTANCE 

CONTROL BLEEDING BANDAGING 1 SPLINTING 

REPEAT. 

Initial and Focused exam: 

Priority patients every 5 minutes 

Stable patients every 15 minutes 

Have a Plan! Route! Code 3? 

Treatment En Route? 

ONGOING ASSESSMENT 

Ã Motor Response 

1 Ã Verbal Response 1 

REVISED TRAUMA SCORE (RTS) 

,- . ... . 

(Uoded Values) 

SBP + RR + GCS 

Revised: 1212001


SIMPLE TRIAGE and RAPID TREATMENT 

-\ START 

, 

b - 

REPOSITION 

ASSESS 

RespiratiodRate ABSENT 

ASSESS 

Circulation 

0 

< 2 sec. / 

RADIAL PULSE 

PRESENT 

I Y 

ASSESS 

Mental Status 

* 

Airway and 

REASSESS 

Respiration 

Simple Triage and Rapid Treatment 

Revised: 121200 1


ACUTE LIFE-THREATENING EVENT (ALTE) 

An ALTE may occur during sleep, wakefulness, or feeding in the pediatric patient. It is described as an 

episode that is frightening to the observer and characterized by a COMBINATION of: 

* Transient Apnea 

* Color Change 

* Marked Muscle Tone Changes 

* Choking 1 Gagging 

Upon EMS arrival this pediatric patient may appear completely normal and asymptomatic. However, 

a complete and accurate history of the event is critical in determining ALTE. 

Base Hospital contact is required. If the circumstances surrounding the incident are vaguelunclear it 

is the base station MICNs responsibility to determine the appropriate destination for the patient. 

ALTE may be a symptom of many specific disorders including, but not limited to, gastrointestinal 

reflux, infection, seizures, airway abnormality, hypoglycemia, metabolic problems, or impaired 

regulation of breathing during sleep and feeding. ALTE was previously called a "Near-miss SIDS." 

THE MOST IMPORTANT DIAGNOSTIC STEP IS TO OBTAIN A CAREFUL HISTORY 

OF THE CURRENT COMPLAINT FROM THE PERSON WHO WITNESSED THE EVENT. 

The evaluation and history taking for ALTE patientsconsists of: 

* Color (red, pale, cyanotic) 

* Respiratory Effort (apnea, obstruction, irregular) 

* Sleep Status (awake, asleep) 

* PositionMotor (prone, supine, uprightllimpness) 

* Breathing PatternINoises (choking, stridor) 

* Eye Movement (closed, startled, rolled, fluttering) 

* Relationship to Feeding 

* Fluid in the Mouth 

* Duration 

* Need for Intervention 

* Age 1-3 years: Base Contact andor Transport is required. 

Age 0- 12 months: Transport regardless of chief complaint andor mechanism of injury. 

' ALTE patients age 12 months and under: BASE CONTACT g.mJ TRANSPORT to a PCCC is required. 

Revised: 121200 1 

PAGE 1 OF 2


BROSELOW PEDIATRIC EMERGENCY TAPE 

The Broselow Pediatric Emergency Tape is a mandatory piece of equipment carried on all ALS 

units in Los Angeles County. The Broselow Tape is used to estimate weight, drug dosages, and 

correct size of equipment for pediatric patients up to 74 pounds [34 kg]. It is mandatory to use 

the Broselow Tape on all ALS pediatric patients. [Refer to "EMS Update 2001 '7 

After determining the correct color code, document the three-digit color code in the Peds Color 

Code Box, Incident Info Section of the EMS Report [F-902Ml. For billing purposes, convert the 

kilograms to pounds and document in the weight box. Use only the color code when reporting to 

the Base Hospital. 

The color coding system is designed to reduce calculation errors associated with medication 

administration. If the infant's size falls into the "gray" area [first section of the tape: 3 kg., 

4 kg., or 5 kg.] it is necessary to report the specific weight and color to the Base Hospital. 

For all other color coded sections it is only required to report the color code. 

GY3 

YEL 

GY4 

WHT 

Placement of the Broselow Tape for measuring from the 

standing or supine position is as follows : 

Place the RED end of the tape for.. .... 

STAND IN G : To the heel of the foot and measure to the 

top of the head. 

SUPINE: To the top of the head and measure to the 

heel of the foot [while extending the leg]. 

Note: 

The pediatric drug dosages are only to be taken from the "Color Code Drug Doses 

LA County Kids" (laminated cards) that are carried on each ALS unit. 

THE BROSELOW TAPE IS ONLY TO BE USED TO DETERMINE THE COLOR CODE. 


GY5 

BLU 

PAGE 2 OF 2 

PNK 

ORG 

RED 

GUN 

PUR 

-

LEVEL of CONSCIOUSNESS 


EMS personnel shall perform a patient assessment to determine orientation and level of consciousness 

an each patient they encounter. This assessment should determine patient's state of awareness and 

orientation to time, place, person, or purpose [A & 0 X 3 per LA County Medical Guidelines]. 

Inappropriate aggressiveness or hostility should alert members to the possibility that the patient's 

thinking process may be impaired. EMT-Is shall access an EMT-P resource any time a patient is 

unable to reasonably answer one or more of the following questions: 

^ - 

+ Name 

+ Day of the week I year I time of day 

+ Where helshe lives I where they are now 

GLASGOW COMA SCALE (GCS) 

ADULT (% 14 year) 

Spontaneous 

To Voice 

To Pain 

None 

Obedient 

Purposeful 

Withdrawal 

Flexion 

Extension 

None 

Oriented 

Confusion 

Inappropriate 

Incomprehensible 

None 

21 HLD (12 months to 14 years) 

Spontaneous 

To Voice 

To Pain 

None 

- 

Obedient 

Localizes 

Withdrawal 

Flexion 

Extension 

None 

- 

5 Oriented 

4 I Confusion 

3 Inappropriate 

2 Incomprehensible 

1 1 None 

In addition to the numerical Glasgow Coma Scale (GCS), document a brief descriptive assessment 

on the EMS Report Form (F-902M) . 

The GCS is required to assess neurological status on all patients greater than twelve (12) months of 

age. This includes patients who do not have an altered level of consciousness. 

After consultation with the primary care giver, the patient examiner shall estimate the appropriate- 

ness of the response for the younger child that is not able to communicate (motor response-obedient 

and verbal response-oriented). 

Revised: 512005 PAGE 1 OF 2


REVISED TRAUMA SCORE (RTS) 

The Revised Trauma Score (RTS) is a physiological scoring system to determine the survival 

probability of trauma patients. If the patient (age one year and above) meets trauma center criteria 

and is transported to a Trauma Center or PTC the RTS shall be completed and documented on the 

EMS Report Form (F-902M). 

THREE assessment elements comprise the RTS: 

+ SYSTOLIC BLOOD PRESSURE (SBP) 

+ RESPIRATORY RATE (RR) 

+ GLASGOW COMA SCALE (GCS) 

ASSESSMENT ELEMENT IS GIVEN A "CODED VALUE" (CV). 

THE "CVS" ARE THEN TOTALED TO GIVE THE RTS ("0-12"). 

The "coded value" (sum) of the: SBP + RR + GCS = R T S 

RTS = (2+2+3) 

CALCULATING 

Nx: If unable to auscultate or palpate a blood pressure due to hypo-perfusion7 enter a value of "1 ." 

(The lower the score the more critical the patient.) 

Document the rational for a palpated blood pressure in the F-902M Comments section . 


The RTS is heavily weighted toward the GCS to compensate for major head injury 

without multi-system trauma or major physiological changes.


PATIENT REFUSAL of TREATMENT 1 TRANSPORTATION 

EMT-Is may allow a patient to refuse treatment I transport if glJ the following conditions are met: 

The patient's condition does not meet any criteria on the Patient Resolution Guide (PRG). 

* The patient does not meet altered level of consciousness criteria as described in DHS, Ref. No. 809. 

The patient understands the severity of their condition and has a plan for follow-up medical care. 

Patient understands and signs the F-902M in the space provided. Additionally, the patient receives 

the Patient After Care Instruction form [back of the F-902M Pink copy]. 

Note: IF THE PATIENT DOES NOT MEET THE ABOVE CRITERIA, AN ALS RESOURCE SHALL 

BE REQUESTED TO DOCUMENT THE PATIENT'S REFUSAL (AMA). A PARAMEDIC 

WORKING ON A BLS RESOURCE MAY NOT HANDLE AMA'S IN LIEU OF AN ALS RESOURCE. 

* A BLS resource shall request a Paramedic RA. 

* EMT RA shall request the closest ALS resource e.g., Paramedic Engine, ALS RA. 

The ALS resource shall make base hospital contact while with the patient. 

Advise base hospital of all circumstances, patient's condition, and the reason for refusal. 

* Have the patient or legal guardian sign the AMA form [back of the F-902M White copy]. If the patient 

refuses to sign the AMA form, this shall be documented in the Comments section of the F-902M. 

.'\ 

Refer to Book 35, Section 2.0: "Patient Destination Guidelines". 

An EMS Battalion Captain shall be requested to respond to the incident if the Paramedics are 

uncomfortable with any aspect of the AMA. (Dept. Bulletin No. 01-10) 

, PATIENTS IN CUSTODY 

. Patients under the care or in custody of law enforcement often pose a challenge for pre-hospital care 

providers. These patients represent a very high degree of medical-legal risk. Patient care, 

documentation, and transportation must be in accordance with existing policies and procedures. 

Members are required to conduct a complete Initial and Focused assessment which includes vital signs, 

pertinent negative findings and a statement on the F-902M (EMS Report) which outlines the chief 

complaint and/or the reason for the 9- 1 - 1 call. Members must remember that the history on these 

patients should be suspect due to the possibility of the patient being under the influence of illicit drugs, 

may not have access to their prescription medications, or may have sustained trauma with no obvious 

signs or symptoms; and patient care should not be based solely upon the history obtained. 

All members are reminded that patients in custody may refuse care BUT cannot refuse transportation to an 

emergency department for evaluation. Patients who refuse treatmentltransport and whose chief complaints 

meet the PRO Section I and I1 or Reference 808 criteria require transport and/or base hospital contact. 

Transporting Restrained Patient's (Reference No. 838) 

Restraint equipment (handcuffs, plastic ties, or "hobble" restraints) applied by law enforcement officer: 

Must provide sufficient slack to allow patient to take full tidal volume breaths. 

Requires the officers continued presence (the officer shall accompany the patient in the ambulance) 

Must not compromise the patients respiratory/circulatory systems. (Transport patient in supine position.) 

Must not cause vascular, neurological, or respiratory compromise. 

Patient's restrained extremities shall be evaluated for pulse quality, capillary refill, color and temperature, 

nerve and motor function immediately following application and every 15 minutes thereafter. 

Documentation is necessary to justify actions done or not done if unable to perform the above. 

Restraints may be attached to the frame of the gurney but not to the movable side rails. 


CHILD / ELDER / DEPENDENT ADULT ABUSE 


EMT-Is and EMT-Ps are required to report all cases of suspected abuse and/or neglect as soon as possible. 

ABUSE 

NEGLECT 

CHILD 

ELDER 

, , 

punishment, willful cruelty, unjustifiable 

punishment, or sexual assault. 

Failure of any person having the care and/ 

or custody of a child, elder, or dependent 

adult to exercise that degree of care which 

a reasonable person in a like position 

would exercise. 

Any person between the ages of 18 and 

64 years that cannot fully care for 

DEPENDENT 

- 

himherself due to physical and/or 

ADULT mental limitations. 

1. Request OCD to notify and have the 

appropriate law enforcement agency 

report to the incident location or hospital 

if the patient is to be transported. 

2- The law enforcement agency will assign an 

investigator. If the patient does not require 

immediate transport wait for the responding 

law enforcement agency unless a responsible 

Any person under 18 years old. I1 

adult (other than the abuser) remains on scene. 

3. The member in charge of patient care shall 

Any person 65 years old or older. 

forward the completed Department of Social 

Services Report to the appropriate EMS 

Battalion Captain within 36 hours. 

4. Make a Journal (F-2) entry, that shows the 

, report was completed and forwarded. 

NB: While on scene obtain names, addresses, and telephone numbers of witnesses, victims, siblings, parents, 

and law enforcement / investigating officer (s) involved with the incident, 

Field members may obtain copies of the Social Services (8572) form "Suspected ChildAbuse Report" from 

the concerned EMS Battalion Captain or find the form listed in the Prehospital Care Policy Manual, Book 33, 

Reference No. 822.2. The Social Services form "Suspected Dependent Adult/Elder Abuse " may also be found 

in Book 33, Reference No. 829.2. 


\

DETERMINATION OF DEATH 

A patient may be determined dead if in addition to the absence of respiration, cardiac activity, and 

\ neurological reflexes, one or more of the following conditions exists (DHS, Reference # 814): 

) 

+ Decapitation. 

+ Massive crush injury. 

+ Penetrating or blunt injury with evisceration of the heart, lung, or brain. 

+ Decomposition. 

4 Incineration. 

+ Extrication time greater than 15 minutes, with no resuscitative measures performed prior to extrication. 

+ Pulseless, non-breathing victims of a multiple victim incident where insufficient medical resources 

precluded initiating resuscitative measures. 

+ Drowning victims, when it is reasonably determined that submersion has been greater than one hour. 

- 

+ Rigor mortis requires assessment (as described in Section 1.7a ). 

Patients Determined to be Dead 

If the initial assessment reveals rigor mortis andor post-mortem lividity &, 

EMS personnel shall perform the following assessments: 

(NN: Assessment steps may be performed concurrently.) 

RESPIRATORY 

* Assuring that the patient has an open airway 

* Look, listen, and feel for respiration 

(This includes auscultation of the lungs for a minimum of 30 seconds) 

CARDIAC 

* Auscultation of the apical pulse for a minimum of 60 seconds 

* Adults and children: Palpation of the carotid pulse for a minimum of 60 seconds 

Infants: Palpation of the brachial pulse for a minimum of 60 seconds 

NEUROLOGICAL 

* Assess pupil response with a penlight or flashlight 

* Check for a response to painful stimuli 

Resuscitative measures shall not be initiated on patients who have been determined dead (according 

A to this policy) or on patients who meet DHS, ~ ef. No. 815, "Honoring Prehospital DNR Orders" 

Medical Patients in Cardiopulmonary Arrest 

Initiate immediate resuscitation and ALS intervention for patients who do not meet 

conditions described in Section 1.7. In general, these patients shall be: 

* Treated in the field long enough for possible resuscitation to occur. 

, * Rapidly transported if an adequate airway or venous access cannot be established. 

* Treated and transported if the patient is: A suspected drug overdose, hypothermic, 

in refractory ventricular fibrillation or ventricular tachycardia. 



Crime Scenes I Accidental Deaths I Suspected Suicides 

+ Responsibility for patient health care management rests with the most medically qualified 

person on scene. 

+ Authority for crime scene management shall be vested in law enforcement. It may be necessary 

to ask law enforcement officers for assistance to create a "safe path" into the scene to access the 

patient, while minimizing scene contamination. 

+ If law enforcement is not on scene, prehospital care personnel shall attempt to create a "safe path" 

and secure the scene until their arrival. 

Procedures Following Determination of Death 

All therapeutic modalities initiated during the resuscitation must be left in place. 

(This includes ET 1 ETC tubes, IV catheters, EKG electrodes, and oral 1 nasal pharayngeal airways.) 

The deceased shall not be moved without the Coroner's authorization. 

- 1 

NB: It may be necessary to move the deceased if the scene is unsafe or if the deceased is creating a ,' 

hazard. In such emergent situations, field personnel may relocate the deceased to a safer 

location or transport to the most accessible receiving facility. 

Documentation for Reports 

+ The criteria used to determine death. (Listed in Section 1.7a.) 

Â The condition of the patient and what, if any, resuscitation interventions were initiated. 

+ If the deceased was moved, document the location and the reason why. If movement of the 

deceased was authorized by the Coroner document: The case number and the representative 

who authorized the movement. 

-- 

Revised: 121200 1


PREHOSPITAL DO-NOT-RESUSCITATE (DNR) ORDERS 

' -\ 

, FOR PULSELESS AND APNEIC PATIENTS WITH VALID DNR ORDERS: 

EMT-Is shall a begin CPR or attach defibrillator 

EMT-Ps shall a begin CPR or attempt ALS procedures (Combi-tube, ET, cardiotonic drugs, etc.) 

1. Identification by witness who can absolutely 

identify patient/ID bands; and 

2. Written physicians order in patient's chart, 

such as: 

Â No Code 

Â NoCPR 

+ Do-Not-Resuscitate; or 

3. Verbal physician's order (in person) which 

must be followed immediately in writing. 

1. Check the "DNR" box on the F-902M, 

(EMS Report form). 

2. Briefly describe in the Comments section: 

Â Any care given 

Â The physician's name and telephone 

number 

Â The date the DNR order was originally 

signed 

3. Attach a photocopy of the facility's DNR 

order to the F-902M (White copy). 

1. Identification by witness who can absolutely 

identify patient1ID bands; and 

2. Presence of an original (or copy): 

Â Los Angeles County Do-Not-Resuscitate 

(DNR) Form (Ref No. 81 5.1) 

Â State Prehospital Do-Not-Resuscitate 

(DNR) Form (Ref No. 815.2) 

1. Check the "DNR" box on the F-902M 

(EMS Report form). 

2. Briefly describe in the Comments section: 

Â Any care given 

Â The physician's name and telephone 

number 

. Â The date the DNR order was originally 

signed 

3. If available, attach page 2 of the DNR form 

(provider agency copy) to the F-902M (White 

copy) prior to forwarding. If the provider 

agency copy or photocopy is not available, 

record all DNR information on the F-902M. 

Do a take the patient's copy if it is the only 

copy on scene. 

In the prehospital setting, a Living Will or Durable Power of Attorney are non-acceptable DNR forms. 

Revised: 121200 1 PAGE 1 OF 2

A Section 1: Field Procedures 1 Protocols 

PREHOSPITAL DO-NOT-RESUSCITATE (DNR) ORD'ERS 

Resuscitation shall begin immediately and paramedics shall contact the base hospital for further 

direction if there is any objection or disagreement by family members or caretakers about withholding 

resuscitation; or if prehospital personnel have any reservations about the validity of the DNR order. 

For patients who are a pulseless and apneic with valid DNR orders, EMT-Is and EMT-Ps shall 

provide for their comfort, safety, and dignity by using the following appropriate supportive measures: 

EMT-IS: 

+ Maintain Airway (Oropharyngeal 1 Nasopharyngeal Airways) and Suctioning 

+ Administer Oxygen 

+ Control External Hemorrhage 

+ Apply Dressings, Bandages, and Slings 

+ Immobilize Skeletal Injuries 

+ Position of Comfort 

E M T - P s : (In addition to the above) 

+ Visualize airwaylremove foreign bodies by means of a laryngoscope and Magill forceps 

+ Contact base hospital if IV access andlor pain medication is necessary 

* In the event of deterioration of the patient's vital signs, level of consciousness, or of 

cardiopulmonary arrest, continue transporting to the designated receiving facility (even 

though it may not be the most accessible). Transport to the patient's requested treating 

facility. 

* If the patient's caretaker is unable to provide care, advise transport. 

(A private ambulance may be suggested.) 

