Rhode Island Emergency Medical Services Statewide EMS Protocols October 2016Rhode Island Department of Health

Special SituationsSection 6

Special SituationsGeneral Changes and Additions• This section has 7 protocols.

Medical ProtocolNew Protocol Previous Protocol

Previous Protocol Section

6.01 Multiple Patient Incident 6.6 Major Incident Special Situations6.02 Helicopter Emergency Medical Services (HEMS) 6.1 Air Ambulance (Helicopter) Special Situations6.03 Medical Orders for Life Sustaining Treatment /Comfort 1 6.3 Comfort 1 Special Situations

6.04 Refusal of Patient Care NEW – not in previous version

6.05 Interfacility Transport 6.5 Interfacility Transfer Special Situations

6.06 Patient in Police Custody 5.3 Patient Subdued by Taser® Traumatic Injuries

6.07 Specialized Patient Care 6.8 Specialized Patient Care Special Situations

6.01 Multiple Patient Incident

Protocol Summary

• Replaces RIEMS Protocol 6.6 entitled “Major Incident”.

• This protocol is for all levels of care.

• Incorporates the START/Jump START triage algorithm.

6.01 Multiple Patient Incident

Protocol Summary

• Unlike the former Major Incident protocol the Multiple Patient Incident (MPI) protocol is all-hazards centric rather than terror/CBRNE focused.

• Promotes municipally-driven MCI planning to support this protocol.

6.02 Helicopter Emergency Medical Services (HEMS)

Protocol Summary

• Replaces RIEMS Protocol 6.1 entitled “Air Ambulances (Helicopter)”. This protocol is for all levels of care.

• Increases the from scene to ED transport timeframe from 30 minutes to > 45 minutes.

• Highlights the fact that helicopter to scene travel time and ground transport to a suitable landing zone need to be factored when determining actual patient travel time to a hospital facility.

6.03 Medical Orders for Life Sustaining Treatment (MOLST) and Comfort 1

Protocol Summary

• Replaces RIEMS Protocol 6.3 entitled “Comfort1”.

• Protocol is for all levels of care.

• Affirms that an appropriately executed MOLST applies in and out of hospital/care facility settings and is to be followed by EMS.

• For patients with appropriately executed Comfort 1 documentation, the individual’s palliative care measures (to include manual airway management, suctioning, etc.) are to be applied.

MOLST Form

6.04 Refusal of Patient Care/Transport

Protocol Summary

• New protocol for all levels of care.

• Sets standards and provisions for what is considered to be competent and acceptable standards a patient refusal.

6.04 Refusal of Patient Care/Transport

Protocol Summary

Evidence of altered mental status, including from alcohol intoxication, makes the patient unable to competently refuse transport and care.

The altered mental status may be from a medical emergency and requires hospital evaluation.

6.05 Interfacility Transport

6.06 Patient in Police Custody

Protocol Summary

• Replaces RIEMS Protocol 5.3 entitled “Patient Subdued by Taser®”.

• This protocol is for all levels of care.

• Added to the previous protocol that was limited to conductive energy weapons (Taser), this protocol now includes persons exposed to OC/Cap-Stun spray.

• Added protocols relative to persons suffering from excited delirium.

6.07 Specialized Patient Care

Protocol Summary

• This protocol is for all levels of care.

• Routine Patient Care• Attempt to contact most

knowledgeable person • Emergency Care Plan

• Follow ECP• Transport Patient

Continue on to RI EMS Procedure Protocol ModuleSection 7