Prehospital Policies and Protocols

Communication from the EMS Medical Director:

Monkeypox Guidance for EMS Professionals

Formation of the San Diego Resuscitation Consortium Workgroup

2021 Protocol Clarifications and Revisions

Oxygen Delivery Modalities for IFT Notification

"Leave Behind Naloxone" Program

Protocol Guidance - Expanded Stroke Windows, Midazolam, and Ketamine

Fentanyl Implementation

Medical Directors Guidance during Morphine Shortage

Use of IV Acetaminophen in Adults

Capnography use in CCT

2022-2023 protocol update graphic for web

2022-2023 Treatment Protocol packet available now!

Please see the CoSD EMS Protocol Change Log for 2022-2023

Medication shortage information
Normal saline-related guidance
April 20, 2022

Epinephrine-related guidance
April 7, 2022	Use of expired medications
April 7, 2022	New option for push-dose epinephrine preparation
March 29, 2022	Mitigation strategies
February 28, 2022	Cardiac and push-dose epinephrine guidance

Dextrose-related guidance
February 28, 2022

2021 - 2022 Prehospital Policies and Protocols

All policies and protocols take effect July 1, 2021

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000 - Systems

S-001	Emergency Medical Services System Compliance with State Statutes and Regulations (12/12)
S-002	Approval of Emergency Medical Services System Standards, Policies and Procedures (7/07)
S-003	Program Record Keeping: Training and Certification (7/19)
S-004	Quality Assurance/Quality Improvement for the Prehospital Emergency Medical Services System (1/05)
S-005	EMS Medical Director's Advisory Committee (Base Station Physicians' Committee) (7/07)
S-006	Prehospital Audit Committee (7/10)
S-007	Transfer Agreements (7/07)
S-008	Interfacility Transfers - Levels of Care (7/21)
S-009	Guidelines for the Prevention of Transmission of Contagions and Contaminants (7/19)
S-010	Emergency Department Ambulance Diversion (7/21)
S-011	EMT/Advanced EMT/Paramedic Disciplinary Process 07/10)
S-014	Guidelines for Verification of Organ Donor Status (7/17)
S-015	Medical Audit Committee on Trauma (7/18)
S-016	Release of Patient Information/Confidentiality (7/04)
S-017	Downgrade or Closure of Emergency Services in a Hospital Designated as a Basic Emergency Receiving Facility (7/07)
S-018	EMS for Children (EMSC) Advisory Committee (7/02)
S-019	Cardiac Advisory Committee (7/19)
S-020	Designation of a Cardiovascular “STEMI” Receiving Center (7/19)
S-021	De-Designation of a Cardiovascular “STEMI” Receiving Center (7/19)
S-022	Infant Safe Surrender (7/15)
S-028	Designation of Stroke Critical Care Receiving Center (7/19)
S-029	Stroke Advisory Committee (7/19)

100 - Treatment Protocols

SECTION I	Introduction / Glossary / Abbreviations
S-100	Introduction (7/21)
S-101	Glossary of Terms REVISED (10/21) Effective 10/18/21
S-102	List of Abbreviations (7/21)

SECTION II	Inventory / Medication Lists and Charts / Skills List
S-103	BLS/ALS Ambulance Inventory (7/21)
S-104	Skills List (7/21)
S-104(a)	Spinal Motion Restriction Algorithm (7/18)
P-115	ALS Medication List (7/21)
P-115(a)	Pediatric Weight Based Dosage Standards (7/21)
P-117	ALS Pediatric Drug Chart (7/21)