* Generally, emergency transport is not necessary but left to the discretion of EMS personnel. 

(Emergency transportation may be necessary for such cases as hemorrhage, unmanaged 

airway, severe pain, etc.). (DHS, Reference # 8 15) 



ADVANCED HEALTH CARE DIRECTIVES (AHCD) 

California law on AHCDs recognizes that adults have the fundamental right to control the decisions 

relating to their own health care, including the decision to have life-sustaining treatment withheld or 

withdrawn. The AHCD enables patients (over the age of 18) who are unable to speak for themselves 

(e.g., coma, Alzheimer's, etc) to provide their health care instructions. 

A VALID AHCD MUST MEET THE FOLLOWING REQUIREMENTS: 

4 Patient is unable to make their own life decisions 

d Power-of-Attorney Health Care Agent is designated with effective DATE 

d End of Life Decision box is designated (checked) 

d Two witness signatures and DATED, or 

d Notary Public 

d Signed by a Patient Advocate or Ombudsman if the patient is in a skilled nursing facility 

Note: An AHCH has reciprocity between states and must be honored if all the above are completed. 

If the patient's caretaker is unable to provide care, advise transport. (A private ambulance may be suggested.) 

Generally, emergency transport is not necessary but left to the discretion of EMS personnel. 

Emergency transportation may be necessary for such cases as 

hemorrhage, unmanaged airway, severe pain, etc. (DHS, Reference # 81 8) 

GUIDELINES FOR PREHOSPITAL CARE PERSONNEL: 

Provide the level of care according to the patient's wishes and/or medical condition when 

dealing with Advanced Health Care Directives and bbDo-Not-Resuscitate (DNR)" orders. 

_ AJ-S and BLS shall provide for the patient's comfort, safety, and dignity by using 

(he following appropriate measures: 

+ ASSIST VENTILATIONS (via a bag-valve-mask device) 

+ CHEST COMPRESSIONS 

+ AUTOMATED EXTERNAL DEFIBRILLATOR (AED) 

(only ifBLS is on scene prior to the arrival of ALS) 

pulmonary resuscitation, 

defibrillation, drug therapy, 

and other life saving measures. 

+ ADVANCE AIRWAY + CARDIAC DRUGS: 

MANAGEMENT Adenosine Epinephrine 

+ DEFIBRILLATION Atropine Lidocaine 

+ CARDIOVERSION Dopamine 

+ AIRWAY MANEUVERS (including removal offoreign body) + HYDRATION 1 DIURESIS 

SUCTIONING + GLUCOSE ADMINISTRATION 

+ OXYGEN ADMINISTRATION + PAIN CONTROL (i. e., morphine) 

+ HEMORRHAGE CONTROL 



TASK ORIENTED EMS STANDARD OPERATING GUIDELINES 

EMS Standard Operating Guidelines (SOGs) are intended as guidelines to establish pre-determined 

, tasks for each member of the company. Company Commanders shall assign taskslresponsibilities 

based upon the expertise of each team member. Additionally, the tasks designated for each of the 

following four positions are not intended to supersede any pre-existing duties assigned to the member. 

The medical condition of the patient determines the work flow and sequencing of tasks. 

\ 

. ./Â¥ 

A-B 

Person 

c 

Person 

D 

Person 

E 

Person 

The "A-B" (Airway-Breathing) person who assesses the airway; applies oxygen; 

determines the respiratory rateltidal volume; and any signs of distress while 

checking breath sounds. In cases of cardiac or respiratory arrest, the "A-B" person 

inserts the airway and performs bag-valve-mask (BVM) ventilation. 

The "C" (Circulation) person is responsible for preserving the circulation by stopping 

any overt bleeding, and obtains the pulselrate and blood pressure. For pulseless patients: 

applies the automated external defibrillator (AED); attempts defibrillation; and provides 

chest compressions for CPR, as necessary. 

The "D" (Disability) person is responsible for preventing further patient disability by 

assessing the current degree of disability and applies splintslspinal immobilization as 

necessary. In cardiac arrest cases: assists with equipment needs (such as oxygen bottles, 

backboard, and gurney); assists the paramedics with IV line preparation and equipment 

needs. In many situations, the fourth member of the company is unavailable since the 

Engineer has apparatus responsibilities. However, the Engineer may assist the rescue 

as described above and may be able to assist when the patient is outside of a structure. 

The "E" (Executive) person ensures that all of the other team members are properly 

performing their tasks. In cardiac arrest cases, the "E" person assists the "C" person 

set up the automated external defibrillator (AED) to ensure rapid application. The "E" 

person assesses the scene for safety, initiates the F-902M, keeps records of interventions 

and their delivery times, interacts with family members to obtainlrecord patient 

information which includes: medical history, allergies, a current medications list, 

current address (include ZIP code), and (if available) Medi-Cal number. 

Even when dispatched simultaneously (with an ALS unit), fire company members 

shall perform the above tasks (including defibrillation) as a team. 

Suggested personnel for each EMS team assignment and equipment to be carried to the patient: 

A-B 

c 

D 

E 

FF or FF/PM 

Firefighter 

Engineer or A0 

Captain 

Revised: 121200 1 PAGE 1 OF 4 

Oxygen, BVM, and airway 

managementJsuction bag 

AED and medical box 

Flashlight, splints, backboard, 

gurney as needed 

F-902M and Radio 

tf


Note: ALL personnel shall exercise good judgment and follow Department policy regarding 

equipment and medical supplies carried to the patient(s) on initial approach. 

Medicallstarter Box Medicallstarter Box Medicallstarter Box MedicallTrauma Box 

Oxygen Oxygen Oxygen Oxygen 

(with respiratory supplies) (with respiratory supplies) (with respiratory supplies) (with respiratory supplies) 

Defibrillator Trauma Box Disposable OB Kit Defibrillator 

Additionally, for incidents occurring above the first floor , the gurney shall be brought in. 

SIZE-UPS 

Size-ups shall be given to additional resources responding with the fire company. 

In particular, a size-up for an EMS incident shall be provided under the following conditions: 

+ Requests for an ALS unit when a BLS unit is dispatched for an "A" or "B" category call. 

+ Additional resources requested beyond the original dispatch. 

When multiple resources are dispatched to a single incident, the first unit on scene shall provide a 

brief size-up and may cancel or down grade, to non-emergency, the additional resources when 

appropriate. It is not uncommon for a BLS Engine, a Paramedic Assessment Engine, and a 

Paramedic Rescue to be dispatched on a single incident. Exercise good judgment in terms of 

additional resources to proceed through, and if so, whether emergency or non-emergency. 

In addition, if the patient is stable but still requires transport or an ALS resource for documentation 

only, consideration shall be given to have that resource proceed through nun-emergency. 

Revised: 121200 1 

The "EMS size-up" (given on TAC 10) shall include the following information and 

be very brief (vital signs normally are not included): 

PAGE 2 OF 4

TEAM 

TEAM 

A-B 



To further describe the tasks to be performed by each team member, the following 

examples of EMS incidents (with the SOGs for fire personnel) are listed: 

COMPANY PERSONNEL 

FF or 

FFPM 

Firefighter 

Engineer 

or 

A0 

Captain 


Firelighter 

Engineer 

or 

A0 

Captain 

TASKS 

Assess airway; suction as needed; basicladvanced airway, BVM; 

observe for chest rise and gastric distention. Announce 10-second 

time intervals when the paramedic performs intubation. 

Utilize the automated external defibrillator (AED) to 

analyze EKG rhythm; defibrillate as needed; chest 

compressions of CPR; carotid pulse checks; if applicable, 

obtain the AED Code Summary and initiate the F-901 

(Cardiac Arrest Outcome Data Sheet). 

Anticipate and provide necessary equipment; direct paramedics 

to the patient; assist with IV line preparation; gather and 

properly dispose of medical waste. 

Supervise team; assess scene safety; assist bbC" Person with 

AED rapid application; interact with familyhystanders. Initiate 

F-902M; record patient assessment data (and times); interventions 

(and times); patient's medical history and list of medications, 

and (if available) Medi-Cal number, address (include ZIP code). 

Give a brief size-up to the paramedics. 

TASKS 

Administer Oxygen at 15Llmin.; auscultate lungs to determine 

equal breath sounds; assess: airway, rate of respirations, and 

tidal volume. As needed: suction, BVM, provide and maintain 

cervical support. 

Check for: pulse and rate; blood pressure; perform total body 

check; control bleeding. Assess: LOC, skin signsleyes. 

Determine GCS I RTS, chief complaint, and obtain medical 

history. Apply dressings, bandages, splints, and spinal 

immobilization as needed. 

Anticipate and obtain necessary equipment. Provide lighting. 

Direct paramedics to the patient; obtain gurney; assist with IV 

line preparation; gather and properly dispose of medical waste. 

- 

Supervise team; assess scene safety; determine the need for 

additional resources; interact with farnilyhystanders; initiate 

F-902M. Record patient assessment data (and times); record 

interventions (and times); obtain patient's medical history and 

current medications list, and (if available) Medi-Cal number, 

address (include ZIP code). Give a brief size-up to the 

paramedics.

TEAM 

A-B 

c 

D 

E 


MEDICAL COMPLAINT CHEST PAIN SEIZURE DIABETIC PATIENT 


FIRE 

Engineer 

or 

A0 

Revised: 121200 1 

Captain 

- 

BLS & ALS 

ALS RA 

PM 

BLS RA 

FF 

BLS RA 

FF 

ALS RA 

PM 

TASKS 

Assess: airway, respiratory rateltidal volume. 

Auscultate lungs for breath sounds. 

As needed: administer Oxygen, suction, BVM. 

Assess: pulselrate, blood pressure, skin signs, eyes. 

Complete total body check. 

Determine LOCIGCS. 

Obtain chief complaint and medical history. 

Anticipate and obtain necessary equipment (gurney). 

Direct paramedics to the patient. Assist with IV line 

preparation. Gather and properly dispose of medical waste. 

Supervise team. Assess scene safety and additional 

resource needs. Interact with familyhystanders. Obtain 

the patient's correct address (include ZIP code), Medi-Cal 

number (if available), medical history, allergies and list of 

current medications. Initiate the F-902M, record patient 

assessment data (and times), interventions (and times). 

Give a brief size-up to the paramedics.


PATIENT TRANSFER OF CARE FROM ALS TO BLS UNIT 

) The decision to transport a patient is governed by: 

The patient's medical condition The patient's chosen receiving facility 

* DHS policies and guidelines Medical judgment of the on-scene medical authority 

LAFD policies 

If the patient does not require ALS level care, the patient may be transported by a BLS ambulance. 

Members shall include the following steps when transferring care from an ALS unit to a BLS unit: 

Base hospital approval is required if the patient meets base hospital contact criteria. 

Obtain agreement from the BLS receiving team to accept responsibility for the patient. 

Advise the BLS receiving team of the patient's condition, history, physical assessment, 

and all treatment rendered. 

The ALS unit initiates the F-902M EMS Report and completes the appropriate sections 

ensuring that the unit and team member numbers are clear and legible. 

* The Green copy of the F-902M report shall be retained by the ALS unit. 

All other F-902M report copies are given to and completed by the BLS [transporting] unit. 


EMT-1 EXPANDED SCOPE OF PRACTICE 


County of Los Angeles EMS Agency (Ref. No. 802) EMT-I Expanded Scope ofpractice 1 

- - 

(Treatment Protocols, Interfacility, andlor 9- 1 - 1 responses) 

Prior to arrival of paramedics or transport: 

Â Place patient in position of comfort 

Â High flow 02 

Â Monitor vital signs 

Â Shock position PRN 

Monitor, maintain, and adjust preset rate: 

+ Glucose solutions 

+ Isotonic salt solutions (e.g., Normal 

Saline or Ringer's Lactate) 

(May turn off if infiltrated) 

Adjusted to TKO rate by hospital personnel: 

Â Folic acid-max 1 mg/1000 ml 

+ Multi-vitamins-ma. 1 vial/1000 ml 

Â Thiaminemax 100 mg/1000 ml 

Require infusion pump at preset rate: 

+ KCL-max 20 mEq11000 ml 

+ Total Parenteral Nutrition 

+ Chemotheraputic agents with required 

precautions (Spill Kit) 

May be implanted or external: 

Â Insulin 

+ Demerol (Meperidine) 

Â Morphine 

revised: 121200 1 PAGE 1 OF 1 

Approved by transferring physician: 

Â Nasogastric (NG) tubes 

Â Gastrostomy tubes 

Â Heparin locks 

+ Foley catheters 

Â Tracheostomy tubes 

+ Indwelling vascular access lines 

+ CVP monitoring devices 

+ Arterial lines including Swan Ganz 

catheters 

If available and indicated, assist patient or 

allow self-administration if criteria is met: 

+ Sublingual nitroglycerine aerosol or tablets 

* Systolic BP greater than 100 

Â Bronchodilator inhaler or nebulizer 

* Alert enough to use inhaler 

+ Epinephrine device (Auto-Injector) 

* Signs and symptoms of severe allergic 

reaction (Respiratory distress or 

hypoperfusion) 

+ If assistance is given, EMT-Is shall not 

cancel EMT-P response. 

+ An ALS resource shall be requested if 

one has not been dispatched. 

+ In life-threatening situations, consider 

BLS transport if ALS arrival is longer 

than BLS transport time.


POISON CONTROL CENTER 

The California Poison Control Center is a facility that provides information and advice 

regarding the management of individuals who have or may have ingested or otherwise 

been exposed to poisonous or possibly toxic substances. 

1 ACCESSING A POISON CONTROL CENTER: 1 

1 9-1-1 PROVIDERS I (800) 404- 4646 1 

Health Professionals (800) 41 1- 8080 

Public Hotline (800) 876- 4766 

SYSTEM-WIDE MENTAL ASSESSMENT RESPONSE TEAM 

In 1993 the Department of Health Services in cooperation with the Los Angeles Police Department 

committed resources to staff a system-wide mental assessment response team (SMART) in the City. 

SMART is designed to provide a cooperative, compassionate mental health 1 law enforcement 

response team to assist affected citizens in accessing available mental health services. The team is 

able to assist in providing quick resolutions without unnecessary incarceration or hospitalization. 

SMART consists of nine teams including a supervisory team. Each team will be composed of one 

police officer and one Department of Mental Health clinician. 

The SMART goals are to: 

* Prevent unnecessary incarceration andlor hospitalization of mentally ill individuals. 

* Provide alternate care in the least restrictive environment through a coordinated and 

comprehensive system-wide approach. 

* Prevent the duplication of mental health services. 

* Allow police patrol units to return to service sooner. 

1 SMART HOURS of OPERATION 

1 Telephone: (213) 485-4188 1 Day Watch: 1 0700 hours to 1530 hours 1 

1 PM Watch: 1 1530 hours to 2400 hours 1 

SMART personnel shall request an ambulance to transport a person when: 

* The person is in need of immediate medical attention requiring transportation by EMS personnel 

* The person is extremely violent and requires restraint to the extent that they must be transported 

in a recumbent position. 

* The violent person is injured or physically ill and is in need of immediate medical attention. 

NB: When a mentally disordered andor violent person is transported by ambulance, 

at least one police officer shall accompany the patient. 


-


b CITY VOLUNTEER PROGRAMS 

CRISIS RESPONSE TEAM [CRT] 

On November 25, 1998, under the direction of the Mayor's Office, Volunteer Bureau, Crisis 

Response Teams began City-wide operation. Crisis Response Team (CRT) members are trained 

civilian volunteers who respond, on request, to FirelPolice emergencies to perform immediate 

andlor short term on-scene intervention to victims, families, witnesses, and survivors of traumatic 

events. 

These teams do not perform counseling functions and will not function in the capacity of 

Department Critical Incident Stress Debriefing Teams for Firefighters and/or Police Officers. 

CRT members may be requested for any incident which, in the judgment of the incident commander, 

necessitates rapid intervention and referrals for humanitarian services such as : 

Grief management Drownings 

Shelter Fires with displaced occupants 

Food acquisition Homicides 

Abused/neglected children Major traffic accidents 

Death Suicides 

Drive-by shootings 

The goal of the CRT is to allow emergency responders to complete operational duties while the \, 

CRT team provides humanitarian services. -. 9' 

Requests for CRT shall be made through Operations Control Dispatch Section [OCD]. OCD will 

coordinate notification with the appropriate Police Division. CRT members are identifiable by their 

jackets and picture identification. They are instructed to report to the incident commander upon 

their arrival. 

Any questions regarding the CRT may be directed to the Bureau of Human Resources, 

Bureau Liaison Officer, [2 1 31 485-3396. 

COMMUNITY EMERGENCY RESPONSE TEAM [CERT] 

The Community Emergency Response Team [CERT] are civilian volunteers [trained 

by the Fire Department] who assist their communities during the initial phase of a disaster, 

e.g., major earthquake. The purpose of the CERT Program is to improve community self-reliance 

and, therefore, survival in the event of a large disaster. It is known that emergency service 

resources will be depleted, to the extent that some individuals or neighborhoods will need to rely 

on themselves during the first 24 to 72 hours. 

Note: 

The management of City Volunteer Programs is delineated in LAFD Training Bulletin 71 


/

I 


MISCELLANEOUS 

Members shall use the following terms to indicate the urgency of the situation when 

requesting police response through Operations Control Dispatch (OCD): 

Fire Department needs " H E L P I' 

Use this term when there is imminent grave danger to LAFD personnel e.g., members 

are being attacked, attack is imminent, or other immediate hazardldanger. 

Assigned to response: 

ALL AVAILABLE POLICE UNITS IN THE AREA 

(one unit dispatched Code 3 and other units ASAP) 

FIRE COMPANY 

BATTALION CHIEF AND/OR 

EMS BATTALION CAPTAIN (if EMS incident) 

Fire Department needs " A S S I S T A N C E " 

Use this term when there is a large hostile crowd and apparent danger to LAFD 

personnel or apparatus. 


ALL AVAILABLE POLICE UNITS IN THE AREA 

(one unit dispatched Code 2 and other units ASAP) 

BATTALION CHIEF AND/OR 

EMS BATTALION CAPTAIN (if EMS incident) 

" B A C K - U P " the Fire Department 

Use this term when there are belligerent individuals and a likelihood of physical 

altercation. 


ONE POLICE UNIT ASSIGNED, CODE 2 

" M E E T " the Fire Department 

Use this term when requesting LAPD to accompany you to a known "trouble area" or 

when the Incident Commander requests LAPD for traffic or crowd control. 



ONE POLICE UNIT ASSIGNED, CODE 2

MISCELLANEOUS 

Section I: Field Procedures I Protocols 

+ THE HIGHEST RANKJNG MEDICAL AUTHORITY on scene (generally a 

paramedic) is responsible for the overall. medical care rendered to patients. 

+ The Incident Commander is responsible for scene management, this includes: 

Scene Safety 

Resource Allocation 

Communications 

+ In order to effectively supervise EMS incidents, officers are expected 

to have a clear understanding of-and the ability to apply-the following: 

Department of Health Services policies and procedures (Prehospital 

Care Policy Manual, LAFD Book 33): 

1 802 1 EMT- 1 Scope of Practice I 

1 806 1 Procedures Prior to Base Hospital Contact I 

1 808 1 Base Hospital Contact and Transport Criteria 1 

1 814 1 Deteminatioflronouncement of Death in the Field 1 

1 Patient Refbsal of Treatment or Transport 

1 834 1 

502, 508, 5 10, 

511, 512, 515, 

518,519,520 

822,829 

Patient Destination Policies 

Suspected Abuse Policies and Procedures 

BODY ARMOR VESTS 

The BODY ARMOR VEST shall be donned prior to entering a potentially hostile environment. 

