General Operations

The General Operations Module also covers information covered in the Policies & Procedures Manual and Medical Procedures Reference as well as from the Collaborative Protocols. Questions directly referencing protocol medication specifics will also be found in this module.  Anticipate seeing questions in this module concerning medication math,

The following are excerpts from the Policies & Procedures Manual:

SECTION 1: Clinical Judgment Policy

The Hudson Valley Regional EMS ALS Protocols are guidelines which should be used in conjunction with good clinical judgment. Since patients do not always fit into a rigid formula approach, situations may occur which are not included in these protocols. In situations where there is no existing protocol and a clear need for ALS exists, the ALS provider shall contact Medical Control who shall order the most appropriate treatment within the provider’s scope of practice as defined by level of training, certification, and protocols.

SECTION 2: Protocol Exceptions Policy

Should a situation arise which fails to conform to the Regional ALS Protocols, the ALS Provider and on-line Medical Control Practitioner may agree upon an altered course of action. Should either the Medical Control Practitioner or the ALS Provider not agree upon carrying out the altered course of action, either has a right to refuse the action.
All implemented Medical Control Orders must be documented on the PCR and/or addendum.
In any instance where consensus about orders cannot be reached, then all standing orders as well as medical control orders, for which there is consensus, will be completed and documented.
Any issues for which consensus is not reached will be referred to quality assurance mechanisms via appropriate agency and HVREMAC policies.
While acting in a setting which falls beyond the scope of the ALS Protocols, no ALS Provider shall be faulted or suffer punitive action for:
–  Following on-line Medical Control orders, provided the orders are within the ALS Provider’s standard of care, scope of practice and qualifications.
–  Refusing to follow an order which the ALS Provider believes to increase risk to the patient;
–  Refusing to perform a procedure which is beyond the ALS Provider’s standard of care, scope of training and qualifications.
Whenever an action occurs outside the ALS Protocols, the Medical Control Practitioner and the ALS Provider shall each generate and forward a report of the action to the HVREMAC within three (3) days of the occurrence.


SECTION 5: Transfer of Care Policy

1. ALS Providers may transfer care of a patient to another provider within the following provisions:
a. To an equal or higher level of care provider:
i. When transport is by helicopter critical care team.
ii. When transport is by another provider/service with the same level of qualifications.
iii. When patient is turned over to an appropriate receiving facility.
iv. When ALS capabilities are exceeded (ex. MCI) and patient is triaged to other ALS or BLS services.

b. To a lower level of care provider:
i. When the ALS Provider at the scene recognizes that there is no indication for ALS intervention. The ALS provider may release patients not having received, or not requiring ALS care, to Basic Life Support personnel for care and transportation to an appropriate receiving facility provided the presumptive diagnosis does not anticipate the need for ALS care. This can only be accomplished when the lower level provider accepts care.
ii. When ALS capacity is exceeded (ex. MCI) and patients are triaged to other ALS or BLS services.
iii. After providing ALS level care, in consultation with online medical control, and with the acceptance of the BLS medical provider. All documentation must include the number of the medical control practitioner.
iv. When a coroner or other appropriate agency takes custody.

In each situation, the ALS Provider will document the type of incident on the PCR or appropriate supplemental document.


SECTION 8: Destination Decisions Policy

Patients shall be transported to the nearest appropriate hospital, as defined by state/regional protocols, medical condition, and patient choice. ALS providers must make every effort to educate and inform patients of the need to go to the most appropriate facility.
Medical Control must approve any anticipated deviation from this standard.
When transportation is not to the nearest appropriate hospital, the ALS Provider shall contact Medical Control at the intended receiving hospital to see if they are willing to accept that patient. All communications will be documented in accordance with the Communications Policy. If the intended receiving hospital is not a Medical Control hospital, the provider must contact medical control at any Medical Control Hospital.
When patients are transported to a hospital not providing the Medical Control for the transport, the Medical Control Practitioner will notify the clinical practitioner (Physician, Physician’s Assistant, or Nurse Practitioner as appropriate) designated as in charge of the Receiving Hospital emergency department of the transport and the patient treatment/status.


Resource: Clinician on the Scene

NON-REGIONALLY Credentialed Clinician
• Verify the identity and specialty of the clinician with the patient, family members or
through any written credentials
• If the identity CANNOT be verified, initiate any treatment indicated per protocol, and
consult REGIONAL Medical Control Physician as soon as possible. The clinician on the
scene may speak to the REGIONAL Medical Control Physician if he/she desires
• If the identity CAN be verified, request the clinician to sign the Clinician Release Form and
go with the patient in the ambulance
• If the clinician is willing to sign the Clinician Release Form and accompany the patient in
the ambulance, make equipment available to the clinician for their treatment, and assist
with the transportation of the patient
• If the clinician is not willing to both sign the Clinician Release Form and accompany the
patient in the ambulance, initiate treatment per the protocols and contact Medical Control
• If you are called to a clinician’s office, the patient is under the clinician’s care until the
clinician releases the patient to your care
• If there are any conflicts or questions, contact Medical Control Physician
Key Points
• Clinicians include, but are not limited to: physicians, physician assistants, nurse
practitioners, midwives
REGIONALLY Credentialed Medical Control Physician
• Verify the REGIONAL Physician’s credentials
• If the Physician is able to accompany the patient in the ambulance add the REGIONAL
Physician’s name and identification on the PCR
• If the on scene Physician is not able to accompany the patient in the ambulance consult
Medical Control Physician and request the 2 physicians confer
• Transport as appropriate and contact Medical Control Physician as needed
• Document both physicians’ identification on the PCR