SECTION III	Adult Treatment Protocols
S-120	Abdominal Discomfort/GI/GU (7/21)
S-121	Airway Obstruction (7/21)
S-122	Allergic Reaction/Anaphylaxis (7/21)
S-123	Altered Neurologic Function (Non-Traumatic) (7/21)
S-124	Burns (7/21)
S-126	Discomfort/Pain of Suspected Cardiac Origin (7/21)
S-127	CPR/Arrythmias (7/2021)
S-129	Envenomation Injuries (7/21)
S-130	Environmental Exposure (7/21)
S-131	Hemodialysis Patient (7/21)
S-132	Decompression Illness/Diving/Altitude Related Incidents (7/21)
S-133	Obstetrical Emergencies/Newborn Deliveries REVISED (10/21) Effective 10/18/2021
S-134	Poisoning/Overdose (7/21)
S-135	Pre-Existing Medical Interventions (7/21)
S-136	Respiratory Distress (7/21)
S-138	Shock (7/21)
S-139	Trauma (7/21)
S-141	Pain Management (7/21)
S-142	Psychiatric/Behavioral Emergencies (7/21)
S-143	Sepsis (7/21)
S-144	Stroke and Transient Ischemic Attack (7/21)

SECTION IV	Pediatric Treatment Protocols
S-160	Airway Obstruction (7/21)
S-161	Altered Neurologic Function (Non-Traumatic) (7/21)
S-162	Allergic Reaction/Anaphylaxis (7/21)
S-163	CPR/Arrythmias (7/21)
S-164	Envenomation Injuries (7/21)
S-165	Poisoning/Overdose (7/21)
S-166	Newborn Deliveries REVISED (10/21) Effective 10/18/21
S-166(a)	Out of Hospital Birth Form (7/19)
S-167	Respiratory Distress (7/21)
S-168	Shock (7/21)
S-169	Trauma (7/21)
S-170	Burns (7/21)
S-172	BRUE (Brief, Resolved, Unexplained Event) (7/21)
S-173	Pain Management (7/21)
S-174	Abdominal Discomfort GI/GU (7/21)
S-175	Psychiatric/Behavioral Emergencies (7/21)
S-176	Environmental Exposure (7/21)
S-177	Sepsis (7/21)

200 - Air Medical

A-200 Air Medical Unified Scope (7/2019)

300 - Education

P-300	EMT-Paramedic Training Program Student Eligibility (7/15)
P-301	Paramedic Training Program Requirements and Procedures for Approval (7/17)
P-301A	Paramedic Training Program Application Form (Application Form) (7/16)
P-302	Guidelines for Placement of Paramedic Interns in San Diego County (7/18)
P-302A	Application for Out-of- County Paramedic Internship
P-303	Mobile Intensive Care Nurse Authorization/Reauthorization (7/18)
P-305	Paramedic Accreditation in San Diego County (7/18)
S-306	Designation of Authorized Providers of Continuing Education for EMS Personnel (3/11)
S-306A	Application for Authorization as Approved Provider of Prehospital CE in SD County
S-307	Continuing Education for Prehospital Personnel (3/12)
S-308	Public Safety - First Aid Training Programs (7/17)
S-308A	Public Safety - First Aid Training Programs (Application Form) (7/17)
B-325	Perilaryngeal Airway Adjuncts Training Program Requirements (7/10)
B-326	EMT-Basic Optional Skills Student Eligibility (5/09)
B-351	EMT Training Programs (7/17)
B-351A	EMT Training Programs Application (Application Form) (11/19)
B-352	EMT Certification/Renewal (7/18)
B-353	EMT Out-of-County Status (7/18)
B-360	Advanced EMT Training Programs (7/10)
B-361	Advanced EMT Certification/Recertification (7/18)