Protection from an attack depends on concealment of the vest so the attacker cannot purposefblly 

aim at or attack the unprotected area of the body. The vest shall be covered by a brush jacket, 

EMS safety coat, or firefighting turnout coat. 

Members shall wear their vests to the following incidents: 

+ Assault with a Deadly Weapon (ADW) + Sniper Incident 1 Police Standby 

+ Domestic Violence 1 Family Dispute + Tactical Alert 

+ Shooting 

+ Incidents in Known "Trouble Area" 

+ Stabbing I Cutting 

+ Other Violent Crimes or Conditions 

Nd: A vest may be worn anytime a member feels it is necessary. 


7

Section I: Field Procedures 1 Protocols 

MISCELLANEOUS 

MEDICAL WASTE DISPOSAL 

Before leaving the scene collect all usedcontaminated materials and place in zip-lock bags for 

discard in the biohazard containers at the hospital. 

Place the disposable sharp supplies into a puncture resistant container. Leave these containers at 

the receiving hospital when 314 fbll and secured properly. 


PAGE 3 OF 3

Section I: Field Procedures I Protocols 

MANAGEMENT OF MULTIPLE VICTIM INCIDENTS 

Normally BLS resources will not have the responsibility of medical incident control of multiple 

victim incidents. However, they may be the first resource on the scene of such an incident. 

An ALS resource shall be requested for incidents involving the transport of five or more 

patients and for patients whose condition meets the Patient Resolution Guide (PRG) criteria. 

The BLS resource shall obtain the following assessment information and initiate patient triage 

tags prior to the arrival of the ALS resource. (Refer to Book 35? Section 1.1, START; U FD 

Book 70, Multi-Casualty Incident Procedures; DHS, Reference No. 519.) 

ROLE OF THE PROVIDER AGENCY: 

+ Institute ICS as necessary. 

+ Implement START as necessary. 

t Establish communication with either the MAC or base hospital for the purpose of 

patient destination andor medical direction. In general, the Medical Alert Center (MAC) 

should be contacted for 10 or more patients and the base hospital for less than 10 patients. 

t Additional BLSIALS transporting units may be requested fi-om Operations Control Dispatch 

as necessary. 

+ Request? if necessary? the hospital based medical resources from the MAC? as outlined in 

DHSy Ref. No. 8 17? Hospital Emergency Response Team (HERT). 

1 t NATUm OF INCIDENT 

PROVIDE THE FOLLOWING SCENE INFORMATION TO 

THE MAC OR BASE HOSPITAL,: 

t SEVERITY STATUS: estimated number of immediate? delayed? minor, and 

deceased patients. If indicated? include total number and category of pediatric patients. 

t RECEIVING FACILITIES closest to location to include trauma centers? PTCs, 

PMCs, and EDAPs. 

v 

v 

'# 

v 

'# 

v 

1. 

2. 

3. 

4. 

5. 

6. 

7. 

8. 

Patient number [e.g., patient # 3 of 81 

Chief complaint 

Age 

Gender 

Brief patient assessment 

Brief description of treatment provided 

Sequence number 

Transporting provider and unit number? destination, and ETA 

vvvvvvvvvvvvvvvvvvvvvvvvvvvvvvvvvvvvvvvvv. 

~*A*A*A*A*A*A*A*A*A*A*A*A*A*A*A*A*A*A*A*A*A*A*A*A*A*A*A*A*A*A*A*A*A*A*A*A*A*A*A*A*A 

@ PROVIDE THE FOLLOWING PATIENT INFORMATION AS TIME PERMITS: 


7

Section I: Field ProcedureslProtocols 

MCI EMS REPORT SHORT FORM 

The Multiple Casualty Incident (MCI) Short Form has been developed by the Los Angeles 

County EMS Agency as an optional form for use by providers in situations where multiple 

patients are encountered on scene. The form is a "shortened" version of the Los Angeles 

County EMS form that encompasses the essential data for the incident while providing a 

valuable timesaving tool to providers for multi-patient incidents. The MCI short form may 

be used in place of the standard EMS Report Form in MCl's. 

Page one Page one (back copy) Patient Release 

When more than ten (10) patients are encounteredl the provider has the option of using the 

MCI Short Form. When this form is usedl a standard EMS Report Form (F-902M) does not need 

to be filled out. During a mass casualty incidentl the MCI Short Form can be used as a stand- 

alone forml used along with a triage tagl or used in place of a triage tag (these options are at 

the discretion of the department or provider). (Refer to Departmental Bulletin No. 04-1 9) 

Each MCI EMS Report Short Form can accommodate up to four patients and is formatted in 

quadruplicate. The back of the first page allows the patient to release the Fire Department from 

liability. Use this section ONLY when patients that DO NOT meet the criteria of the LAFD 

PRG or the LAFD Book 33, Ref. No. 808 * are released from the scene. 

The fourth page has an adhesive backing and could be placed on the patient for tracking. 

Once the patient is released from the scenel the patient can keep the adhesive copy for their 

records. This adhesive copy can also be used as a record for the receiving facility! if the patient 

seeks medical treatment on their own. 

The MCI EMS Report Short Form will be carried by all companies and 

will be included in the MCI packet. 

* Patients who meet the above criterial require an EMS Report Form F-902M 

completion and base hospital contact. 


Section 2: Patient Transportation 1 Destination 

LAFD PATIENT DESTINATION GUIDELINES 

prepared to receive emergency cases and administer emergency care appropriate to the needs of the 

patient, in the absence of "decisive factors to the contrary." 

4 ALS units utilizing Standing Field Treatment Protocols (SFTPs) shall transport patients in accordance 

with this policy. 

4 The most appropriate health facility for a patient may be that facility which is affiliated with the patient's 

health plan. Depending upon the patient's chief complaint and medical history, it may be advantageous 

for the patient to be transported to a facility where helshe may be treated by a personal physician and/or 

the individual's personal health plan where medical records are available. 

4 The MAR facility may or may not be the closest facility geographically. Transport personnel shall take 

into consideration traffic, weather conditions, or other similar factors which may influence transport time 

when identifying which hospital is most accessible. 

+ Patients shall @ be transported to a medical facility that has requested diversion due to "Internal Disaster." 

PATIENTS TRANSPORTED BY BLS PERSONNEL 

Stable patients requiring only basic life support (BLS) shall be transported to the MAR, regardless of its 

diversion status (Exception: Internal Disaster). 

For pediatric patients, the MAR is the most accessible Emergency Department Approved for Pediatrics. 

For perinatal patients, the MAR is to be the most accessible Perinatal Center. 

BLS personnel may honor patient requests provided that the patient is stable, requires basic life support 

measures only, and the ambulance is not unreasonably removed from its primary area of response. 

I 

- Transport patients to the MAR unless: 

* The base hospital determines that a more distant hospital is more appropriate to meet the needs of the patient. 

* The patient meets criteria or guidelines for transport to a specialty care center. 

* The patient requests a specific hospital [provided the patient's condition is considered stable to tolerate 

additional transport time, the receiving hospital agrees to accept the patient, and the EMS provider has 

determined that such a transport would not unreasonably remove the unit from its primary area of response]. 

* If transport to the desired hospital involves an extended transport time [> 20 min.] notify OCD of the 

extended time and contact the receiving facility to determine if they will accept the patient. 

* If the desired hospital is unreasonably far, request the EMS Battalion Captain. 

NA: On an "as needed basis", the EMS agency may extend maximum transport time. grequests cannot be 

honored, the provider should attempt to arrange for alternate transportation i.e., private ambulance. 

ALS units may be directed to an alternate "open" facility when the medical facility has requested diversion 

of patients requiring ALS, if: 

* The patient does not exhibit an uncontrollable problem in the field (e.g., unmanageable airway, 

uncontrolled hemorrhage). 

* The ALS unit estimates that it can reach an alternate facility within 15 minutes (Code 3) from the 

incident location. 

* There are no "open" facilities within this time frame, ALS units shall be directed to the MAR 

regardless of its diversion status (Exception: Internal Disaster). N-: On an "as needed basis,'' 

the maximum transport time may be extended. 


PAGE 1 OF 1

CALIFORNIA 

CENTINEIA FREEMAN- 

MEMORIAL CAMPUS 1 

ADULT 

ADULT 1 

12 & OLDER 

16 & OLDER 1 

-- - 

COMMUNITY OF LONG BEACH ADULT PEDIATRIC 

IACIUSC 

1 

ADULT 

1 

PEDIATRIC 

1 

LITTLE COMPANY OF MARY- 

L I 

TORRANCE 

I 1 E COMPANY OF MARY ADULT 

SAN PEDRO 

PEDIATRIC 1 

1 SAN GABRIEL VALLEY I ADULT I 14 & OLDER 1 

1 SANTAMONICAIUCLA I ADULT I PEDIATRIC 1 

"Sexual Assault" refers to patients who state they were sexually assaulted or if EMS personnel 

suspect the patient was a victim of sexual assault. Prehospital personnel shall notify the local 

law enforcement agency of sexual assault victims regardless whether the patient complains of 

physical injuries. EMS personnel, in conjunction with law enforcement, are highly encouraged 

to transport suspected sexual assault patients, who deny physical injuries, to a designated SART 

Center. (DM Reference No. 508) 


1

\ 

Trauma patients shall be secured and transported from the scene as quickly as 

possible, consistent with optimal trauma care. EMT-Ps shall make base hospital 

contact with the area's trauma hospital, when it is also a base hospital, on all injured patients who 

meet Base Contact and Transport criteria, trauma triage criteria and/or guidelines, or in the paramedic's 

judgment it is in the patient's best interest to be transported to a trauma hospital. Hospital contact shall 

be accomplished in such a way as not to delay transport. 

Patients who fall into one or more of the following categories are to be transported directly to the area's 

designated trauma hospital, if transport time does not exceed 20 minutes. If existing field resources at 

the time of transport allow, patients may be transported an additional 10 minutes (to a maximum of 30 

minutes). Transport pediatric trauma patients to the designated PTC. (DHS, Reference No. 506) 

Systolic Blood Pressure: Adults < 90 

Children < 70 

Abnormal capillary refill 

1 No spontaneous eye opening 

Penetrating cranial injury 

Penetrating thoracic injury within 

Blunt injury to chest with unstable chest 

wall (Flail chest) 

Penetrating injury to neck 

Diffuse abdominal tenderness 

Patients surviving falls from heights > 15 feet 

Intrusion of motor vehicle into passenger space 

Cardiopulmonary arrest with penetrating torso trauma 

Blunt head injury associated with altered consciousness 

(GCS equal to or less than 14, excluding patients < 1 year 

IOpen 

old), seizures, unequal pupils, or focal neurological defecit 

or closed injury to the spinal column associated with 

sensory deficit or weakness of one or more extremities 

Mechanism of injury is the most effective method of selecting critically injured patients before 

unstable vital signs develop. Paramedics and base hospital personnel shall consider mechanism of 

injury when determining patient destination. Transportation to a trauma hospital is advisable for: 

* Survivors of vehicular accidents (in which fatalities occurred) who complain of injury 

* Pedestrians struck by automobiles 

* Patients ejected from vehicles 

* Patients requiring extrication 

* The very young, very old, and patients with precarious previous medical histories 

The following extremis patients require immediate transport to the most accessible receiving (MAR) facility: 

* Patients with an obstructed airway 

* Cardiac arrest from traumatic injuries (Exception: Transport a penetrating torso injury to a 

Trauma Center) 

* Patients whose lives would be jeopardized by transportation to any but the most accessible receiving 

(MAR) facility, as determined by the base hospital personnel 



When base hospital contact cannot be made, for any reason, paramedics shall 

decide the destination for trauma patients using the guidelines set forth. 

BLS personnel shall transport patients to the most accessible receiving (MAR) facility / 

trauma catchment/boundary area is a geographical area surrounding a trauma hospital in which the 

trauma hospital has agreed to accept trauma patients. The boundaries may either be defined by streets1 

freewaysllandmarks or transport time. (DHS, Reference # 504) 

* Secure Catchment Boundaries1 Area: A catchment area around a trauma hospital strictly defined 

by streetslfreeways or other physical landmarks. Hospitals with secure catchment areas will only 

accept trauma patients from incident locations within the defined area. 

* Open Catchment BoundariesIArea: A catchment area around a trauma hospital defined by 

transport time (i.e., a hospital will accept patients who can be transported to its facility within 

a 30-minute, Code-3 transport time). The boundaries of a trauma hospital with an open catchment 

area will vary throughout any given day due to variations in weather and traffic patterns. 

ALS personnel responsibilities include: (1) Maintaining current knowledge of which geographic areas are 

securelopen catchment areas or areas undesignated for trauma within the assigned area; (2) Advising the 

base hospital of the designated trauma hospital covering the incident location when making base contact 

on a trauma patient. 

SECURE Catchment 1 Boundaries for ADULT and PEDIATRIC Trauma Patients: 

Henry Mayo Newhall Memorial Huntington Memorial (PMC) 

St. Francis Medical Center St. Mary Medical Center (PMC) 

Northridge Medical Center-Roscoe Campus 

I SECURE Catchment 1 Boundaries for ADULT and 1 

OPEN Catchment I Boundaries for PEDIATRIC Trauma Patients: 

Cedars-Sinai Medical Center (PMC , PTC) UCLA Medical Center (PMC, PTC) 

Long Beach Memorial (PMC, PTC) California Medical Center 

F~~atchment I Boundaries for Trauma Patients: 

Childrens Hospital L. A. (PMC, PTC) 

HarborIUCLA Medical Center (F'MC, PTC) Providence Holy Cross 

LACAJSC Medical Center (PMC, PTC) 

Trauma patients from incidents occurring in an undesignated area shall be transported to: 

* The assigned Air Ambulance Trauma Transport Program hospital 

(Antelope ValleylEast County only); or 

* The closest/open County-operated trauma hospital within the 30-minute transport 

guidelines, by groundlair; or 

* The most accessible receiving hospital (Extremis) (EDAP for pediatric patients). 


\

1 139 1 CEDARS SINAI 1 LA 1 PAGE632-J1 

1 145 1 CHILDRENS 1 1 PAGE 594-A4 

248 

438 

533 

81 8 

HARBOR / UCLA 

LAC~USC 

LONG BEACH MEMORIAL 

UCLA MEDICAL CENTER 

All Pediatric Trauma Centers (PTCs) have an 

OPEN trauma catchment area for pediatric trauma patients. 

Pediatric patients (14 years of age or younger), who meet Trauma Center Criteria and/or 

Guidelines, shall be transported to a designated PTC 

133 CALIFORNIA TRAUMA EDAP PERINATAL x 

139 CEDARS-SINAI TRAUMA PMC EDAP PERINATAL NICU PTC x 

145 

248 

270 

305 

CHILDRENS 

HARBOR /UCLA 

TORRANCE 

1 

HOLY CROSS 

324 1 HUNTINGTON MEM. 

TRAUMA 

1 TRAUMA 1 PMC 1 

EDAP 

EDAP 

PERINATAL NICU 

1 PERINATAL 1 NICU 1 1 X 1 

LONG BEACH MEM. TRAUMA PMC EDAP PERINATAL NICU PTC 

533 

571 

667 

134 

818 


HENRY MAY0 

NORTHRIDGE 

ST. FRANCIS 

ST. MARY 

UCLA 

TRAUMA 

TRAUMA 

TRAUMA 

TRAUMA 

TRAUMA 

TRAUMA 

PMC 

PMC 

PMC 

PMC 

LA 

LONG BEACH 

LA 

EDAP 

EDAP 

EDAP 

EDAP 

EDAP 

EDAP 

EDAP 

PAGE 2 OF 2 

PERINATAL 

PERINATAL 

PERINATAL 

PERINATAL 

PERINATAL 

PERINATAL 

PAGE 764-A6 

PAGE 635-B3 

PAGE 792-E2 

PAGE 632-B2 

1 438 1 USC 1 TRAUMA 1 PMC 1 EDAP 1 PERINATAL 1 NICU 1 PTC 1 I 

NICU 

NICU 

NICU 

NICU 

NICU 

NICU 

PTC 

PTC 

PTC 

x 

x 

x 

x 

x 

x 

J

- - 

1 CALIFORNIA MEDICAL CENTER [CALI 

CEDARS SINAI MEDICAL CENTER [CSM] 

CHILDRENS HOSPITAL OF LOS ANGELES [CHH] 

HARBOR I UCLA MEDICAL CENTER [HGH] 

HENRY MAY0 NEWHALL MEMORIAL [HMNI 

PROVIDENCE HOLY CROSS MEDICAL CENTER [HCHI 

1 HUNTINGTON MEMORIAL HOSPITAL [HMH] 

1 

LAC I USC MEDICAL CENTER [USC] 

LONG BEACH MEMORIAL MEDICAL CENTER [LBM] 

NORTHRIDGE HOSPITAL MEDICAL CENTER [NRHI 

ST. FRANCIS MEDICAL CENTER [SFM] 

ST. MARY MEDICAL CENTER [SMM] 

UCLA MEDICAL CENTER [UCL] 

Revised: 0512005 PAGE 1 of 26 

-- 

ADULT 

ADULT PEDIATRIC 

ADULT 

ADULT 

ADULT 

ADULT 

ADULT 

ADULT 

ADULT 

ADULT 

ADULT 

PEDIATRIC 

PEDIATRIC 

PEDIATRIC 

PEDIATRIC 

ADULT PEDIATRIC

LA COUNTY 

TRAUMA CENTERS 

Revised: 512005 PAGE 2 of 26

1 LEGEND 

CAL 

Revised: 05/2005 

CALIFORNIA MEDICAL CENTER 

TRAUMA CENTER CATCHMENT AREA 

DESTINATION CRITERIA 

OPEN catchmentl boundaries for PEDIATRIC trauma patients 

and 

SECURE catchmentl boundaries for ADULT trauma patients. 

PAGE 3 of 26 

THOMAS GUIDE MAP BOOK PAGE 

CALIFORNIA 133 EDAP, PERINATAL, TRAUMA, SART 634-D6 

-


" 1 TRAUMA CENTER CATCHMENT AREA 


California 

Medical Center 

Trauma Center 

Catchment Area 

PHASE 2 

Target Date: 02101105 

CAL California Medical Center 

- TRAUMA 

TRAUMA CENTER 

AREA 

BOUNDARIES 

Ã‘Ã FREEWAYS 

- MAJOR STREETS 

NORTHERNBOUNDARY 

Sanla Monica (10) Freeway 

Western Avenue 

EASTERNBOUNDARY 

Central Avenue 

SOUTHERNBOUNDARY 

Century Blvd (PHASE 2) 

WESTERNBOUNDARY 

Crenshaw Boulevard 

Crealed: 1110Z041PLN 

s

CEDARS-SINAI MEDICAL CENTER 

" 1 TRAUMA CENTER CATCHMENT AREA I 

CSM 

UCL 

CHH 

MULHOLLAND DR / CAHUENGA PASS / GRIFFITH PARK AREA 

(PARAMEDIC / BASE HOSPITAL JUDGEMENT) 

SANTA MONICA (1 0) FREEWAY 

MOTOR AVE 1 SANTA MONICA (1 0) FREEWAY 

1 DESTINATION CRITERIA 

OPEN catchment1 boundaries for PEDIATRIC trauma patients 

and 

SECURE catchment1 boundaries for ADULT trauma patients. 

