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ACADEMY OF MEDICINE OF CINCINNATI
SOUTHWEST OHIO
ADMINISTRATIVE PROTOCOLS AND PROCEDURES
FOR PARAMEDIC SERVICES
320 Broadway, Cincinnati, Ohio 45202
Approved July 2002
I. INTRODUCTION
A. In consideration of the agreement by the undersigned emergency medical services
to abide by the provisions of these administrative protocols and procedures,
the Academy of Medicine authorizes and permits the undersigned emergency medical
services to operate under the auspices of the Academy of Medicine and to utilize
the Academy of Medicine's Protocols and Standing Orders for Paramedic Services.
B. These administrative protocols and procedures are the result of a cooperative
effort among the members of the Academy of Medicine, Hamilton County Fire Chiefs
Association, and others. It is intended that cooperative efforts between the
Academy and the Hamilton County Fire Chiefs Association shall continue and that
such cooperative efforts shall underscore any interpretations of these administrative
protocols and procedures.
C. It is recognized by the parties hereto that several committees and organizations
are involved in the provision of emergency medical services provided under the
auspices of the Academy of Medicine. These include:
1. The Academy of Medicine of Cincinnati:
a) The Academy of Medicine of Cincinnati will serve as the official
body for establishing medical policy for emergency medical services operating
in and around Hamilton County, Ohio, pursuant to Ohio Revised law. The Protocols
and Standing Orders for Paramedic Services issued by the Academy of Medicine
constitutes the community standard for the provision of pre-hospital medical
care. The Academy of Medicine will communicate all medical policy to the Hamilton
County Fire Chief's Association, to Departments or Agencies providing emergency
medical services under the auspices of the Academy of Medicine, and to individual
paramedics through the various committees and subcommittees organized under
the auspices of the Academy of Medicine. The Academy of Medicine will also
mediate conflicts arising within the emergency medical service through the
grievance procedures set forth in the administrative protocols.
2. Emergency and Disaster Services Committee (EDS):
a) The EDS Committee will be compromised of physicians and other
persons with interest and/or expertise in emergency services and/or disaster
services appointed by the president of the Academy. The EDS Committee may
also include three representatives appointed by the Hamilton County Fire Chiefs
Association; one representative from the Tri-State Trauma Coalition, one representative
from the Metropolitan Medical Response System, and one representative from
the Health Council. Other members will be considered on a case by case basis.
The chairman of the EDS Committee will be a member of the Academy of Medicine
appointed by the president of the Academy. This committee will advise the
Council of the Academy about issues pertaining to emergency medical services.
One member of this committee will be designated to coordinate disaster planning.
3. Southwest Ohio Pre-Hospital Care Operations Committee (SWOPHCOC):
a) The SWOPHCOC will be an ad hoc committee of the Academy of Medicine.
The membership will include emergency physicians, emergency nurses, paramedics
and EMTs, with each hospital and squad represented equally. Members of the
committee shall be appointed by the president of the Academy. The PHCOC will
report to and receive guidance from the EDS Committee.
4. The Compliance and Inspection Subcommittee of the Pre-Hospital Care Operations
Committee (C/I):
a) The Compliance and Inspection Subcommittee of the PHCOC will
be composed of members appointed by the president of the Academy and may include
at least one member from each of the following categories:
(i) Emergency Physician;
(ii) Emergency Nurse;
(iii) EMT-P;
(iv) EMT B;
(v) Representative from the EMS Caucus of the Hamilton County Fire Chiefs
Association.
b) The Compliance Subcommittee will be chaired by a physician member of
the Academy of Medicine appointed by the president of the Academy. The function
of the subcommittee will be to perform original site visits and repeat site
visits as determined by the administrative protocols and to investigate
complaints about pre-hospital care in accordance with these administrative
protocols. The Compliance Committee shall report on all matters to the EDS
Committee
5. Hamilton County Fire Chiefs Association: The Hamilton County Fire Chiefs
Association, consisting of major providers for the delivery of emergency medical
care by the fire service within Hamilton County, will operate their services
under the community standards set forth in the administrative and medical
protocols and standing orders issued by the Academy of Medicine.
6. Other County Fire Chiefs Associations: Other County Fire Chiefs Associations
may adopt the Southwest Ohio Academy of Medicine Administrative Protocols
and Procedures for Paramedic Services and the Southwest Ohio Academy of Medicine
Protocols and Standing Orders for Paramedic Service upon the review and approval
of the EDS Committee.
D. Each Emergency Medical Service which is a signatory, to this agreement agrees
to comply with the following administrative protocols, compliance procedures
and grievance procedures.
