Book 35 - EMS Field Manual - LAFD Training

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Section 1: Field Procedures 1 Protocols 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 . Revised: 512005 The RTS is heavily weighted toward the GCS to compensate for major head injury without multi-system trauma or major physiological changes.
Section 1: Field Procedures 1 Protocols 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. Revised: 512005 PAGE 1 OF 1
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Page 4 and 5: EMS Field Manual (Book 35) TABLE of
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Page 16 and 17: CHILD / ELDER / DEPENDENT ADULT ABU
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Page 36 and 37: CALIFORNIA CENTINEIA FREEMAN- MEMOR
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Page 41 and 42: - - 1 CALIFORNIA MEDICAL CENTER [CA
Page 43 and 44: 1 LEGEND CAL Revised: 05/2005 CALIF
Page 45 and 46: CEDARS-SINAI MEDICAL CENTER " 1 TRA
Page 47 and 48: UCLA HOSPITAL CENTER CATCHMENT AREA
Page 49 and 50: HENRY MAY0 NEWHALL MEMORIAL HOSPITA
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CSM NRH UCL LEGEND UCLA MEDICAL CEN
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Section 2: Transportation 1 Destina
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,) Section 2: Patient Transportatio
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Section 2: Trans~ortation 1 Destina
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MHG CNT MLK SFM HGH Section 2: Tran
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Section 2: Patient Trans~ortation 1
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A Section 2: Patient Trans~ortation
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Section 3: Apparatus 1 Equipment .
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CAV / NAV Section 3: Apparatus / Eq
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tion 3: Apparatus 1 Equipment MULTI
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BASE HOSPITAL HAILING AND CHANNEL A
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Section 4: Records 1 Documentation
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Abdomen ABD Abortion AB Apical Puls
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-- Section 4: Records I Documentati
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Laceration Large Middle Midline Sec
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[ Protocol PRO ABBREVIATIONS Proxim
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0 Year I Old Male Decrease I Negati
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BIBLIOGRAPHY Section 4: Records 1 D
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I Los Angeles Fire Department EMS F
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Book 35 - EMS Field Manual - LAFD Training

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