CEDARS SINAI 

UCLA 

cH'LDRENs 

HOSPITAL 

139 

818 

145 

PMC, EDAP, PERINATAL, TRAUMA, PTC 



PMC, EDAP, PEDIATRIC TRAUMA CENTER (PTC) 


632-J 1 

632-B2 

5 94-A4

CEDARS-SINAI MEDICAL CENTER 



UCLA HOSPITAL 

CENTER CATCHMENT AREA 1 


Harbor 1 UCLA Medical Center has an OPEN catchment area and will 

accept patients who can be transported to its facility within a 30-minute, 

Code-3 transport time. 

1 LEGEND 

The times may vary throughout any given day because 

of variations in weather and traffic patterns. 

THOMAS GUIDE MAP BOOK PAGE

HARBOR 1 UCLA HOSPITAL 



HENRY MAY0 NEWHALL MEMORIAL HOSPITAL 


1 LEGEND 


SECURE catchment area for 

ADULT and PEDIATRIC trauma patients. 

1 HMN 1 HENRY MAY0 NEWHALL 1 270 

I I PROVIDENCE 

HcH HOLY CROSS 

1 NRH 1 NORTHRIDGE 


EDAP, PERINATAL, TRAUMA 

EDAP, PERINATAL, TRAUMA 


EDAP, PERINATAL, TRAUMA 1 530-J2 

I

HENRY MAY0 NEWHALL MEMORIAL HOSPITAL 



,-

6.b PROVIDENCE HOLY CROSS MEDICAL CENTER 

"1 TRAUMA CENTER CATCHMENT AREA 


Providence Holy Cross Medical Center has an OPEN catchment area and will accept 

patients who can be transported to its facility within a 30-minute, Code -3 transport time. 

1 LEGEND 

The boundaries will vary throughout any given day because 

of variations in weather and traffic patterns. 

I I HcH PROVIDENCE 

HOLY CROSS 

CHILDRENS HOSPITAL 

I cHH I 

NRH 

I HMN I 

Revised: 05/2005 

NORTHRIDGE 

HENRY MAY0 

NEWHALL 


I I I 

I 1 501-HI I 

305 EDAP, PERINATAL, TRAUMA 

145 

PMC, EDAP, PTC 

571 1 EDAP, PERINATAL, TRAUMA 1 530-J2 

-- 

EDAP, PERINATAL, TRAUMA I 

PAGE 11 of 26 

5 94-A4 

4554%

PROVIDENCE HOLY CROSS MEDICAL CENTER 



1 LEGEND 

HMH 

USC 

HUNTINGTON MEMORIAL HOSPITAL 



SECURE catchment area for 


A secure catchment area is strictly defined by streetdfree ways 

or other physical landmarks. 

HUNTINGTON 

MEMORIAL 

LAC/USC MEDICAL 

324 

438 


PMC, EDAP, PERINATAL, TRAUMA 

PMC, EDAP, PERINATAL, TRAUMA, PTC, 

SART 


565-H6 

635-B3

HUNTINGTON MEMORIAL HOSPITAL 


COUNTY 


LEGEND 

USC 

HMH 

CHH 

LAC 1 USC MEDICAL CENTER 



LAC/USC MEDICAL 

HUNTINGTON 

MEMORIAL 

OPEN catchment area for 


CHILDRENS HOSPITAL 

438 

324 

145 


PMC, EDAP, PERINATAL, TRAUMA, PTC, 

sART 

PMC, PERINATAL, EDAP, TRAUMA 

PMC, EDAP, PEDIATRIC TRAUMA CENTER 


635-B3 

565-H6 

594-A4


LAC 1 USC MEDICAL CENTER 


PAGE 16 of 26

@ 

LONG BEACH MEMORIAL HOSPITAL 


LEGEND 

ORANGE COUNTY LINE 


SECURE catchment area for ADULT trauma patients 

OPEN catchment area for PEDIATRIC trauma patients. 


I I 1 1 1 LONG BEACH 

PMC, EDAP, PERINATAL, TRAUMA, 

795-E2 

LBM MEMORIAL 533 PTC 

1 SMM 1 ST. MARY MEDICAL 1 134 1 EDAP, PERINATAL, TRAUMA I 795-~6 

1 SFM 1 ST. FRANCIS MEDICAL 1 667 1 EDAP, PERINATAL, TRAUMA 1 705436 


LONG BEACH MEMORIAL HOSPITAL 



NORTHRIDGE MEDICAL CENTER 



SECURE catchment area for trauma patients and will accept patients who can 

be transported to its facility within a 30-minute, Code -3 transport time. 

LEGEND 

The times may vary throughout any given day 

because of variations in weather and traffic patterns. 

s 

THOMAS 

PROVIDENCE HOLY CROSS 

NRH NORTHRIDGE 


PAGE 19 of 26 

GUIDE MAP BOOK PAGE 

501 -HI 

530-J2

NORTHRIDGE MEDICAL CENTER ROSCOE 



ST. FRANCIS MEDICAL CENTER 





LEGEND 

SFM 




PAGE 2 1 of 26 


ST. FRANCIS MEDICAL 667 EDAP, PERINATAL, TRAUMA 705-B6

ST. FRANCIS MEDICAL CENTER 



ST. MARY MEDICAL CENTER 





1 LEGEND 




sMM 1 ST. MARY MEDICAL 1 134 1 EDAP, PERINATAL, TRAUMA 1 795-~6 

LBM 


LONG BEACH 

MEMORIAL 

533 PMC, EDAP, PERINATAL~TRAUMA, PTC 795-E2 

PAGE 23 of 26

ST. MARY MEDICAL CENTER 



CSM 

NRH 

UCL 

LEGEND 

UCLA MEDICAL CENTER 



OPEN catchment area for PEDIATRIC trauma patients 

and 

SECURE catchment area for ADULT trauma patients. 

CEDARS-SINAI 

NORTHRIDGE 

UCLA 

139 

57 1 

8 1 8 



EDAP, PERINATAL, TRAUMA, 

EDAP, PMC, PERINATAL, TRAUMA, PTC 


632-J 1 

530-J2 

632-B2

I 

UCLA MEDICAL CENTER (UCL) 


Pacific Ocean 

Revised: 0512005 Page 26 of 26

Section 2: Transportation 1 Destination 

TRAUMA CENTER DIVERSION 

\ v When the designated trauma hospital requests diversion to trauma, transport the patient to: 

The closest open County-operated trauma hospital within the 30-minute transport guidelines, 

by ground or by air; 

The closest open trauma hospital with an open catchment area within the 30-minute transport 

guideline by ground (DHS Reference # 504) 

For multiple victim incidents (five or more patients), secure catchment boundaries shall be adhered 

to. It is understood that during a multiple victim incident, as a result of normal triage procedure, 

trauma patients may ultimately be transported to a trauma hospital as the next closest facility 

(crossing the catchment/ boundary) as receiving hospitals in the surrounding geographic area of the 

incident are utilized to their maximum capacity. 

EDAp / PMC / PTC Added to the guidelines for identifying critically ill or injured 

pediatric patients requiring transport to a PMC is ALTE (Acute 

Life Threatening Event). In 2003, the new category of Pediatric Trauma Center (PTC) was added 

to the list of Specialty Care Centers. Pediatric patients meeting Trauma Center CriteriaIGuidelines 

will be transported to the most accessible PTC that may be reached within 30 minutes. In cases 

when a PTC cannot be reached within this time frame, transport to an adult trauma center. 

Factors to consider prior 

\ transport to an EDAP, 

PMC, or a PTC: 

Does not meet PMCRTC transport 

Transport time to PMC is > 30-min. 

BLS transport when ALS unit is not 

available 

Uncontrollable, life threatening 

situation ( e.g., unmanageable airway or 

uncontrollable hemorrhage, respiratory 

or cardiac arrest) 

(Refer to the PRG, Principle) 

* Severity of illness or injury and stability of the child's condition 

* Current status of the pediatric receiving facility 

* Anticipated transport time 

* Destination request by family or physician if patient's condition allows 

Critically ill (MEDICAL) 

Severe respiratory distress 

Cyanosis 

ALTE 21 2 months of age 

Persistent altered mental status 

Status epilepticus 

Cardiac dysrhythmia 

Critically injured (TRAUMA) 

Trauma criteria and1 

or guidelines * 

Transport time does not 

exceed 30 minutes * 

* For patients who meet 

DHS Ref.# 506 

Transport to the most accessible Perinatal Center: Patients who are at least 20 weeks 

pregnant and who appear to be in active labor or have perinatal complications, chief 

complaint is related to the pregnancy, and injured perinatal patients who do not meet trauma criteria or 

guidelines. For patients who have made previous arrangements for OB care, honor patient destination 

request if: Patient condition permits such transport, transport to requested OB facility would not exceed 

20 minutes, and would not unreasonably remove the transporting unit from its area of primary response. 

(DHS, Reference # 5 1 1) 


BURN PATIENTS 

Destination for patients sustaining bum injuries shall be determined as follows: 


* Patients who meet trauma or PTC criteria and/or guidelines shall be transported to 

the appropriate trauma hospital or PTC. 

* Patients who do not meet trauma or PTC criteria and/or guidelines shall be transported to the 

most accessible receiving (MAR) appropriate for their age. (DHS, Reference 5 12) 

Note: Firelighter's, who sustain bum injuries, that do not meet base station contact 

criteria, shall be TAKEN DIRECTLY to either the Grossman Burn Center at 

Sherman Oaks Hospital or Torrance Memorial Hospital Burn Center. 

To expedite the appropriate care associated with the complexities of bums when 

a firelighter sustains a bum injury, no matter how slight, the following shall be 

adhered to : 

+ Firelighter medically evaluated by paramedics. 

4 Request for the concerned EMS Battalion Captain shall be made 

through OCDS. 

4 Transport consistent with DHS, Reference 512. However, when the bum injury does not 

meet base contact criteria, the member shall be transported directly to one of the above 

bum centers. 

This is particularly directed at minor bums that are recognized as a first-degree with high probability 

of progressing to a second-degree and any second-degree bum. Serious bums require base contact 1 

as noted in DHS Reference No 808. Bums secondary to or associated with injuries meeting trauma 

center criteria shall be transported to a trauma center prior to a bum center. 

1 DECOMPRESSION 

Paramedics should simultaneously establish base hospital contact with LACIUSC Medical Center and 

the Medical Alert Center (MAC) via the Hospital Emergency Administrative Radio (HEAR) 

for any patient suspected of having a decompression emergency. 

LAC/USC Medical Center will provide medical orders for patient care and determine if the 

patient should be transported directly from the incident location to a hyperbaric chamber. 

MAC will determine which hyperbaric chamber is most appropriate to the needs of the patient and 

coordinate transportation to the chamber for the patient and medical personnel. (Factors considered include: 

patient condition, distance, altitude, ETA of available transportation, and limitations of various aircraft.) 

*Obtain dive incident history of the patient and dive partner, if able. 

'Coordinate patient transportation to the appropriate receiving facility. 

*Retrieve patient's dive equipment (e.g., regulator, tank, gauges, weight belt, 

etc.) and transport with patient. 

As a general rule, the integrity of the dive equipment should be maintained and not 

tampered with except by investigating authorities. (Refer to DHS, Reference No. 518.) 

NA: If MAC cannot be accessed directly fi-om the field and another base hospital is contacted, 

that base hospital should contact MAC for coordination of treatment and transport. 


PAGE 1 OF 2

,) 


DECOMPRESSION 1 

Paramedics should simultaneously establish base hospital contact with LAC/USC Medical Center 

and the Medical Alert Center (MAC) via the Hospital Emergency Administrative Radio (HEAR) 

for any patient suspected of having a decompression emergency. 

LACNSC Medical Center will provide medical orders for patient care and determine if the 

patient should be transported directly from the incident location to a hyperbaric chamber. 

MAC will determine which hyperbaric chamber is most appropriate to the needs of the patient and 

coordinate transportation to the chamber for the patient and medical personnel. (Factors considered 

include: patient condition, distance, altitude, ETA of available transportation, and limitations of 

various aircraft.) 

* Obtain dive incident history of the patient and dive partner, if able. 

* Coordinate patient transportation to the appropriate receiving facility. 

Retrieve patient's dive equipment (e.g., regulator, tank, gauges, weight belt, 

etc.) and transport with patient. 

As a general rule, the integrity of the dive equipment should be maintained and not 

tampered with except by investigating authorities. (Refer to DHS, Reference No. 518.) 

NA: If MAC cannot be accessed directly from the field and another base hospital is contacted, 

that base hospital should contact MAC for coordination of treatment and transport. 

Revised: 121200 1 

PAGE 2 OF 2


PATIENT DESTINATION GUIDELINES 

a'- EMS personnel shall use the following guidelines when making patient destination decisions: -V 

, 1 

PATIENTS 0-14 YEARS OLD: Transport to themost accessible EDAP I PMC I PTC 

1 PATIENTS 15 YEARS or OLDER: Transport to the most accessible receiving (MAR) facility 1 

Emergency Departments Approved for Pediatrics (EDAP) 

Brotman 

California 

Cedars Sinai ** + 

Centinela Freeman-Centinela 

Centinela Freeman-Memorial 

Childrens Hospital LA * * + 

Columbia - West Hills 

Downey Regional 

East LA Doctors 

Encino Tarzana - Tarzana 

Gardena Memorial 

Glendale Adventist 

Glendale Memorial 

Harbor/UCLA Medical Center * * + 

Henry Mayo Newhall Memorial 

Huntington Memorial * * 

Kaiser - Woodland Hills 

KingIDrew 

LAC/USC Medical Center ** + 

Little Company of Mary-San Pedro 

Little Company of Mary-Torrance 

Long Beach Memorial ** + 

Northridge - Roscoe Campus 

Pacifica of the Valley 

Providence Holy Cross 

Providence St. Joseph 

Robert F. Kennedy 

St. Francis 

St. John's 

St. Mary Medical Center 

San Gabriel Valley 

Santa Monica - UCLA 

Simi Valley 

Torrance Memorial 

UCLA Medical Center * * + 

Valley Presbyterian 

Verdugo Hills 

White Memorial 

** PMC + PTC Italics denotes "Trauma Center" 

If the patient is stable, honor the patient's or physician's request. Normally, the transportation time shall 

not exceed 20 minutes (non-emergency). Extended transport times require authorization from OCD. 

Internal Disaster: No BLS or ALS Transport 

Emergency Room (ER) Saturation: No ALS Transport 

Neuro, CT Scan, Trauma, PTC: No ALS Transport (for patients requiring these specialties) 

"Service Area" hospitals may @ divert except for INTERNAL, DISASTER. Diversion 

transportation time is 15 minutes (Code 3) to an open emergency room (ER). If ER is open, within 

the 15 minute transport time, transport to the most accessible ER. 


PAGE 1 OF 1 

1'


TRANSPORTING PATIENTS IN CUSTODY 

Utilize the following procedural guidelines when requested by LAPD 

(or other law enforcement agencies) to transport a patient in custody: 

+ A law enforcement officer shall ride in the back of the rescue ambulance with the patient 

at all times. 

+ Patients shall be transported to the most accessible medical facility. (Patient's from the 

Central Jail or Parker Center shall be transported to LACAJSC's 13th floor Jail Ward, unless 

in extremis). 

+ Restrained patients shall not be transported in the prone (facelchest downward) position. 

Such patients shall be transported in the left lateral position. 

+ Restraint equipment, applied by EMS personnel, must be either padded leather or soft 

restraints. Restraint methods must allow for quick release. (DHS Reference # 838) 

+ Restrained extremities shall be evaluated for pulse quality, capillary refill, color, nerve, 

and motor status every 15 minutes or less. 

REQUIRED DOCUMENTATION ON THE EMS REPORT FORM (F-902M) 

SHALL INCLUDE: 

The type of and reason restraints were needed. 

2 Identity of agencylmedical facility applying restraints. 

Assessment of the circulatory and neurological status of the restrained extremities. 

Any abnormal findings require the restraints to be removed and reapplied or 

supporting documentation. 

Assessment of the cardiac and respiratory status of the restrained patient. 

HOSPITAL REFUSAL TO ACCEPT RESCUE AMBULANCE PATIENTS 

Personnel encountering serious problems at a hospital emergency room (i.e., refusing patient) shall 

contact OCD and request an EMS Battalion Captain to respond to their location. It shall be the 

responsibility of the EMS Battalion Captain to investigate the circumstances and ensure that proper 

base hospital notification/docurnentation is made. Journal entries of the incident shall be made and 

the Station Commander notified. Once a patient arrives inside the intended emergency room, the 

patient shall remain. 


PAGE 1 OF 1

hospitals have an agreement with the EMS Agency that only those patients within a given boundary 

will be transported to their facility. Service area hospitals may honor patient requests from outside 

of their service area; however, they are not obligated to do so. 

All LAFD ambulances with any ALS or BLS patient, within a defined service area, will transport 

to the service area hospital, maintaining the service area hospital agreement. 

(In most instances the service area hospital is also the MAR.) 

Patients who meet criteria or guideline for a specialty care center (e.g., EDAP, PMC, Trauma, 

Perinatal) not provided by the service area hospital, shall be transported to the appropriate 

specialty care center. 

Patients exhibiting uncontrollableproblems in the field will be transported to the most accessible 

medical facility regardless of incident location. 

Patients from multiple casualty incidents may have to cross boundaries, depending on incident 

location or direction from the base hospital or Medical Alert Center. 

N-: Service area hospitals shall not be on diversion for any categories other than Internal Disaster. 

It is the responsibility of BLS and ALS personnel to recognize the appropriate receiving hospital 

based on the patient's condition and incident location. 


CENTINELA FREEMAN-CENTINELA 

CENTINELA FREEMAN-MEMORIAL 

EAST LA DOCTORS 

GOOD SAMARITAN 

EDAP 

EDAP 

EDAP 

EDAP 

PERINATAL 

PERINATAL 

PERINATAL 

PERINATAL 

PERINATAL 

I I I 

1 MEMORIAL HOSP. OF GARDENA 1 ED AP 1 PERINATAL 1 1 

WHITE MEMORIAL MED. CENTER 

Patient requests for transport to a service area hospital when the incident location is outside the 

hospital's defined service area or inside the service area of another hospital may be honored by: 

1 BLS Resource (For BLS patients): 

EDAP 

PERINATAL 

NICU 

NICU- 

NICU 

The receiving hospital agrees to accept the patient. 

The transporting unit is not unreasonably removed from its primary response area. 

1 ALS Resource: 

Base Hospital concurs that the patient's condition is stable to permit the estimated transpoi -t time. 

The requested hospital agrees to accept the patient. 

The transporting unit is not unreasonably removed from its primary response area. 

NICU 

NICU 

N*: The receiving hospital may be contacted directly if the ALS unit is transporting a BLS patient. 