II. ADMINISTRATIVE PROTOCOLS
A. Two Paramedics Per Run.
1. Except as otherwise provided in these Protocols or, by the Academy
of Medicine, two (2) certified paramedics shall be on the scene for any situation
where the Protocols and Standing Orders for Paramedic Services are utilized
as the authority to act. One paramedic may transport a patient to the hospital
(with a non-paramedic driver) except in the following circumstances, where two
paramedics shall be present (although one of the paramedics may be the driver),
it is recommended that both paramedics be in back if possible:
a) Patient under CPR;
b) Patient with major trauma or burns;
c) Patient unconscious;
d) Patient actively seizing;
e) Patient suffering airway compromise or significant respiratory distress;
f) Patient with chest pain clinically compatible with myocardial infarction;
g) Patient with deteriorating condition or vital signs;
h) Any situation where one medic feels that he/she needs the assistance
of a second medic
2. These requirements apply to both primary responder units and back-up units.
Scheduling for back-up units shall provide for the availability of two paramedics
to respond just as with the primary unit.
3. If unplanned circumstances arise where only one paramedic is available
to respond, the paramedic shall call for mutual aid or back-up response, if
needed (see a-h above). When one paramedic is unexpectedly alone, the paramedic
shall perform life-saving paramedic skills as quickly as possible and transport
the patient to the nearest appropriate medical facility as soon as possible.
4. In those situations or services where the two (2) required paramedics
will arrive on the scene separately, the following provisions apply:
a) The required two (2) paramedics shall be dispatched simultaneously;
b) The second paramedic shall arrive at the scene within a reasonable amount
of time under all of the circumstances;
c) The second paramedic may be called off if the first paramedic determines
that reliance upon the Protocols and Standing Orders for Paramedic Services
will not be necessary;
d) It is the responsibility of the Emergency Medical Service to document dispatch
and response times for all paramedics in all situations where the two (2)
required paramedics do not arrive at the scene in the same unit or simultaneously;
e) If ten percent (10%) of the runs in any month result in only one (1) paramedic
on the scene where care must be provided under the Protocols and Standing
Orders for Paramedic Services by the one paramedic, then scheduling and any
other changes necessary to correct such problem shall be made. Documentation
of the problem and any corrective action shall be provided to the medical
director and shall be included in the annual report to the EDS Committee;
f) An Emergency Medical Service may obtain an advisory opinion from the EDS
as to the reasonable amount of response time for the second required paramedic
under the particular circumstances confronting the Emergency Medical Service
requesting the opinion.
5. In any situation where there is a single paramedic on the scene intending
to act under the Protocols and Standing Orders for paramedic services, communication
with a.base hospital physician shall be established, if at all possible.
B. 24-Hour Paramedic Service
1. Each emergency medical service that chooses to provide paramedic services
operating under the auspices of the Academy of Medicine shall provide paramedic
services an a 24-hour basis.
2. Each emergency medical service shall be required to show that it has sufficient
certified EMT-Ps to provide 24-hour paramedic service.
C. Voice Communication Capability
1. Each unit used to transport patients shall be equipped with appropriate
voice communication capability.
D. Continuing Education
1. Each paramedic employed by an emergency medical service to provide
paramedic services under the auspices of the Academy of Medicine shall be certified
by the State of Ohio, and shall meet all continuing education requirements.
2. The Academy of Medicine may request additional training that it may deem
necessary.
3. All paramedics are required to maintain current ACLS cards. A 90 day grace
period is allowed when a card expires, to be enrolled in a new course.
E. Required Drugs, IV Solutions, and Equipment for All Paramedic Services
1. Communication equipment capable of voice transmission and compatible with Academy
of Medicine approved medical command base stations.
2. Cardiac monitor and defibrillator and pacemaker.
3. Airway maintenance equipment, including but not limited to:
a) oral airways;
b) bag valve mask;
c) suction apparatus;
d) oxygen delivery equipment;
e) laryngoscope and blades;
f) ET tubes - various sizes;
g) nasopharyngeal airways.
4. Pneumatic anti-shock garment (PASG) or MAST.
5. IV solutions including:
a) normal saline;
b) macro drip IV sets and micro drip piggy back IV sets;
6. Rapid glucose monitoring capability with appropriate CLIA
License
7. Medications sufficient to follow Southwest Ohio Academy of
Medicine Protocols
8. Other Medications Approved by Squad Medical Director
9. Documentation Regarding Compliance with Board of Pharmacy,
State of Ohio and other Licensing bodies
10. All standard EMS equipment.
a) Pulse Oximeter
b) End Tidal CO2 monitoring equipment (either colormetric or
electronic)
c) Esophageal Detector Devise (EDD)
11. Optional Equipment:
a) 12-lead EKG machine
b) Manual Jet Ventilator Device
c) Cricothyrotomy Equipment
d) IV Pump, Syringe Pump
12. If other supplies are added by an emergency medical service, they must be approved by
and used under the authority of the emergency medical service's medical director.