400 - Medical Control

S-400	Management of Controlled Drugs on Advanced Life Support Units (7/16)
P-401	Scope of Practice of Paramedic in San Diego County (7/21)
S-402	Prehospital Determination of Death (7/14)
P-403	Physician on Scene (7/14)
P-403A	Physician on Involvement with EMT-Paramedics
P-405	Communications Failure (7/10)
P-405A	Report of ALS Services Provided without Base Hospital Contact
S-407	Triage to Appropriate Facility (7/07)
P-408	Variation from San Diego County Protocols for Advanced Life Support (7/10)
P-408A	QCS Confidential Prehospital Quality Assurance Report
S-409	Reporting of Issues in Patient Care Management (1/05)
P-410	San Diego County Special Assignment - Paramedic (7/10)
S-411	Reporting of Suspected Child, Dependent Adult, or Elder Abuse/Neglect (11/19)
S-411A	Mandated Reporter Flowchart (1/13)
S-412	Consent for Prehospital Treatment and Transport (7/17)
S-413	Triage, Multiple/Mass Casualty Incidents, Annex D (7/19)
S-414	Do Not Resuscitate - DNR (7/19)
S-415	Base Hospital Contact/Patient Transportation and Report (7/18)
S-415A	Assess and Refer Option for Patients During the COVID-19 Pandemic (Expanded January 18, 2022)
S-416	Supply and Resupply of Designated EMS Agencies and Vehicles (7/16)
S-421	Sexual Assault Patient Destination (7/21)
S-422	Application of Patient Restraints (7/12)
P-430	Fireline Paramedic (7/18)
B-450	Emergency Medical Technician Scope of Practice (7/17)
B-451	Advanced Emergency Medical Technician Scope of Practice (7/10)
T-460	Identification of the Trauma Center Patient (7/18)
T-460A	Trauma Decision Tree Algorithm (7/18)
A-475	Air Medical Support Utilization (7/16)
S-476	Emergency Medical Services at Special Events (7/19)

600 - Data Collection

S-601	Documentation Standards and Transferal of Prehospital Care Record (PCR) Info (7/18)
S-602	EMS Provider Data Submission Process (7/18)
S-603	System Management and Support During Downtime (7/18)
S-610	Transfer of Care Guidelines (1/17)
S-610A	Transfer of Care Procedure (1/17)

700 - Base Hospital/Trauma Center

P-701	EMT-Paramedic Base Hospital Designation (3/11)
P-702	De-designation of an EMT-Paramedic Base Hospital (7/05)
T-705	Trauma Catchment Service Area (7/21)
T-708	Trauma Care Coordination within the Trauma System (7/21)
T-710	Designation of a Trauma Center (7/21)
T-711	De-designation of a Trauma Center (7/21)
T-712	Trauma Center Bypass (7/18)
T-716	Transfer of Stable Trauma Service Health Plan Members (7/21)
T-717	Trauma Center Injury Prevention Activities (7/21)
T-718	Public Information & Education on Trauma Systems (7/21)
T-719	Trauma Provider Marketing and Advertising (7/21)

800 - Service Provider Agency

P-801	Designation of Providers of Advanced Life Support Service (3/11)
S-803	Recovery of Prehospital Patient Care Reusable Equipment (7/19)
P-805	Advanced Life Support First Responder Units (7/10)
P-806	Advanced Life Support First Responder Inventory (7/19)
P-807	Wildland ALS Kit Inventory (7/18)
B-808	Advanced EMT Service Provider Designation (7/10)
D-822	Perilaryngeal Airway Adjuncts Service Provider Designation (7/10)
S-830	Ambulance Provider's Permit Application Process (7/15)
S-831	Permit Appeal Process (7/15)
S-833	Ground Ambulance Vehicle Requirements (7/16)
B-834	BLS First Responder Inventory (7/18)
S-835	Requirements for Ground Critical Care Transport Services (7/07)
S-836	Critical Care Transport Unit Inventory (7/17)
S-837	Public Safety - First Aid optional Skills Provider Designation (7/17)
N-840	Non-Emergency Transport Provider's Permit Application Process (7/15)
N-841	Non-Emergency Medical Transport Service Requirements (7/15)
B-850	Basic Life Support Ambulance Service Provider Requirements (7/15)
A-875	Prehospital EMS Aircraft Classification (11/10)
A-876	Air Ambulance Dispatch Center Designation/Dispatch of Air Ambulance (7/17)
A-877	Air Ambulance Service Provider Authorization (11/10)
S-880	Ground Ambulance EMS Radios (7/17)
S-881	Hospital EMS Radios (7/17)

2022 - 2023 Prehospital Policies and Protocols

All policies and protocols take effect July 1, 2022