PAGE 1 OF 1 

/-^ 

1

Section 2: Trans~ortation 1 Destination 

Good Samaritan Hospital & California Hospital 

Good Samaritan Hospital and California Hospital have the above service 

area boundaries and are divided by Olympic Blvd. 

If BOTH hospitals are listed as emergency department "SATURATED," 

adult patients from incident locations: 

NORTH of Olympic B1vd.-transport to Good Samaritan Hospital. 

SOUTH of Olympic B1vd.- transport to California Hospital. 


Rescue ambulance personnel shall access the Mobile Data Terminal (MDT) to 

determine the hospital emergency department status prior to initiating transport. 

If either hospital is listed as an emergency department "SATURATED," service 

area patients shall be taken to the other hospital. 

CAI, California Medical Center 133 EDAP, PERINATAL, NICU Thomas Guide Pg. 634-D6 

1 

I I I 

GSH 1 Good Samaritan Hospital 1 220 [PERINATAL, NICU 

I 

1 Thomas Guide Pg. 634-D3 1 

Revised: 512005

HOSPITAL OF THE GOOD SAMARITAN 

& 


Service Area 


Section 2: Transportation I Destination 

Centinela Freeman-Centinela & Centinela Freeman-Memorial 

Patients fiom incident locations: 

4 Within the "Secondary Service Area'' may be transported to Centinela Freeman- 

MEMORIAL (DFH) or CENTINELA FREEMAN-CENTINELA (CNT). 

4 West of the 405 Freeway, may be transported to Centinela Freeman- MARINA (DFM). 

BMC 

CNT 

DFM 

DFH 

kl?W 

4 All PEDIATRIC patientsy age 14 or less not meeting pediatric trauma or PMC criteria, 

shall be transported to Centinela Freeman- MEMOFUAL Hospital. 

4 All adult patients, age 352, with the chief complaint of CHEST PAIN or 

SYMPTOMATIC DYSRHYTHMIAy shall have ALS transport to CENTINELA FREEMAN- 

CENTINELA 

Permissible EXCEPTIONS to transporting patients to this destination are: 

d Incidents involving patients requiring transport to a specialty care facility 

(trauma center or pediatric critical care center). 

4 When honoring a patient request in accordance with Department customer service guidelines. 

d When facility is closed due to internal disaster. 

Brotman Medical Center 

Centinela Freeman-CENTINELA 

Centinela Freeman MARINA 

Centinela Freeman MEMORIAL 

Kaiser-West LA 

172 

141 

457 

153 

362 

EDAP 


EDAPy PERINATAL, NICU 

EDAP, PERINATAL, NICU 

PERINATAL 

Thomas Guide Pg. 672-Gl 

Thomas Guide Pg. 703-D4 

Thomas Guide Pg. 762-B6 


Thomas Guide Pg. 632-J6

Secondary Service Area: 

The Secondary Service Area will become effective when all receiving hospitals within 

15 minutes from the incident location7 in the Secondary Service Area7 have requested 

diversion to ED saturation. In this instance, patients may be transported to DFH or CNT. 

I 

Manchester Ave. Boundary: 

When both DFH and CNT have requested diversion due to ED saturation7 patients 

will be transported as follows: 

Patients NORTH of MANCHESTER Ave. will be transported to DFH. 

Patients SOUTH of MANCHESTER Ave. will be transported to CNT. 

Revised: 512005

MHG 

CNT 

MLK 

SFM 

HGH 

Section 2: Transportation I Destination 

Memorial Hospital of Gardena 

LEGEND 1 

Memorial Hospital of Gardena 

Centinela Hospital-CENTINELA 

KingDrew 

St. Francis 

HarborRJCLA 

EDAP, PERINATAL 


EDAP, PERINATAL 


EDAP, PERINATAL, TFUUMA 

PMC, EDAP, PERINATAL, 

TRAUMA, PTC 

Thomas Guide Pg. 734-A5 


Thomas Guide Pg. 704-G7 

Thomas Guide Pg. 705-B6 

Thomas Guide Pg. 764-A6


MEMORIAL HOSPITAL OF GARDENA 

Service Area 

PAGE 6 OF 8

Section 2: Transportation 1 Destination 

White Memorial Medical Center 

(Including East LA Doctors) 

DESTINATION CRITERIA k 

While in the White Memorial Service Area, rescue ambulance personnel shall transport to the most 

accessible, open hospital within the Service Area, e.g., White Memorial Medical Center, East Los 

Angeles Doctors, or LACAJSC Medical Center.. 

LEGEND 

WMH White Memorial Med.Cent. 

970 

Thomas Guide Pg. 635-A4 


1 ELA l~ast Los Angeles Doctors 1 157 1 EDAP, PERINATAL 1 Thomas Guide Pg. 635-D7 1 

1 I PMC, PERINATAL, NICU, 

LAC/USC Medical Center 438 TMw, pTc (USE) 1 Thomas Guide Pg. 635-B3 


WHITE MEMORIAL MEDICAL CENTER 

Service Area 


PAGE 8 OF 8

Section 2: Patient Trans~ortation 1 Destination 

LOS ANGELES COUNTY EMS RECEIVING FACILITIES 1 

/Al hambra Hospital 1 (626) 570-1606 1 100 S. Raymond Ave., Alhambra, 91801 1 

Beverly Hospital * A (323) 726-1222 309 W. Beverly Blvd., Montebello, 90640 

Brotman Medical Center * (310) 836-7000 3828 Delmas Terrace, Culver City, 90231 

1 . California Hospital Medical Center * A I (213) 748-2411 1 1338 S. Hope St, Los Angels, 90015 1 

1 Cedars-Sinai Medical Center ** A I (310) 855-5000 1 8700 Beverly Blvd., Los Angeles, 90048 

1 Centinela Airport Medical Center 1 1 9601 S. Sepulveda, Los Angeles, 90045 

1 Centinela Freeman-Centinela * A 1 (310) 673-4660 1 555 E. ~ardy~t., Inglewood, 90301 

Centinela Freeman-Marina (310) 823-891 1 4650 Lincoln Blvd., Marina Del Rey, 90291 

Centinela Freeman- Memorial * A (310) 674-7050 333 N. Prairie Ave., Inglewood, 90301 

Century City Hospital (ER CLOSED 4/04) 

Children's Hospital of Los Angeles * ** (323) 660-2450 4650 Sunset Blvd., Los Angeles, 90027 

Coast Plaza Doctors (562) 868-3751 13100 Studebaker Road, Norwalk, 90650 

Columbia West Hills Medical Center * A (818) 676-4000 7300 Medical Center Dr., West Hills, 91307 

Downey Regional * A (562) 904-5000 11 500 Brookshire Ave., Downey, 90241 

1 East Los Anaeles Doctors * A 1 (323) 268-5514 1 4060 E. Whittier Blvd., Los Angles,90023 

JEncino Tarzana Regional -Encino 1 (818) 995-5000 1 16237 Venture Blvd., Encino, 91436 

1 Encino Tarzana Regional -Tarzana * A 1 (818) 881-0800 1 18321 Clark St., Tarzana, 91356> 1 

Garfield Medical Center * A (626) 573-2222 525 N. Garfield Ave., Monterey Park, 91754 

Glendale Adventist Medical Center * A (818) 409-8111 . 1509 Wilson Terrace, ~lendal'e,91206 - 

Glendale Memorial * A (81 8) 502-1 900 1420 S. Central Ave., Glendale, 91225-7036 

I , 

Good Samaritan A 1 (213) 977-21 21 1 616 S. Witmer St., Los ~n~eles,~~fl017 

' , ' - 

Harbor/UCLA Medical Center * ** A . 

(310) 

222-2345 1000 W. Carson St., Torrance, 90509 

Henry Mayo Newhall Memorial * (661) 253-8000 23845 W. McBean Parkway, ~alencia, 91355 

Huntington Memorial * ** A (626) 397-5000 100 W. California Blvd., Pasadena, 91109 

1 Kaiser Hospital - Baldwin Park A 1 (626) 851 -1 01 1 1 1011 Baldwin Park Blvd., Baldwin Park, 91706 1 

Kaiser Hospital - Bellflower A (562) 461 -3000 9400 E. Rosecrans Ave., Bellflower, 90706 

1 Kaiser Hospital - South Bay A 

I 

1 (310) 325-51 11 

t 

1 25825 S. Vermont Ave., Harbor City, 90710 1 

Kaiser Hospital - Sunset (LA) A (323) 783-401 1 4867 Sunset Blvd., Los Angels, 96027 

a? 

1 Kaiser Hospital - Panorama City A 1 (818) 375-2000 1 13652 Cantara St., Panorama City, 91402 1 

1 Kaiser Hospital - West Los Angeles A 1 I (323) 857-2000 1 I 6041 Cadillac Ave., Los ~ngeIe~9.Qw . 

Kaiser Hospital -Woodland Hills * A (818) 719-3800 5601 De Soto Ave., Woodland Hills, 91367 

Little Company of MayTorrance * A (310) 540-7676 4101 Torrance Blvd.,Torrance, 90503 


PAGE 1 OF 2 

I

^ 


1 Little Company of Mary-San Pedro * A 

1 Long Beach Community * A 

(31 0) 832-331 1 

(562) 498-1000 

1300 W. 7th St, San Pedro, 90732 

1720 Terrnino Ave., Long Beach, 90804 

Long Beach MemorialMedical Center * ** A (562) 933-231 1 2801 Atlantic Ave., Long Beach, 90806 

LA County Olive View Medical Center A (81 8) 364-1 555 14445 Olive View Dr., Sylrnar, 91342-1495 

LAC/USC Medical Center ** * A 

Martin Luther King JrDrew Medical Center * A 

Memorial Hospital of Gardena * A 

(323) 226-2622 

(310) 668-4321 

(310) 532-4200 

1200 N. State St, Los Angeles, 90033 

12021 S. Wilmington Ave., Los Angeles, 90059 

1145 W. Redondo Beach Blvd., Gardena, 

I I 

Mission Community Hospital I (818) 787-2222 I 14850 Roscoe Blvd., Panorama City, 91402 

Monterey Park Hospital A (626) 570-9000 900 S. Atlantic Blvd., Monterey Park, 91754 

Olympia Medical Center 

Pacific Hospital of Long Beach A 

Pacifica Hospital of the Valley * A 

Providence Holy Cross Medical Center * A 

Providence Saint Joseph Medical Center * A 

Saint Francis Medical Center * A 

Saint John's Hospital and Medical Center * 

Saint Mary Medical Center * A 

San Gabriel Valley Medical Center * A 

Santa Monica - UCLA Medical Center * A 

Sherman Oaks Community Hospital 

(323) 938-3161 

(562) 595-191 1 

(81 8) 767-3310 

(818) 365-8051 

(81 8) 843-51 11 

(310) 603-6000 

(310) 829-5511 

(562) 491-9000 

(626) 289-5454 

(310) 319-4000 

(81 8) 981 -71 11 

5925 San Vicente Blvd., Los Angeles, 90019 

2776 Pacific Ave., Long Beach, 90806 

9449 San Fernando Road, Sun Valley, 91352 

15031 Rinaldi St, Mission Hills, 91345 

501 S. Buena Vista St, Burbank, 91505 

3630 Imperial Highway, Lynwood, 90262: , 

2103 Santa Monica Blvd., Santa Monica, 90404 

1050 Linden Ave., Long Beach, 90813 

218 S. Santa Anita St, San ~~bri$l,91776> . 

1250 Sixteenth St, Santa Monica, 90404 

4929 Van Nuys Blvd., Shennan OW, 91403 

1 UCLA Medical Center * ** A 1 (310) 825-91 11 1 10833 Le Conte Ave., Los Angeles, 9@24 1 

1 Valley Presbyterian Hospital * A 1 (818) 782-6600 1 15107 Vanowen St, Van Nuys, 91405 1 

1 Verdugo Hills Hospital * A I (81 8) 790-71 00 1 1812 Verdugo Blvd., Glendale, 91208, 

1 White Memorial Medical Center * A I (323) 268-5000 1 1720 Cesar Chavez Ave., Lo8 Angeles, 90033 1 


"Italics" Denotes TRAUMA CENTER 

* EDAP 

** PMC 

PAGE 2 OF 2 

PTC 

A PERINATAL 

"1



BATTALION OFFICES 

PAGE 1 OF 1

RECEIVING HOSPITALS SORTED BY EMS BATTALION OFFICE 


California, Orthopaedic 

Glendale Adventist, Glendale Memorial, 

Huntina ton Memorial 

Hudson Clinic 

Centinela Airport Clinic, Centinela Freeman- 

Centinela, Centinela Freeman-Marina, 

Centinela Freeman-Memorial 

Children's, Kaiser Los Angeles, 

Queen of AngelsIHollywood Presbyterian 

HarborIUCLA, Kaiser South Bay, 

Little Company of Mary-San Pedro, 

Little Company of Mary-Torrance, 

Long - Beach Memorial, Pacific of Long Beach, 

St. Mary, Torrance Memorial 

Alhambra, Beverly, East Los Angeles Doctors, 

Garfield, ~aiser Baldwin park; LACIUSC, 

Monterey Park, San Gabriel Valley, 

White Memorial 

St. John's, Santa MonicaIUCLA, 

UCLA, Veterans Administration Wadsworth 

Encino Tarzana-Encino, 

Sherman Oaks, Valley Presbyterian 

Good Samaritan 

Henry Mayo, Kaiser Panorama City, 

Mission Community, Olive View, Pacifica, 

Providence Holy Cross, Verdugo Hills 

Coast Plaza Doctors, Downey Regional, 

Gardens Memorial, Humphrey Clinic, 

Kaiser Bellflower, KingIDrew, St. Francis 

Providence St. Joseph 

Northridge-Roscoe, Simi Valley 

Columbia West Hills, Encino Tarzana-Tarzana 

Kaiser Woodland Hills 

Brotman, Cedars-Sinai, Century City, 

Kaiser West Los Angeles, Olympia 

PAGE 1 OF 1

3 9 1 3 1 10 78 1 14 14 114 1 

PAGE 1 OF 1 

Section 2: Patient Transportation 1 Destination

A Section 

1 1 

2: Patient Transportation 1 Destination 

LAFD RESCUE AMBULANCE LOCATIONS 

1 1 1 7 1 2230 N. Pasadena Ave. 1 Lincoln Heights 1 pg. 595 A-7 1 (21 3) 485-6201 , ' 

1 3 I 3 1 803 1 1 1 108 N.FremontAve. 1 Bunker Hill 1 634 F-3 1 (213) 485-6203 1 

5 1 

5 1 1 4 I 6621 W. Manchester Ave. 1 Westchester 1 702 F-3 l(213) 485-6205 1 

1 1 1 430 E. Seventh St. 1 Civic Center 1 634 F-5 1(213)485-6209 1 

1 11 I 11 I811 1 11 11819 W.SeventhSt. 1 Westlake 1 634 C-3 1(213)485-6211 1 

1 11 I 1206 S. Vermont Ave. 1 Pico Heights 1 634 A-4 l(213) 485-6213 1 

1 3 I 915 W. JeffersonBlvd. 1 USC Campus 1 634 B-7 (213) 485-6215 1 

1 1 1 1601 S. Santa Fe Ave. 1 Industrial Eastside 1 634 H-7 1 (2 13) 485-621 7 

1 9 1 12229 W. Sunset Blvd. 1 Brentwood 1 631 G-3 (310)575-8519 1 

1 21 1 21 1 1 3 11187 E.52ndSt. 1 South Los Angeles 1 674 E-4 1 (213) 485-6221 1 

1 V824 1 12 I 9411 Wentworth St. 1 SunlandlShadow His 1 503 D-3 1 (8 18) 756-8624 1 

1 26 I 26 I 826 I 3 I 2009 S. Western Ave. 1 West Adams 1 633 H-6 1 (2 13) 485-6226 1 

1 828 1 15 1 11641 Corbin Ave. 1 Porter Ranch 1 500 E-1 1 (818) 756-9728 1 

1 n I 33 18% I 13 I6406 S.MainSt. 1 South Los Angeles 1 674 C-6 1 (2 13) 485-6233 1 

351- I 835 I 5 I 1601 N. Hillhurst Ave. 1 Los Feliz 1 594 A-4 l(213) 485-6235 1 


A Section 2: Patient Trans~ortation 1 Destination 

1 44 1 1 844 I 2 1 1410 Cypress Ave. I Cypress Park 1 595 H-4 (213) 485-6244 1 

1 47 1 47 1 1 7 1 4575 E. Huntington Dr. S. 1 Monterey Hills 1 595 D-6 l(213) 485-6247 1 

1 49 1 1 V849 I 6 1 400 Yacht St.,Berth 194 1 Wilmington 1 824 F-1 1(310)548-7549 1 

I 51 I 51 I 1 4 1 10435 Sepulveda I LAX 1 702 0-5 ] (213) 485-6251 1 

1 55 1 55 1 1 2 I 4455 E. York Blvd. I Eagle Rock 1 594 J-1 l(213) 485-6255 1 

1 57 1 57 1257 1 V857 1 13 1 7800 S. Vermont Ave. 1 South Los Angeles 1 704 A-1 1(213)485-6257 1 

1 59 1 59 1 1 9 1 11505 W. Olympic Blvd. 1 West Los Angeles I 632 B-6 I(310) 575-8559 1 

\ 161 1 61 1 861 1 18 15821 W.ThirdSt. 1 Park LaBrea 1 633 D-1 1(213)485-6261 1 

1 4 1 1930 Shell Ave. 1 Venice 1 671 J-5 l(310) 575-8563 1 

1 65 16512651 1 13 11525. E.103rdSt. 1 watts 1 704 F-5 l(213) 485-6265 1 

1 68 I 68 1 868 1 18 I 5023 W. Washington Bl. 1 Mid-City 1 633 D-5 1(213)485-6268 1 

Il-70 1 1 15 1 9861 Reseda Blvd. 1 Northridge 1 500 J-5 1(818)756-8670 1 

1 17 1 681 1 De Soto Ave. 1 Canoga Park 1 530 C-6 l(818) 756-8672 1 

- - - - - - 

I 74 I 74 I 1 12 1 7777 Foothill Blvd. 1 Tujunga 1 503 H-3 l(818) 756-8674 1 

1 V876 I 5 I 31 11 N. Cahuenga Bl. 1 Cahuenga Pass 1 593 D-1 l(213) 485-6276 1 

1 V878 I 14 1 4230 Coldwater Cyn. Av 1 Studio City 1 562 E-5 l(818) 756-8678 1 

80 1 1 691 1 World Way West 1 LAX Crash Rescue 1 702 E-5 l(213) 485-6280 1 


PAGE 2 OF 3

Section 2: Patient Trans~ortation / Destination 

1 81 1 81 1 881 1 12 114123 Nordhoff St. 1 Arleta I P ~ . 502 B-7 1 (818) 756-8681 1 

1 83 1 83 1 1 10 I 5001 BalboaBlvd. 1 Encino 1 561 D-3 1(818)756-8683 1 

1 6 I 1331 W. 253rd St. 1 Harbor City 1 794 A-4 l(310) 548-7585 1 

1 87 1 87 1 1 15 1 10241 Balboa Blvd. 1 Granada Hills 1 501 C-4 l(818) 756-8687 1 

1 89 1 89 1 889 1 14 1 7063 Laurel Canyon Blvd. 1 North Hollywood 1 532 G-5 l(818) 756-8689 1 

1 91 1 91 1 V891 1 12 1 14430 Polk St. 1 482 A-4 l(818) 756-8691 1 

1 95 1 95 1 1 4 1 10010 International Rd. 1 LA Airport 1 702 J-5 l(213) 485-6295 1 

1 97 1 1 V897 1 14 1 8021 Mulholland Drive 1 Laurel Canyon 1 592 J-1 l(818) 756-8697 1 . ! 