13. Any devices needing manufacturers recommended calibration and service shall have
records of such available for review.
F. Medical Director
1. Each emergency medical service shall have a medical director
who shall be a licensed physician.
2. Duties of Medical Director:
a) Assures the adequate training and continuing education of paramedics.
b) Assures the Academy of Medicine of Cincinnati Southwest Ohio Academy
Of Medicine Protocols and Standing Orders for Paramedic Services are followed
in the management of all patients cared for by the EMT-Ps.
c) Assists in the development of medically related dispatch procedures
and transportation policies.
d) Assists the Administrative Head in establishing criteria for patient
disposition.
e) Assists the administrative head in developing and implementing a quality
assurance program, including systematic audits, to include how problems
are identified and corrected. The quality assurance program should include
a review of run reports. Such a report could include:
(i) runs involving deaths;
(ii) cardiac arrests;
(iii) questioned runs or misadventures;
(iv) repeat runs within 24 hours on the same patient;
(v) runs involving complaints;
(vi) runs involving DNRs;
(vii) a random sampling of 10% of the runs each month;
(viii) runs in which second paramedic did not arrive on the scene within
reasonable amount of time.
f) The medical director shall possess a thorough knowledge of pre-hospital
emergency care, emergency medical systems and emergency medicine. It is
recommended that the medical director be certified in ACLS and BTLS or Board
Certified in Emergency Medicine or Pediatric Emergency Medicine
g) The Medical Director will comply with the requirements set forth by
the State of Ohio and the Regional Physicians Advisory Board for Medical
Director minimum requirements.
G. Variances
1. Application
a) Any emergency medical service may apply to the EDS Committee for a variance
from any of the provisions of the administrative protocols.
b) The application for a variance shall set forth the exceptional circumstances
requiring relief from an administrative protocol giving, in detail, the
reasons for the need for a variance, the duration of the variance sought,
and the terms of the variance.
2. Decision by EDS
a) The EDS Committee shall, within 45 days of receipt of a request for
a variance, conduct a hearing on the request.
b) Prior notice shall be given to the EMS requesting a variance with an
opportunity to be heard.
c) The decision whether to grant or deny a request for a variance or to
grant the variance with conditions or limitations shall be within the sole
discretion of the EDS Committee.
d) The EDS Committee may grant a variance with conditions including limits
on the duration or terms and may impose alternative requirements.
3. Communication Variance Forms shall be submitted to the Medical
Director and the EDS Committee for review.
III. COMPLIANCE PROCEDURES
A. Site Visits
1. A site visit is an inspection of an emergency medical service
by members of the Compliance Committee (including at least one physician and
one paramedic) to ensure compliance with the requirements of the Administrative
Protocols and the Protocols and Standing Orders for Paramedic Services. The
on-site physician member of the inspection team will lead the site visit process
and be responsible for a site visit report. No member of the inspection team
shall have any potential conflict of interest with the Emergency Medical Service
being inspected.
2. Site visits shall be conducted at the time an emergency medical
service requests the right to operate under the auspices of the Academy of Medicine
and every three years thereafter.
3. The emergency medical service will be notified sixty (60)
days in advance of a site visit and will receive a packet of material outlining
the items to be inspected. The packet of material shall include any requests
for information that can be completed in advance of the site visit.
4. In the course of the site visit, the Compliance Committee
team shall inspect the following:
a) Inspect the equipment required for all paramedic services under these
administrative protocols.
b) Document compliance of:
(i) Scheduling and response system (including times)
(ii) Certifications to include list of names of paramedics and EMT B's
(iii) EMT B's with certificate expiration dates with the intent to verify
current certification of all paramedics and EMT B's.
(iv) Organizational structure (including existence of appropriate Medical
Director)
(v) Drug license and drug records
(vi) Review of continuing education, annual reports, squad run sheets,
and all quality assurance programs. Squad run sheet review will include
the form used and how it is completed. Patient identity should not be revealed.
B. Compliance Committee Report
1. Within 90 days of a site visit, the Compliance Committee shall
issue its report, specifying any deficiencies discovered or setting forth its
finding that the emergency medical service has successfully satisfied all of
the requirements of the site visit. If no report is issued within 90 days of
the site visit, a new site visit must be conducted before any deficiencies may
be reported.