-- 

9 9 199 10 1 14145 Mulholland Drive 1 Beverly Glen I 562 A-7 l(818) 756-8699 1 

1 103 1 103 1 1 15 1 18143 Parthenia St. 1 Northridge 1 531 A-1 l(818) 756-8603 1 

1 109 I I V909 1 10 I 16500 Mulholland Drive I Encino Hills 1 561 E-7 l(818) 756-8609 1 

1 Ill ] I I 6 I 1444 S. Seaside, Berth 256 1 Fish HarborlTenn Is. 1 824 D-5 l(310) 548-7541 1 

114 I 8060 Balboa Place-Air Ops Van Nuys Airport 

Legend: "V" = Variable Staffing 


PAGE 3 OF 3 

,

Section 3: Apparatus 1 Equipment 

. . . . 

APPARATUS TOWING / BREAKDOWN PROCEDURES 

1 0630-2300 HOURS 1 

1. Notify OCD and Battalion Commander of status. 

2. OCD shall contact the Shops or mechanic to 

determine: tow, repair, or if a relief apparatus is 

required. 

3- Battalion Commander shall arrange transportation. 

4. OCD shall report time towing contractor was 

notified. 

5. Tow to nearest S&M facility; if accident, tow to 

Central Shops. 

6- A member shall accompany the apparatus or 

meet the contractor at the Shops for security 

and to validate the tow invoice. 

2300-0630 HOURS 

1- Notify OCD and Battalion Commander of 

status. 

- 

\ 

' 

Company Commander shall determine if 

repairs may be made by members or Heavy 

Rescue; and if a relief apparatus is required. 

3, Update OCD of status. 

4. Tow utilizing procedures 5 and 6 above. 


2. Company Commander shall determine if field 

repair or towing is required. 

3- Company Commander shall arrange for a relief 

apparatus and change over. 

4. After change over, notify OCD that a tow 

is needed. 

5- A member shall accompany the apparatus or 

meet the contractor at the Shops for security and 

to validate the tow invoice. 

2300-0630 HOURS 


2. Company Commander shall arrange for repair 

or change over to a relief apparatus. 

3. Update OCD of status. 

4. Store apparatus in quarters overnight and tow 

utilizing towing procedures above. 

If the Shops are closed and Rescue Maintenance is not in quarters, contact OCD on the telephone 

outside of the office for entry. Use the gate keys in the lock box to open the yard and leave apparatus. 

Leave a note to briefly describe the apparatus type, problems, and status. Secure yard before leaving. 

The following information is needed for the tow invoice: 

1. Name of towing service 

2. Make, year, and Shop No. of apparatus 

3. Address where towing was initiated 

4. Date and time tow contractor was notified 

5. Time towing service arrived on scene 

6. Time towing was completed 

Sign the receipt, include your assignment and telephone number, then forward to S&M at: 

Mail Stop 253. An F-80 is required for the repairs, but not for the towing. 



APPARATUS MAINTENANCE 

Maintenance procedures are performed periodically based on the pre-described maintenance 

schedules set forth in Volume 3-710 and Department Log Books. The Station Commander is 

ultimately responsible for the condition of apparatus under hislher command, but each 

member shares equally in the responsibility of maintaining Department apparatus. 

To increase the performance and life of Department apparatus, daily, weekly, monthly, and 

bi-monthly preventive maintenance checks are preformed. Certain basic procedures in daily 

maintenance pre-checks on all apparatus shall be accomplished at the beginning of each shift or 

at any time a change of relief occurs. Refer to LAFD, Book 8, Drivers Training Manual, Module 4. 

The Preventive Maintenance form [F-3 771 RA applies to all Rescue Ambulances (active, reserve, 

and standby) that are serviced by field personnel. It is used to record the preventive maintenance 

performed and problems discovered. Refer to MOP, Volume 3- 711-48.32. 

The form is: 

+ Completed monthly by the responsible member. 

+ Original forwarded to Battalion Commander within the first two weeks of each month 

(prior to Battalion inspection). 

+ Copy retained in Apparatus Log Book until replaced by original from Battalion. 

+ Original retained in Log Book for one year. 

All needed repairs will be reported as directed in MOP, Volume 4,813-40.40 and 40.50 (this includes 

brake adjustment, emergency lighting, steering, warning devices, etc.). - 1 

Revised: 12/2001 PAGE 1 OF 1

CAV / NAV 

Section 3: Apparatus / Equipment 

AVI 1 Available within 60 seconds (1 minute) 

Available within 180 seconds (3 minutes) Fire Resources 

Available within 60 seconds (1 minute) ALS 1 BLS Rescue Ambulance 

k 

NAV 

Not available for dispatch 

Mobile Data Terminal (MDT) unit status shall be updated and correct at all times while 

AVI (Available), CAV (Conditionally Available), or NAV (Not Available). 

A Journal (F-2) entry shall be made for CAV / NAV status (include times and reason). 

Resources that are CAV shall maintain radio watch at all times. 

CHANNEL 4: METRO (RESCUE ONLY) CHANNEL 18: FRANK HOTCHKIN 

MEMORIAL TRAINING 

CHANNEL 7: METRO 

CENTER [FHMTC] 

CHANNEL 8: VALLEY 

Provide the following information to OCD when requesting CAV status: 

e The amount of time (before the resource will be available to respond - within 1-3 minutes). 

+ The CAV status reason: 

Routine Training 43 

, I 

37 1 Required Training 1 44 

38 1 Mechanical 

39 r~eturnin~ From Move-up 

-- 1 45 

I 46 

40 Returning From Incident 

47 

4 1 Community Relations 

48 

# 

42 1 Equipment1 Supplies Restock 1 49 

- -- - 

StafFing 

CAV Other - Must Specify 

Fire Prevention 

Non-Emergency Move-up 

Continuing Education 

Oil Change 

EMT Training 

Provide the following information to OCD when requesting NAV status: 

+ The location where the resource will be NAV. (This may be a fire stations first-in district or a location code.) 

+ The NAV status reason: 


26 1 Routine Training 

27 EMT Re-certification 

I 

29 Decontamination 

30 Annual Apparatus Testing 

3 1 NAV Other - Must Snecifi 

- - 

32 1 Change Over 

33 1 No Hospital Beds 

34 1 Oil Change 

m 

1 

1 

I 

35 1 Required Training 1

. Section 3: Apparatus 1 Equipment 

- . . . 

OBTAINING A SPARE GURNEY 

A cache of spare gurneys is maintained at each EMS Battalion Office. 

The procedure to obtain a spare gurney is as follows: 

* Notify the Station Commander and EMS Battalion office. 

* Ascertain the availability of spare gurneys at the EMS Battalion office. 

* Take the defective gurney to the EMS Battalion office and attach an F-175 tag stating the problem. 

* Label the new gurney with your RA designation, using 2%'' red decals. 

Place decals on each side panel of the gurney. 

* Make appropriate journal entry when you return to quarters. 

Use Extreme Caution at all times when operating gurneys to prevent patient injury 

andlor private property damage. Particular attention shall be given when: 

Repositioning into a chair position, moving through confined areas and doorways, 

transporting combative andlor altered mental status patients, and loading patients 

inlout of an ambulance. Active measures are required by members to assure the 

safe position of the patients hands and extremities to prevent injuries. 


tion 3: Apparatus 1 Equipment 

MULTI-CASUALTY MEDICAL SUPPLY CACHE 

caches are designed for rapid deployment of emergency medical supplies to a multi-casualty incident, 

, \ major catastrophe, or at the Incident Commander's discretion. Each cache weighs approximately three- 

1 hundred pounds and consists of six plastic boxes, 12 wooden backboards, and a full complement of 

dressing and bandaging material; and each cache is designed to provide basic first-aid and EMT-I level 

treatment for 15 to 50 patients. They are transportable inside Department helicopters, heavy apparatus, 

plug buggies, and rescue ambulances. The following deployment locations provide for geographic 

coverage, potential need, and transport considerations: 

, HAZARDOUS MATERIALS CACHE 

)V 

HAZARADOUS CHEMICAL AGENT EMERGENCY 

- For signs and symptoms of Cyanide 

: poisoning administer Amyl Nitrite in 

conjunction with decontamination. 

+ CYANIDE POISONING EXPOSURE: 

Special considerations: 

Wear PPE and ensure decon procedures are completed 

prior to treatment and transpod. 

Apply high flow oxygen via mask, observe for deterioration, 

monitor respirations and LOC. Cardiac monitor and venous 

access. MAKE BASE CONTACT. 

Decontaminate if indicated. Administer antidote, if indicated. 

d Crush ampule 

d Place in a 4x4 Gauze I (tape inside MasWBVM) 

d Allow victim to hold antidote and inhale vapor for 60 sec. 

(ventilate for 60 seconds) 

d Remove ampule 1 ventilate for 15 sec. 

d Admin. a new ampule every 2-3 min. 

The Medical Supply Trailer 

is available for immediate 

response to disasters, 

MCI's, or at IC discretion. 

Can be deployed for 

"Special Event" venues. 

They can be towed by any 

pick-up or larger vehicle with 

a tow package. 

CONTENTS: 

Mark I Kit - 30 

Amyl Nitrite - 36 

(3 boxes of 12) 

Contact MAC: 7-323-722-8073 

whencacheboxisopenedandused. 

Inventory documentation includes 

recording the disaster cache lock 

number on the F-903 and F-2. (7-03) 

Repeat all steps until IV antidote is available in the ED. Treat cardiac dysrhythmias, 

seizures, and hypotension as indicated per LA Co. Treatment Care Guidelines and Ref # 806. 



v 

HAZARDOUS MATERIALS CACHE 

+ MARK I KIT: FOR NERVE AGENTS 

Indications for use include poisoning with 

organophosphate nerve agents with at least 

one sigdsymptom listed: 

Respiratory distresslmesty SOB 

Muscle twitchinglseizure 

Generalized weaknesslparalysis 

Copious secretions (SLUDGE) 

Hold auto-injector by the plastic clip 

with non-dominant hand. 

The larger auto-injector is on top 

and held at eye level. 

With the other handy check your 

injection site for any obstacles such 

as buttons or objects in the pocketsy 

which may interfere with the injections. 

PULL THE SMALL GREEN-TIPPED AUTO-INJECTOR (ATROPINE) OUT OF THE CLIP. 

REMOVE THE SAFETY CAP (yellow on Atropine; gray on 2PAM-DO NOT TOUCH THE 

COLOWD END OF THE INJECTOR after removing the safety cap, since it will inject into 

the &ngers or hand if any pressure is applied). 

HOLD IT LIKE A PEN OR PENCIL, BETWEEN THE THUMB AND FIRST TWO FINGERS. 

POSITION THE GREEN TIP OF THE AUTO-INJECTOR AGAINST THE INJECTION SITE 

(ANTEROLATERAL THIGH). 

APPLY FIRM, EVEN PRESSURE (not a jabbing motion) TO THE INJECTOR until it pushes 

the needle into the thigh or buttock. 

HOLD THE INJECTOR FIRMLY IN PLACE FOR AT LEAST 10 SECONDS. Carehlly 

remove and then massage the area. 

PULL THE BLACK-TIPPED 2-PAM AUTO-INJECTOR OUT OF THE CLIP AND INJECT IN 

THE SAME MANNER. 


BASE HOSPITAL HAILING AND CHANNEL ASSIGNMENTS 

Beverly (Closed) 1 # 9 5 I 5E 1 4 E 1 

, , , 

Cedars-Sinai 1 #94 1 1 B 1 6 B 1 

- - - -- 

Glendale Adventist #I7 8 C * NA 

HarborIUCLA #64 4 D 7 D 

Henry Mayo Newhall #81 4A 5A 

Holy Cross #42 6 A 2A 

Huntington Memorial #92 5 F 2A 

LACIUSC #28 4 C 6 C 

Little Co. of Mary-Torrance 1 #I6 2 D 1 

Methodist Hosp. of So. Cal. #49 8 F 3 F 

Northridge (NRH) #29 1 A 8A 

Pomona Valley # 2 5 7 F 5A 

I I 

Presbyterian Intercomm. #84 3 E 8 E 

Q of A I Hwd. Pres. (Closed 04/04) #75 3 C 7 C 

Citrus Valley 1 #I 8 1 4F 1 * NA I 

Robert F. Kennedy (Closed W04) 1 #71 I 85 1 3 5 1 

St. Francis #53 

St. Joseph 

St. Mary 

Torrance Memorial 

I I I 

UCLA 1 #59 1 2B -1. 3 B 


#35 

#24 on 7 

#79 

PAGE 1 OF 1 

1 E 

5 A 

7 E 

3 D 

8E 

3A 

4E 

3A

Section 4: Records 1 Documentation 

RECORDS AND DOCUMENTATION 

THE JOURNAL (F-2) is maintained by each company and is used to record a history of all pertinent 

.iformation relative to the daily operation of the command. Entries will appear in a chronological order. 

Accuracy, clarity, and completeness of entries are essential on all emergency and non-emergency incidents. 

Incidents where unusual circumstances exist (e.g., crime fatalities, patient refusal of treatment and/or 

transport, etc.) require a more thorough Journal entry. Members making entries in the Rescue Ambulance 

Journal shall adhere to the instructions outlined in the Manual of Operation, Volume 5, 917-00.00. 

FORMAT 

COLOR OF INK: The following entries shall be made in RED ink: 

+ Date (centered at the top of each page and the first available line when a new calendar day begins 

* Move-up (resulting from an alarm), 

+ Alarm information (emergency and non-emergency). 

All other entries shall be made in BLUE or BLACK ink. 

PLATOON CHANGE ENTRIES: 

+ Time, members on duty (include member ID # and assignment), 

+ The status of equipment (cell phone, 800 MHz radio, LAPD ASTRO radio), fuel card, 

and controlled medications. 

INCIDENT ENTRIES: 

+ Incident type (e.g., traffic, chest pain, shooting, etc.) and the F-902M sequence number 

(entered in the margin). 

+ Time of alarm. 

Underline "Location of Incident." 

1 Patient Information: Patient number (in cases of multiple patients), name, age, sex, chief complaint, 

complete vital signs, and treatment rendered. 

+ Disposition: Transport destination, time complete, time in quarters. 

Documentation may include ride-a-longs, interns, drills, training sessions, equipment loans 

and repair, change of rescue staffing during the shift, apparatus placed out of service, injuries, 

illness, exposure, patient in custody (include LAPD unit number) or any other occurrences 

incidental to the tour of duty. 

PHYSICAL SECURITY OF ALL REPORTS, RECORDS, OR DOCUMENTS CONTAINING 

PATIENT HEALTH INFORMATION (PHI) SHALL BE SECURED AND NOT LEFT 

UNATTENDED ON DESKS OR TABLES AT ANY TIME, 

THIS INCLUDES THE JOURNAL (F-2). 

Refer to LAFD Departmental Bulletin No. 03-1 1 

THE HAZARDOUS SUBSTANCE EXPOSURE REPORT (F-3) is generated when a 

member has been or is suspected of being exposed to a hazardous substance. An F-3 is available 

on the Station Network Staffing System. Instructions are outlined in the Manual of Operation, 

Volume 5,917-00.00. 

STORES REQUISITION (F-80) 

1s per Department policy, the F-80 is used to request services or supplies as shown in Volume 4,817 

Service and Supplies /Requisition and Delivery. Four copies of the F-80 are initiated by concerned 

member. Forward part 1 (white), part 2 (canary) and part 3 (pink) to concerned Department subdivision. 

Retain part 4 (goldenrod) until delivery is received. EXCEPTION: Copies of the F-80 Medical Supply 

order shall be maintained in the combined file at the fire station for a period of three years. 


PAGE 1 OF 3


THE RESCUE EQUIPMENT LOAN SLIP (F-215M) 

As per Department policy, all LAFD equipment is to be clearly marked. Complete a "Rescue 

Equipment Loan Slip" (F-215M) in duplicate when equipment is left at a receiving facility. 

Clearly document on the F-2J5M the following information: 

d The incident date and number d Patient's name (or hospital patient file number) 

dHospital arrival time d FD member's name/assignment 

A responsible person, from the receiving facility, shall sign and retain a copy of the F-2 15M (loan receipt). 

The original copy, containing the initiating member's name and assignment clearly printed, is to be 

retained by the rescue ambulance until the equipment is retrieved. A Journal (F-2) entry is also required. 

RECORDS AND DOCUMENTATION 

THE EMERGENCY MEDICAL SERVICE REPORT (F-902M) is a subpoenable legal, medical, 

and billing document that becomes a permanent part of the patient's medical records. First on scene 

prehospital care providers shall initiate an F-902M for ALL calls dispatched, except "returned by 

radio." Refer to LAFD, Book 5 (F-902M Instruction Manual). 

MEDICAL SUPPLIES AND PHARMACEUTICALS procedures are outlined in Departmental 

Bulletin No. 01 -1 3. Refer to DHS, Ref. No. 702.2 and Ref. No. 703 for inventory requirements. 

ONNEL SHAL.L: 

Perform a daily inventory check. 

Document entries of the controlled medications (on hand) on the Controlled Medication 

Inventory [F-9031 form and in the Journal (F-2), any time there is a change in personnel 

or controlled medication. 

Following an incident, all units shall replenish their apparatus inventory of medical supplies and 

pharmaceuticals immediately upon returning to quarters. 

Individual paramedic units are provided with a minimum inventory list of EMS supplies to be 

maintained onboard and intended to supply a resource for an average 24-hour shift. 

However, to meet specific needs, it may be necessary to increase the established minimums 

of certain medications andlor supplies. 

Each fire station shall order EMS supplies and medications (other than controlled medication) on a 

monthly basis. Attach the monthly use summary to the F-80 cover sheet and forwarded to Supply and 

Maintenance for processing. 


PAGE 2 OF 3


HE CONTROLLED MEDICATION INVENTORY (F-903) form shall be maintained on the 

apparatus until completed. Completed forms shall be retained on file, at the assigned location of 

the ALS unit, for a minimum of THREE YEARS. m: A copy of the com~leted Controlled 

Medication Inventory form shall be forwarded monthly to the concerned EMS Battalion Office .) 

A Journal (F-2) entry will be made of the amount of controlled drugs on hand at shift change; 

whenever controlled drugs are received and/or delivered; and any time there is a change of responsible 

personnel. Notify the EMS Battalion Captain between the hours of 0630-0800 of the need for re-supply 

of controlled medication and report the current levels of each controlled medication. 

When a controlled medication is used, provide the original F-902M BLUE to the EMS Battalion 

Captain in exchange for the replacement medication. When the medication is issued, the paramedic 

receiving the medication will sign in places: The EMS Battalion Captain's (controlled medication) 

log and the "Receiving Personnel" column of their individual unit copy of the Controlled Medication 

Inventory form. (Refer to the Departmental Bulletin No. 0 1 - 13 .) 

THE LOS ANGELES FIRE DEPARTMENT SITUATION REPORT (F-904) is used to 

facilitate resolution and feedback to inquiries regarding the emergency medical service and/or 

other Department related critical issues. The data gathered will assist in identifying areas of 

concern relative to performance, patient care issues, and Department training needs. Refer to 

LAFD Departmental Bulletin No. 01 -06. 

THE HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT (HIPAA) 

is a federal legislation for the protection and security of personally identifiable health care 

information. Members are to take reasonable and prudent measures to secure patients' 

protected health information (PHI). 

The Department has implemented policies and procedures regarding "Notice of Privacy Practices" (NPP). 

Members shall provide each patient with a written NPP utilized by the LAFD. Acknowledgement of the 

NPP shall be accomplished by obtaining the patient's signature on the back of the F-902M White copy. 

Enter NPP given in "Comments" or Transfer of Care" section. If patients are unable to acknowledge 

receiving the NPP, the NPP shall be left with the patient at the receiving facility. Exception, when the 

patient is unable, due to altered mental status, age, or in police custody. Document the reason why the 

patient was unable to sign and that the NPP was provided. (Refer to: LAFD Department Bulletin 

No. 03-1 1 and Book 5.) 


PAGE 3 OF 3


CALIOSHA and FEDIOSHA NOTIFICATIONS 

The senior ranking (EMS) member on the rescue ambulance shall make a CallOSHA notification of 

serious industrial injuries, illness, or death (other than a traffic accident). If no Department 

ambulance has responded, the Incident Commander shall make the notification. If the patient is a 

Los Angeles Fire Department member, the station commander (where the member is regularly 

assigned) is responsible for making the CallOSHA notification. 

A serious injury or illness is any injury or illness that may require admission to a hospital for 

24 hours or more (for other than observation), treatment for the loss of any body part, or serious 

permanent disfigurement (i.e., serious bums). 

The reporting member shall journalize (F-2) the CallOSHA notification including the name of the 

person notified and the time of notification. 


CALIOSHA 

Metro/West/South LA 

DowntownIEast LA 

Harbor Area 

San Fernando Valley Area 

Additionally, AS SOON AS POSSIBLE, 

(2 13) 576-745 1 

(562) 949-7827 

(3 10) 5 16-3734 

(818) 901-5403 

Nx: For Federal Employees contact: 

FEDIOSHA (800) 475-4020 or (619) 557-2909 

Contact the District Attorney's Office for all incidents involving: 

Industrial Related Death or Near Death 

1 District Attorney 1 

1 Command Post telephone number 1 (2 13) 974-3607 1 

The following information will be required for all notifications: 

Incident Date and Time 

Patient's Name and Age 

Patient's Home Address 

Patient's Occupation 

Name of Employer 

Employer's Address 

On-site Supervisor's Name and Telephone Number 

Incident Address 

Patient Destination (Receiving facility) 

Extent of Injury 

Description of Incident 

PAGE 1 OF 1


LEVEL I 

Contact limited to merely being in the presence of a person suspected of having 

a communicable disease. 

1 LEVEL I1 1 Contamination of clothing or equipment by blood and/or body fluids. 

LEVEL I11 

Exposure of skidmucus or conjunctival membranes to blood and/or body 

fluids (e.g., vomitus, urine, feces). This category includes ingestion of 

"possible" contaminated food, needle puncture, and human bites. 

(Refer to LAFD, Training Bulletin No. 82.) 

For known or suspected exposure to an infectious/cornrnunicable disease, blood and/or body fluids, 

or if the member sustains a contaminated needle wound, do the following: 

1 1. 1 Immediately cleanse the affected area. 1 

1 2. 1 Notify your Station Commander. 1 

3. 

4. 

Notify the appropriate EMS Battalion Captain of all "Level 111" exposures. 

On the F-902M, check "Inquiry Requested" box and document in the Comments section. 

5. 

1 6. 1 

Complete and forward an F-420; complete an F-225 or F-166A; and D WC Form 1 for all 

"Level I1 and 111" exposures. 

Ensure a detailed entry in the Journal (F-2) and the member's Personal Record Book. 

Members shall not seek or receive "first care" until consultation and direction has been 

received from the Medical Liaison Unit and/or the EMS Battalion Captain. 

1 

COMMUNICABLE DISEASE EXPOSURE AND NOTIFICATION REPORT (F-420) 

The F-420 shall be carried on all LAFD apparatus and shall be completed by the concerned 

member who may have been exposed to a "Reportable Communicable Disease" and/or received 

a contaminated needle wound. The F-420 original copy is given to the hospital. 

Reportable Communicable Diseases Include: 

+ AIDS 

+ Hepatitis 

+ Meningitis 

+ Syphilis 

+ Tuberculosis 


-


Department equipment which has been contaminated with blood or other body fluids, shall be 

decontaminated by members wearing disposable rubber protective gloves as follows: 

+ Rescue equipment such as traction splints, backboards, KED boards, blood pressure cuffs, 

bag-valve-mask device, airway management instruments, etc., shall be washed with a 

disinfectant-detergent solution and hot water then air dried. 

+ Delicate electronic equipment such as scope/defibrillators, radios, etc., shall be wiped 

down with a 1 : 10 bleachlwater solution (1 part bleach to 10 parts of water) as soon as 

possible post incident. 

t The rescue ambulance patient area should be scrubbed with a 1 : 10 bleachlwater solution, 

rinsed with clear water and air dried. 

Needles are to be handled with extreme care. The Department supplies sharp containers 

that are to be used for all dirty needle disposal. If self-covering IV catheters are not being 

used, the contaminated needles shall be recapped for safety of personnel. Place the cap 

on a flat surface and replace the needle in the cap using a "one-handed method." 

Note: Do not stick needles in RA seat cushions. 


' 

Section 4: Records I Documentation 

SUSPECTED CHILD ABUSE I NEGLECT REPORTING GUIDELINES 

The primary purpose of the Department of Justice Suspected Child Abuse Report form SS 8572 

(DHS, Ref. No 822.2) is to make all agencies aware of possible abuselneglect. In order to 

facilitate this process in Los Angeles County, it is recommended that a prompt verbal report be 

made to both the Department of Children and Family Services (DCFS) and local law edorcement. 

However if the child is in imminent danger, local law enforcement should be notified immediately. 

To make a verbal report to DCFS, call the 

CHILD ABUSE HOTLINE at: (800) 540- 4000 

This should be done as soon as possible. It is recommended that the Child Abuse 

Report form be completed prior to making verbal notification. The Suspected Child Abuse1 

Neglect report is to be completed according to the instructions on the back of the form 

DCFS 

3075 Wilshire Blvd. 

Los Angeles, California 9001 0 

SUSPECTEDELDERAND DEPENDENTADULTABUSE 

REPORTING GUIDELINES 

Paramedics and EMTs, as health care practitioners, are mandated reporters and have a legal 

obligation to report known or suspected elder and dependent adult abuse. 

An elder is a person 65 years of age or older. A dependent adult is a person 18-64.years old, who 

have physical or mental limitations that restrict their ability to protect their own rights or carry out 

normal activities. 

DEPARTMENT MEMBERS SHALL MAKE A REPORT WHENEVER: 

+ The member observes or has knowledge of an incident that reasonably appears to be abuse, or 

+ The member is told of an incident by the victim, or 

+ The member reasonably suspects abuse. 

Mandated reports of physical abuse, sexual abuse, isolation, abandonment, financial abuse, neglect, and 

self-neglect are to be made immediately or as soon as practically possible by telephone. The follow-up 

written report must be SENT WITHIN TWO WORKING DAYS to the agency to which the telephone 

report was made. 

Voluntary reports of other types of abuse, such as mental abuse or abduction, may be made either 

!by telephone or by means of the written report mailed or faxed to the appropriate agency. 


PAGE 1 OF 3


SUSPECTEDELDERAND DEPENDENTADULTABUSE 


When the abuse or neglect is suspected to have occurred in a LONG-TERM CARE FACILITY * 

report either to the local law enforcement agency or to: 

Long Term Care Ombudsman 

1527 Fourth Street, Suite 250 

Santa Monica, CA 90401 

Telephone: (800) 334-WISE (8001 334-9473) 

Fax: (3 10) 395-4090 

Afler hours telephone: (800) 23 1-4024 (State Crisis Line) 

* LONG-TERM CARE FACILITY : Includes, but is not limited to, the following facilities: 

1. Any long-term health care facility, such as a nursing facility, a skilled nursing 

facility, a congregate living health facility, a licensed respite care facility, or an 

intermediate care facility, including habilitative and nursing intermediate care 

facilities for the developmentally disabled. 

2. A community care facility, such as an adult day care facility, an adult day 

support center, an adult residential facility, or a social rehabilitation facility, 

whether licensed or unlicensed. 

3. A swing bed in an acute care facility, or any extended care facility* 

4. A licensed residential care facility for the elderly. 

When abuse, neglect, or self-neglect is suspected to have occurred ANYWHERE ELSE, 

report either to the local law enforcement agency or to: , 

Los Angeles County Adult Protective Services Centralized Intake Unit 

3333 Wilshire Blvd., Suite 400 

Los Angeles, CA 90010 

Telephone: (888) 202-4-CIU (888) 202-4248 

Fax: (213) 738-6485 

Afler hours telephone: (877) 4-R-SENIORS (877) 477-3646 

TELEPHONE REPORT: Reports are to include as much of the following information, as possible: 

1. The name, address, telephone number, and occupation of the person making the report. 

2. The name, address, and age of the elder or dependent adult. 

3. The names and addresses of family members or any other person responsible for the elder or 

dependent adult's care. 

4. The nature and extent of the elder or dependent adult's condition. 

5. The date and place of the abuse incident. 

6. Any other information requested by the receiving agency, including information that led the 

reporter to suspect elder or dependent adult abuse. 

7. Information about the suspected perpetrator. 

Revised: 09D003 PAGE 2 0 ~ 3 

'\ 

J


SUSPECTED ELDER AND DEPENDENT ADULT ABUSE 


#i WRITTEN REPORT: The Report of Suspected Dependent AdultElder Abuse (Ref. No. 829.1) 

must be completed and submitted to the agency initially contacted. Upon completion, immediately 

forward the report to the involved EMS Battalion Captain. The EMS Battalion Captain shall review 

and Fax the report to the appropriate agency. 

THIS PROCESS SlULL NOT EXCEED TWO (2) . . WORKING DAYS (48 HOURS) OF THE 

TELEPHONE REPORK 

0 

WITHIN 48 HOURS 

PARAMEDICS AND EMTS ARE MANDATED REPORTERS. IF YOU SUSPECT ABUSE, NEGLECT, OR 

SELF-MGLECT, YOU AFU3 REQUIRED BY STATE LAW TO WPORT IT. 

RECORD YOUR OBSERVATIONS OF ELDER DUSE AS YOU DO FOR CHILD ABUSE. 

LOS ANGELES COUNTY ELDER ABUSE HOTLINE: (877) 4- R-SENIORS (877) 477-3646 

Shortage of food Unkempt, odorous Unemployed 

Excessive trash Passive or afraid Substance abuser 

Utilities are turned off 1 Bruises, scratches, cuts 1 Mental disorder 1 

How reeks of urinelfoul odors 1 Confhed 1 Uncooperative 1 

Insect and vermin infestation 1 Calls 91 1 fiequently Speaks for dependent person 

Broken whdowslcode 

vioIations, etc. 

I I 

Tells you there is neglect or abuse Aggressive or controlling I 

NPES OF ABUSE: 

Physical 

Sexual 

ADULT PROTECTIVE SERVICES (APS) Social Workers investigate reports of suspected abuse 

and neglect (24-hours a day in life-threatening situations). 


Financial 

Abandonment 

Isolation 

Abduction 

YOUR OBSERVATIONS HELP WITH THE INVESTIGATION. 

ELDERS: 65 years of age or older 

DEPENDENT ADULTS: 18-64 year olds who have physical or mental limitations 

that restrict their ability to protect their o m rights or carry out normal activities. 

PAGE 3 OF 3 

Neglect others 

Neglect by self 

Psychological I 

A


COMMUNICATION FAILURE PROTOCOL 

Communication Failure Protocols (DHS, Ref. No. 81 0) are followed when paramedics are 

unable to establish andor maintain base hospital communications and a delay in treatment may 

jeopardize the life of a patient. In those cases the following procedures will be adhered to: 

Perform a thorough patient assessment and record all findings on the F-902M. 

Initiate the appropriate treatment protocol(s) for the patient's presenting signs1symptoms as 

per the EMT-P Communication Failure Protocol Quick Reference. 

Transport to a general acute care hospital in accordance with LA County Policies. 

Transport as quickly as possible consistent with optimal patient care (may occur at any point 

in the standing orders). 

Make vigorous attempts to establisldmaintain voice contact with physician or MICN while en 

route to the receiving hospital. 

IMMEDIATELY make a VERBAL REPORT to the on-duty emergency room physician or 

MICN at the assigned base hospital. 

Complete the ALS Communication Failure Report Form as described in DHS, Ref. No. 8 10. 

Non compliance with this policy may be construed as hctioning outside the supervision 

(scope) of medical control under the Health and Sdety Code l798.2OO(c)(lO). 

WRITTEN REPORT : Within 24 hours of the incident, involved paramedics shall complete 

Section A and forward the form to the Base Hospital Medical Director at the assigned base hospital. y, , > 


PAGE 1 OF 1 

WITHIN 24 HOURS

/ 


COMMUNICATION FAILURE PROTOCOL 

Communication Failure Protocols (DHS, Ref. No. 81 0) are followed when paramedics are 

unable to establish andor maintain base hospital communications and a delay in treatment may 

jeopardize the life of a patient. In those cases the following procedures will be adhered to: 

1. Pedorm a thorough patient assessment and record all findings on the F-902M. 

2. Initiate the appropriate treatment protocol(s) for the patient's presenting signs/symptoms as 

per the EMT-P Communication Failure Protocol Quick Reference. 

3. Transport to a general acute care hospital in accordance with LA County Policies. 

4. Transport as quickly as possible consistent with optimal patient care (may occur at any point 

in the standing orders). 

5. Make vigorous attempts to establishlmaintain voice contact with physician or MICN while en 

route to the receiving hospital. 

6. IMMEDIATELY make a VERBAL REPORT to the on-duty emergency room physician or 

MICN at the assigned base hospital. 

7. Complete the ALS Communication Failure Report Form as described in DHS, Ref. No. 8 10. 

8. Non compliance with this policy may be construed as hctioning outside the supervision 

(scope) of medical control under the Health and Safety Code 1798.200(~)(10). 

\ WRITTEN REPORT : Within 24 hours of the incident, involved paramedics shall complete 

-4 Section A and forward the form to the Base Hospital Medical Director at the assigned base hospital. 

Revised: I212001 

PAGE 1 OF 1 

WITHIN 24 HOURS


, Mnemonics (memory joggers) are effective tools used to assist EMS personnel in conducting 

more thorough assessments. The following are a few examples to assist with patient assessments. 

1 SECONDARY (FOCUSED) 'SURVEY 1 BURN INJURY I 

(SAMPLE / 3 "T's") 

S -Signs/Symptoms 

A -Allergies 

M -Medications 

P -Past medical history 

L -Last oral intake. 

E -Event preceding. 

T -Tags (Medical) 

T -Tracks 

T -Trauma 

(DCAPP-BTLS) 

D -Deformities 

C -Contusions 

A -Abrasions 

P -Penetration 

P -Paradoxical movement 

1 NEUROLOGICAL I 1 LEVEL OF RESPONSIVENESS 1 

- 

-Depth of coma 

E -Eyes 

R -Respiratory status 

M -Motor response 

INJURED EXTREMITY (Distal to Injury) 

(PMS) 

BONY AREA EXAM 


(AVPU) 

A -Alert 

V -Responds to Verbal stimulus 

P -Responds to Painful stimulus 

U -Unresponsive 

1 TO ELICIT PERSONAL HISTORY I 

W -Weight 

H -History of medical problem 

A -Age, allergies 

M -Under D's care 

-- - 

1 SIGNS OF A TENSION PNEUMOTHORAX 1 

(PUNT) 

P -Progressive Dyspnea 

U -Unilateral Breath Sounds 

N -Neck Vein Distension 

T -Tracheal Deviation


CAUSES OF ASYSTOLE 

(4-H Police Department) 

H -Hypoxia 

H -Hyperkalemia 

H -Hypokalemia 

H -Hypotherrnia 

P -Pre-existing Acidosis 

D -Drug Overdose 

NARCOTICS INHIBITED BY NARCAN h 

Many Doctors Practice Tender Loving 

Care Many Hours Daily 

1 POSSIBLE CAUSES OF PEA 

(MATCH (X4) ED) 

M -Myocardial Infarction (massive acute) 

A -Acidosis 

T -Tension Pneurnothorax 

C -Cardiac Tamponade 

H -Hypoxia, Hypovolemia, 

Hyperkalemia, Hypotherrnia 

E -Pulmonary Embolus 

D -Drug Overdose 

1 COMMON CAUSES OF 

PEDIATRIC SEIZURES 

F -Fever 

H -HeadTrauma 

E -Epilepsy 

(medically diagnosed) 

L -Low blood sugar1 

chemical disturbances 

P -Poison/overdose 


1 ET DRUG ADMINISTRATION 1 

- 

- 

DRUG CHECK PRIOR TO 

ADMINISTRATION 

(DICCE) 

D -Drug/Dose 

I -1ntegritylIndications 

C -Clarity 

C -Concentration/Contraindications 

E -Expiration date 

1 ABDOMINALPAIN 1 

(DR. GERM) 

D -Distention 

R -Rigidity 

G -Guarding 

E -Ecchymosis 

R -Referred Pain 

M -Masses 

ASSESSMENT TOOL 

(SOAP) 

NEUROVASCULAR COMPROMISE 

("5 P's") 

Pain Where, what's causing it? 

Pulse Is there a distal pulse in the injured extremity? 

Paresthesia Any abnormal sensation at the site? 

Paralysis Indicates peripheral nerve damage or 

circulatory impairment. 

Pallor Check color, temperature, and capillary refill.