2. The Compliance Committee report shall be delivered to the
Fire Chief and/or the administrative head of the emergency medical service,
unless otherwise designated in writing; to the medical director of the emergency
medical service; and to the chairman of the EDS Committee.
3. The emergency medical service may respond in writing to the
Compliance Committee report within 30 days of receipt of that report. The EMS
response shall be delivered to the chair of the Compliance Committee and to
the chair of the EDS Committee.
C. EDS Hearing
1. The EDS Committee shall conduct a hearing concerning the Compliance
Committee site visit report and the EMS response (if any) within 45 days.
2. The EDS Committee shall give prior notice of its hearing to
the EMS and the Compliance Committee.
3. The Compliance Committee and the EMS shall have a right to
be heard at the EDS hearing.
4. The EDS may request additional information from the Compliance
Committee and/or EMS.
D. EDS Decision
1. Upon hearing the Compliance Committee report and the EMS response
(if any), the EDS Committee shall render a decision which may provide any one
or more of the following:
a) Follow-up site visit
b) Corrective action
c) Probation
d) Suspension
e) Termination
E. Promulgation of EDS Decision
1. The decision of the EDS Committee shall be provided, in writing,
to the Fire Chief and the administrative head of the EMS, (unless otherwise
designated in writing); to the medical director of the EMS Department; to the
members of the EDS Committee.
2. The decision of the EDS Committee is neither confidential
nor privileged. (However, to the extent that the Compliance Committee report,
the EMS response, or any other documentation refers or relates to individual
patient care, all matters relating to any particular patient's care shall be
kept confidential.).
F. Right of Appeal
1. Any emergency medical service disciplined by the EDS Committee
as set forth above shall have a right of appeal to the Council of the Academy
of Medicine.
2. There shall be no automatic stay of the decision of the EDS
Committee pending appeal to the Council of the Academy of Medicine.
3. Upon request, the Chairman of the EDS Committee or the President
of the Academy of Medicine may grant a stay pending appeal.
III. GRIEVANCE PROCEDURES
A. Complaint
1. Any Individual or Group may file a complaint to be considered
under these grievance procedures.
2. Any such complaint may be made concerning deviations from
the Protocols and Standing Orders for Paramedic Services, the Administrative
Protocols, or any questioned conduct.
3. The complaint should be filed with the EDS Committee Chairman.
4. Once a complaint is received by the chair of the EDS Committee,
notice shall be given to the Fire Chief and administrative head of the EMS,
the medical director, and to the members of the EDS Committee.
5. No complaint shall be investigated, without the written consent
of all parties involved where:
a) litigation is threatened or pending, until such litigation, including all appeals, is completed; or
b) a collective bargaining or other agreement imposes inconsistent procedures or confers rights that cannot be protected under
these grievance procedures.
B. Investigation of Complaints
1. The chair of the EDS Committee shall appoint a team to investigate
the complaint. The investigators may be from the EDS Committee, the Compliance
Committee, the Pre-Hospital Care Operations Committee or any other individuals
determined by the chairman of the EDS Committee to be appropriate for the investigation.
2. Within 45 days of its receipt of the complaint, the investigation
team shall submit its report and recommendation to the chair of the EDS Committee,
the administrative head of the EMS, and to the medical director.
C. Right of Response
1. The EMS shall have a right to respond to the report and recommendation
of the investigation team within 30 days of receipt of its report.
2. This response should be filed with the EDS Chairman.
D. EDS Hearing
1. The EDS Committee shall conduct a hearing on the complaint,
report and recommendation of the investigation team, and EMS response.
2. Prior notice shall be given to all concerned parties.
3. All concerned parties shall be given an opportunity to be
heard.
4. The EDS Committee may request additional information.
5. The EDS Committee, at the request of all concerned parties,
may conduct an informal hearing or consider only written material.
6. The EDS Committee may waive the hearing if requested by all
concerned parties.
E. Decision of EDS Committee
1. Upon hearing the complaint, investigation report and responses,
the EDS Committee shall render a decision. Sanctions, if any, shall be directed
to the emergency medical service(s) involved, not to any individual.
2. The EDS may require corrective action(s) including, but not
limited to, additional training.
3. The EDS may issue a reprimand, probation, suspension or termination
of the EMS if the complaint is found to be a repeat offense; if the complaint
arises from material administrative violations of the Administrative Protocols;
or if the complaint involves substantial systemic problems.
F. Right-of Appeal
1. Any concerned person or entity may appeal the decision of
the EDS Committee to the Council of the Academy of Medicine.
2. There shall be no automatic stay of the decision of the EDS Committee pending appeal. Upon request, the-Chairman of the EDS Committee or
the President of the Academy of Medicine may grant a stay pending appeal.
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