Abdomen ABD 

Abortion AB 

Apical Pulse 

Abrasion 

- 

Accelerated Junctional Rhythm 


Anterior 1 ANT 

ABR Appointment ~ P T 

-- -- 

AJ R Approximately I APPRO: 

Accelerated Ventricular Rhythm AVR Arterial Blood Gases 

Accident ACC 

Acquired Immune Deficiency 

Syndrome 

Acute Life Threatening Event ALTE 

Acute Myocardial Infarction 

Artery 

AIDS As Needed 

As Soon as Possible ASAP 

Aspirin 1 ASA 

Adult Respiratory Distress Syndrome ARDS Assault 1 AST 

Advanced Health Care Directive 

Advanced Life Support 

AHCD 

ALS 

Advised ADV 

After Care Instructions 

Assaulted with a Deadly Weapon 1 ADW 

Asystole ASY 

At Once STAT 

ACI Atrial Fibrillation AF I 

After I Past I Post 

Against Medical Advice 

Agonal 

AMA 

AGO 

Atrial Flutter 

Atrioventricular 

Attempted Suicide 

AFL 

k- 

Airway 1 Breathing I Circulation ABC Auscultation 

Alcohol On Breath AOB 

- - 

Alert & Oriented times 3 Parameters 

(Purpose, Time, Place) 

Allergies ALG 

Altered 

Altered Level of Consciousness 

Ambulance / Ambulatory 

Amount 

ALT 

Automated External Defibrillator 

Axillary 

Backboard BBD 

Bag of Waters BOW 

ALOC Bag-Valve-Mask BVM 

AMB 

AMT 

Ampule AMP Before 

Antecu bital 


PAGE 1 OF 9 

Base Hospital Medical Director BHMD 

Basic Life Support 1 BLS

Section 4: Records / Documentation 

Carbon Dioxide 

Cardioversion 

Catheter 

Centigrade / Celsius 

Central Nervous System 

Cerebrospinal Fluid 

Cerebrovascular Accident 

Certified Nurse Assistant 

Cervical Spine 


CAR 

CATH 

C 

CNS 

CSF 

CVA 

CNA 

C-SP 

Cervical Vertebrae 

Chest Pain 

Chief Complaint 

- 

Chronic Obstructive Pulmonary 

Disease 

- 

---.- 

C-1, C-2, 

etc. 

COPD 

Chronic Renal Failure 

- 

CRF 

Circulation, Sensation, Movement 

- 

Clean and Dress 

- 

CSM 

Clear 

- 

CLR 


- 

Complains Of 

CFP 

Complete Blood Count CBC 

Complete Heart Block 

Congestive Heart Failure 

Contact Not Attempted 

Contagious Disease 

Contusion 

Coronary Artery Bypass Surgery 

Coronary Artery Disease 

Coronary Care Unit 

Corrected To 

Cubic Centimeter 

Date of Birth 

Dead on Arrival 

CHB 

CHF 

CNA 

CONT 

CABS 

CAD 

ccu 

C/T 

DOB 

DOA 

Decrease DECR 

Defibrillation DEF

-- 


ABBREVIATIONS 

Delirium Tremens 1 DT9s Equal and Reactive 

E&R 

Dextrose 5 Percent in Water 

Esophageal Gastric Tube Airway EGTA 

Diabetes Mellitus 

Esophageal Obturator Airway EOA 

Diabetic Ketoacidosis 

Estimated 

EST 

Diagnosis 

DX Estimated Blood Loss 

Dilation and Curettage 

D&C Estimated Time of Arrival ,* 

Discontinue 

Ethyl Alcohol 

ETOH 

Distal 

DIST Evaluation 

EVAL 

Do-Not-Resuscitate 

DNR Examination 

EXAM 

Drop 

gtt Expected Date of Confinement EDC 

Dry Sterile Dressing 

DSD 

Expected Date of Delivery 1 EDD 

Duodenal Ulcer 

Expiratory 

EXP 

Dyspnea on Exertion 

External 

EXT 

Each, Every 

Eyes, Ears, Nose, and Throat EENT 

Electrocardiogram 

1 ECG (EKG] 

Fahrenheit 

F 

Electroencephalogram 

EEG 

Family History 

F H 

Emergency Department 

ED 

Fetal Heart Tones 

FHT 

Emergency Department Approved 

EDAP 

for Pediatrics 

Fever of Unknown Origin 

FUO 

Emergency Medical Service (System) EMS Fixed and Dilated 

F&D 

Emergency Medical Technician- 

Fluid 

Advanced Airway 

Emergency Medical Technician 

Emergency Medical Technician-Paramedic EMT-P 

Follow Up 

Emergency Room 

Foreign Body 

FB 

Esophageal Tracheal Combitube 

Four Times a Day 

QID 

Endotracheal Tube 

ET 

Fracture 

FX 


PAGE 3 OF 9


ABBREVIATIONS 

Frequent FREQ Hypertension 1 HTN 

Gallbladder GB Hyperventilation I 

Gastroenteritis 1 GE 1 ldioventricular Rhythm 

Gastrointestinal 

Genitourinary 

Glasgow Coma Scale GCS 

Immediate Danger to Life & Health IDLH 

Increase INCR 

Inhaled I IN 

Grain Injury 1 INJ 

Gram ~"-" 

Gravida G 

Gunshot Wound 1 GSW 

Has Been Drinking 1 HBD 

Headache 

Inspiration INSP 

Insulin Dependent Diabetes IDD 

--- - 

Intake and Output 

Intensive Care Unit ICU 

International Unit I U 

Intramuscular IM 

Heart Block 

Heart Block- (1st 1 2nd 1 3rd ) 

Intrauterine Pregnancy IUP 

Degree Intravenous IV 

Heart Rate I Hour HR 

I 

Intravenous Piggyback IVPB 

Heart Sounds 1 Intravenous Push IVP 

Height 

- 

Hemorrhage HEM0 

History HX 

History of Present Illness 1 HPI I 

Hospital 

Hospital Emergency 

Administrative Radio 

Hospital Emergency 

Response Team 

1 HOSP 1 

HEAR 

Human Immunodeficiency Virus 1 HIV I 


HERT 

PAGE 4 OF 9 

Involuntary INVOL 

Irrigation 

Joint JT 

Jugular Vein Distention 

Junctional Rhythm 

Keep Vein Open 

Kilogram 

Knock Out 

-- - 

Laboratory 

JVD 

JR 

KVO 

kg 

KO 

1 LAB

Laceration 

Large 

Middle 

Midline 

Section 4: Records / Documentation 

-- - - 

Last Normal Menstrual Period LNMP Military Anti-Shock Trousers 

Lateral 

I 

LAT 

@ 

Milliequivalent 

Left / Liter Milligram 

m!3 

Left Bundle Branch Block LBBB 

Milliliter 

Left Lower Extremity 1 LLE Minimal Blood Loss 

Left Lower Quadrant 

Left Upper Extremity 1 LUE 

Left Upper Quadrant 

Level / Loss of Consciousness 

Licensed Vocational Nurse 

Liquid 

LLQ 

LUQ 

LOC 

Liters per Minute LIMIN 

Long Backboard 

Lumbar Spine 

Lumbar Vertebrae L-I , L-2, etc. 

Meconium 

Medical 

Medical Doctor 

Medications 

Mental Retardation 

--- -- 

Mentally Disordered Person MDP 

Microdrop 

Midclavicular Line 


MCIGlT 

MCL 

PAGE 5 OF 9 

Mobile lntensive Care Nurse 

Mobile lntensive Care Unit 

Moderate 

Month 

Morning 

Morphine Sulfate /Multiple 

Sclerosis 

Most Accessible Receiving (facility) 

Motor Vehicle Accident 

Motorcycie Accident 

Moves All Extremities 

Multifocal 

Multiple 

Myocardial Infarction 

Nasal Cannula 

Nasogastric Tube 

Nasopharyngeal 

Nausea 1 Vomiting 1 Diarrhea 

Negative 

MAST 1 

mL 

MBL 

MICN 

MICU 

MOD 

MO 

AM 

MAR ' 

MVA

Neonatal Intensive Care Unit NICU 

Newborn 1 NB 

Nitroglycerine 

No Apparent Distress 

No Known Allergies 

Non-breathing, Unconscious, Pulseless, Nupu 

Unresponsive 

Normal I N 

Normal Saline 1 NS 

Normal Sinus Rhythm 1 NSR 

Normal Spontaneous Vaginal 

Delivery 

Not Applicable I Not Available NIA 

Nothing by Mouth 1 NPO 

Notice of Privacy Practices 1 NPP 

Object I Objective 1 OBJ 

Obstetrical I Gynecological 1 OBIGYN 

Occasional OCC 

Organic Brain Syndrome OBS 

Oropharyngeal OP 

Ounce OZ 

Overdose OD 

Oxygen 02 

Pacemaker Rhythm PMR 

Palpation 1 PALP 

Para I Pulse P 

I 

Paroxysmal Supraventricular Tachycardia 

Partial Pressure of Carbon Dioxide 

Partial Pressure of Oxygen 

Past Medical History 

Patient 1 Physical Therapy 

Pedal Edema 

Pediatric 

Pediatric Medical Center 

Pediatric Trauma Center 

PSVT 

PO2 

PMH 

PED ED 

PED 

PMC 

PTC 

Pelvic Inflammatory Disease PID 

Penicillin 

Percussion 

- 

PCN 

PERC 

Per Rectal PR 

Personal Protective Equipment 

Possible 

PPE 

POSS 

Posterior POST 

Postoperative 

Postpartum 

Paramedic I Afternoon 1 Evening PM Private 

Prehospital Care Coordinator 

Premature Atrial Contraction 

Premature Junctional Contraction 

Premature Ventricular Contraction 

POST OP 

PCC 

PAC 

PJC 

PVC 

Prenatal Care PNC 

Prior To Arrival 

Paroxysmal Nocturnal Dyspnea PND Private Medical Doctor PMD 


PTA 

PVT

[ Protocol PRO 

ABBREVIATIONS 

Proximal PROX 

Public Access Defibrillator PAD 

Pulmonary Edema PUL ED 

Pulmonary Embolus 

Pulseless Electrical Activity 

PEA 


Sacral Spine S-S P 

Saline Lock I Sublingual SL 

seizure -ffD 

----.....-- -- 

Sexually Transmitted Disease 

Short Backboard SBB 

Shortness of Breath 1 SOB 

Pulses 1 Movement 1 Sensation PMS 

Pupils Equal and Reactive to 

Light 

Radial 

Range of Motion 

Red Blood Cell 

Refused Medical Assistance 

PERL 

RAD 

ROM 

RBC 

RMA 

Sinus Arrhythmia 

Sinus Bradycardia 

Sinus Tachycardia 

small 

Small Bowel Obstruction -+ 

SA 

SB 

1 SBO 

Registered Nurse 

Resident Of 1 Rule Out 

Respiration 

Respiration Rate 

wo 

RESP 

solution 1 SOL 

Specialty Center 

Standing Field Treatment Protocol 

Stab Wound 

Returned by Radio RxR Subcutaneous 

Revised Trauma Score 

Rheumatic Heart Disease 

Right 

RTS 

RHD 

Right Bundle Branch Block RBBB 

Right Lower Extremity 

Right Lower Quadrant 

Right Upper Extremity 

Right Upper Quadrant 

RLE 

RLQ 

RUE 

RUQ 


Subjective 

Substernal Chest Pain 

Sudden Infant Death Syndrome 

Suppository 

SQ 

SUBJ 

SSCP 

SIDS 

SUPP 

-


-- 

Supraventricular Tachycardia SVT Unconscious 

UNC 

Symptom 

Syrup 

Tablet 

Tachycardia 

Temperature 

Tender Loving Care 

Tetanus Toxoid 

SYR 

TAB 

TACH 

Thoracic Spine T-SP 

Thoracic Vertebrae 

Three Times a Day 

Times / By 

To Keep Open 

(Total) Body Surface Area 

Traffic Accident 

Traffic Collision 

Transient Ischemic Attack 

Transport 

Treatment 

Tuberculosis 

Twice a Day 

Tylenol 

Unable to Locate 


T 

Unifocal 

Upon Our Arrival 

Upper Gastrointestinal 

Upper Respiratory Infection 

Urinary Tract Infection 

TLC Venereal Disease 

T-1. T-2. etc. 

TID 

x 

TKO 

Ventricular Fibrillation 

Ventricular Tachycardia 

Verbal Order 

Vital Signs / Versus 

Volume 

Water 

(T) BSA Watt-Second 

TIA 

TRANS 

Weak 

Weight 

--- 

Well Developed / Well Nourished 

White Blood Cell 

Wide Open 

With 

--- 

UOA 

UGI 

URI 

UTI 

VOL 

H20 

WDIWN 

WBC 

BID Within Normal Limits WNL 

TY L 

UTL 

Without 

YearIOld Female 

YearIOld Male

0 

Year I Old Male 

Decrease I Negative 1 Minus 1 - 

Equals 

Female 

Greater Than 

Increase I Positive I Plus 

c 

.No 

Less Than 

Change 

Number 

Percent 1 % 

Secondary To 


Section 4: Records 1 Documentation

Section 4: Records & Documentation 

BIBLIOGRAPHY 

M-S Unit Inventory 1 LAFD Book 33 1 Ref. No. 702 

'advance Health Care Directives (AHCD) 

EMS UPDATE 2003 

UTE (Apparent Life Threatening Event) 

LAFD Book 33 Ref. No. 808.1 

'aMA/Patient Refusal of Treatment or Transport 

LAFD Book 33 

Dept. Bulletin 

Ref. No. 834 

No. 01-10 

'application of Patient Restraints 

LAFD Book 33 Ref. No. 838 

'aspirin Administration to Chest Pain Patients 

Dept. Bulletin No. 99-20 

'assessment of Altered Level of Consciousness 


Glasqow Coma Scale (GCS) 


Revised Trauma Score (RTS) 

EMS UPDATE 1999 

ksessment Unit Inventow 

apparatus Maintenance 

1 I 

1 

LAFD Book 33 1 Ref. No. 703 

I 

LAFD Book 8 1 Module 4 

1 I 

'automated External Defibrillators 

Base Hospital ContactlTransportation Criteria 

Body Armor Vests 

Bomb Scene Incidents 

Burn Patient Destination 

CAUOSHA and FEDIOSHA Notifications 

Cellular Telephone Procedures 1 Dept. Bulletin 1 No. 98-17 

I I 

Communicable Disease Decontamination 

Communicable Disease Exposure and Notification (F-420) 

Source Patient HIV Status 

Source Patient HIV Status Flowchart 

Petition for Order to Test Blood (Accused) 

Infectious Disease Protocols 


Conditionally Available (CAV) & Non-Available (NAV) 

Decompression EmergenciesIPatient Destination 

Determination I Pronouncement of Death in the Field 

Training Bulletin No. 64 

Dept. Bulletin No.98-14, 99-11, 99-14 






MOP, Vol. 1 2/1-4234 & 2/1-56.01 

Dept. Bulletin No. 96.29 






Training Bulletin 





Training Bulletin 

Ref. No. 836.2 

Ref. No. 836 

Ref. No. 836.1 

Ref. No. 836.3 

No. 82 

Ref. No. 810 

No. 98-20 

Ref. No. 518 

Ref. No. 814 

No. 100 

Disposing of Medical Waste 1 MOP, Vol. 1 1 211-84.60 

I I 

EMS Report Short Form for Multi Casualty Incidents (MCI) 

EMS UPDATES 1996-1997,1999,2000,2001,2002,2003 

EMS Safety Eye Shield and Face Masks 

EMT-1 Scope of Practice 


PAGE 1 OF 3 




No. 03-19 

No. 92-7 

Ref. No. 802

BIBLIOGRAPHY 


Eaui~ment Retrieval Procedure 

Firelighter Burn Injuries 

Health Insurance Portability and Accountability Act (HIPAA) 

1 




I Ref. No. 708 

I No. 99-09 

1 No. 03-1 1 

Honoring Prehospital Do-Not-Resuscitate (DNR) Orders LAFD Book 33 Ref. No. 815 

Hospital Directory LAFD Book 33 Ref. No. 501 

Hospitals Requesting Diversion of ALS Units (Guidelines) LAFD Book 33 Ref. No. 503 

Hospital Status Information via Mobile Data Terminals (MDTs) Dept. Bulletin No. 98-21 

Infectious Disease Protocols 

LAFD EMT Re-certification Training Course 


Lifepak 12 Cardiac MonitorIDelibrillator Use Dept. Bulletin No. 0506 

Management of Multiple Victim Incidents LAFD Book 33 Ref. No. 519 

Medical Guidelines (DHS) LAFD Book 32 

Medical Supplies and Pharmaceuticals Dept. Bulletin No. 04-08 

Minimum Equipment Used on Incidents LAFD Book 63 Pg. 54-55 

Multi-Casualty Incident Procedures LAFD Book 70 

Multi-Casualty Medical Supply Cache 

Notice of Privacy Practices (NPP) 1 




No. 89-8 

No. 04-03 

I No. 03-1 1 

Paramedic Emergency Care, Third Edition, Brady, 

1997 Paramedic Training Institute, January 1997 

Syllabus 1 Syllabus 6 

Prehospital Emergency Care, 6th Edition, Brady, 2000 

Patient Destination Guidelines LAFD Book 33 Ref. No. 502 

Decompression Emergencies LAFD Book 33 Ref. No. 518 

Sexual Assault Patient Destination LAFD Book 33 Ref. No. 508 

Pediatric Patient Destination LAFD Book 33 Ref. No. 510 

Perinatal Patient Destination LAFD Book 33 Ref. No. 51 1 

Patient Resolution Guide (PRG) Training Bulletin No. 18 

Patient Transportation Policy 1 Dept. Bulletin 1 No. 04-22 

I , 

Police Custody (Patient Care Policy for Patients in Custody) 1 Dept. Bulletin 1 No. 04-17 

I , 

Reporting of AbuseINeglect-Child, Elder, Dependent Adult 


LAFD Book 33 No. 822,829 

Rescue Ambulance Preventative Maintenance 1 MOP, Vol. 5 ! 

, 

Rescue Equipment Loan Slip (F-215M) MOP, Vol. 5 917-00.00 (1 -89) 

Safety Precautions While Using RA Gurneys 

Service Areas 

Situation Report (F-904) 

' 

1 I 

1 




No. 96-1 1 

1 No. 94-21 

I 

1 No. 01-06 

Spinal Immobilization 

I I 


START (Simple Triage and Rapid Treatment) LAFD Book 70 

Suspected Child Abuse Reporting Guidelines LAFD Book 33 Ref. No. 822 

Suspected Elder and Dependent Adult Abuse Reportinq LAFD Book 33 Ref. No. 829 


PAGE 2 OF 3

BIBLIOGRAPHY 


Towing Apparatus Procedures 1 MOP, Vol. 4 p~/3-44.01 

Trauma Catchment Areas 1 LAFD Book 33 I Ref. No. 504 

1 

I I 

Trauma Hospital Temp. ClosureIDiversion 


of Trauma Patients 

Trauma Triage 



Transporting Patients in Custody 1 Dept. Bulletin 1 No. 93-12 

I I 

Trans. Pre-paid Health Plan Members to Kaiser Facilities 

Treatment 1 Transport of Minors 

Trial Program-Emergency Medical Service Areas for California 

& Good Samaritan Hospitals 

Trial Program, Hospital Transportation Service Areas 



Dept, 

Ref. No. 506 

Ref. No. 838 

No. 03-12 

Ref. No. 832 

V-Vac Hand Powered Suction Unit 1 Training Bulletin 1 No. 72 

I I 

Variable Staffed BLS Ambulance Program 1 Dept. Bulletin 1 No. 04-22 


PAGE 3 OF 3 


No. 92-3 

No. 90-17

I 

Los Angeles Fire Department 

EMS FIELD MANUAL 

Book 35 

Record of Revisions 

Keep your manual current. After receiving and filing additional or revised pages, initial and date 

the appropriate columns following the change number. 

No blanks should appear between initialed blocks. If you have failed to record a revision notice or 

have not received one, notify the Quality Improvement Section at (21 3) 485-71 53. 

CHANGE INITIAL DATE CHANGE INITIAL DATE 

NOTICE # NOTICE # 

*** Revisions incorporated into manual PAGE I OF 2 Revised: 512005

Book 35 - EMS Field Manual - LAFD Training

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