Prehospital Policies and Protocols

Communication from the EMS Medical Director:

EMS Quality Management Policy - Provisional Implementation on January 6

Prehospital Buprenorphine (Suboxone®) Pilot Program Expansion

EMS Medical Director's Guidance on Measles for EMS Professionals

Fentanyl Dosing Clarification (2024-2025 Protocols)

9-1-1 Navigation Program

Nitazenes: Alert for EMS Professionals

Impact Status Scorecard – Realtime Emergency Department Data Pilot Program Expansion

Destination Policy for Patients Meeting Prehospital Trauma Center Criteria

Prehospital Buprenorphine Pilot Program Implementation Notification

Patient-Centered Care Modification from Paramedic to EMT Transport from Scene to Hospital

EMS Cardiac Monitor Data Retention Community Consensus Guidance

Treatment on the EMS Gurney Community Consensus Guidance

Monkeypox Guidance for EMS professionals is published in the Prehospital and Disaster Medicine journal. A customizable Monkeypox 3I Tool is available.

Xylazine Alert for EMS Professionals

Monkeypox Guidance for EMS Professionals

Formation of the San Diego Resuscitation Consortium Workgroup

Implementation of County Ambulance Diversion

Oxygen Delivery Modalities for IFT Notification

"Leave Behind Naloxone" Program

Fentanyl Implementation

Medical Directors Guidance during Morphine Shortage

Use of IV Acetaminophen in Adults

Capnography use in CCT

The 2026-2027 Protocol Packet is available.

Please also see the following:

2026-2027 Protocol Changelog

2026-2027 Protocol Presentation

FAST-ED Assessment Tool

2025 - 2026 Prehospital Policies and Protocols

All policies and protocols take effect July 1, 2025

2025-2026 Protocol Changelog

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000 - Systems

S-001	Emergency Medical Services System Compliance with State Statutes and Regulations (12/12)
S-002	Policy and Protocol Approval Process (7/24)
S-003	Program Recordkeeping: Training and Certification (7/19)
S-005	EMS Medical Director's Advisory Committee (Base Station Physicians' Committee) (7/07)
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) EMS Medical Director's County Ambulance Diversion Memo
S-011	EMT/Advanced EMT/Paramedic Disciplinary Process (7/25)
S-012	EMS System Quality Management (1/26)
S-013	Quality Care Consortium (1/26)
S-014	Guidelines for Verification of Organ Donor Status (7/17)
S-015	Medical Audit Committee on Trauma (7/18)
S-016	Patient Information/Confidentiality (7/25)
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 (7/25)
S-020	ST-Elevation Myocardial Infarction Critical Care System Designation (7/25)
S-021	De-Designation of an ST-Elevation Myocardial Infarction Critical Care System Center (7/25)
S-022	Infant Safe Surrender (7/19)
S-028	Stroke Critical Care System Designation (7/25)
S-029	Stroke Advisory Committee (7/25)
S-030	Extracorporeal Cardiopulmonary Resuscitation (ECPR) Critical Care System (7/25)
S-070	Special Project Proposals (2/26)

100 - Treatment Protocols

SECTION I	Standards / Glossary / Abbreviations
S-100	Patient Management Standards (7/25)
S-101	Glossary of Terms (7/23)
S-102	Abbreviation List (7/25)

SECTION II	Inventory / Medication Lists and Charts / Skills List
S-103	BLS/ALS Ambulance Inventory (7/25)
S-104	Skills List (7/25)
S-104A	Spinal Motion Restriction Algorithm (7/18)
P-115	Medication List (7/25)
P-115A	Pediatric Weight-Based Dosage Standards (7/24)
P-117	ALS Pediatric Drug Chart (7/25)

SECTION III	Adult Treatment Protocols
S-120	Abdominal Discomfort / GI / GU (Non-Traumatic) (7/24)
S-121	Airway Obstruction (7/25)
S-122	Allergic Reaction / Anaphylaxis (7/25)
S-123	Altered Neurologic Function (Non-Traumatic) (7/25)
S-124	Burns (7/25)
S-126	Discomfort / Pain of Suspected Cardiac Origin (7/25)
S-127	CPR / Arrhythmias (7/25)
S-127A	ECPR Decision Algorithm (7/23)
S-129	Envenomation Injuries (7/24)
S-130	Environmental Exposure (7/25)
S-131	Hemodialysis Patient (7/25)
S-132	Decompression Illness / Diving / Altitude-Related Incidents (7/24)
S-133	Obstetrical Emergencies / Newborn Deliveries (7/25)
S-134	Poisoning / Overdose (7/25)
S-135	Existing Devices and Medications (7/25)
S-136	Respiratory Distress (7/25)
S-138	Shock (7/25)
S-139	Trauma (7/25)
S-141	Pain Management (7/25)
S-142	Psychiatric / Behavioral Emergencies (7/25)
S-143	Sepsis (7/24)
S-144	Stroke and Transient Ischemic Attack (7/24)
S-145	Opioid Withdrawal / Opioid Use Disorder (7/25)
S-145A	COWS Score (7/23)
S-150	CHEMPACK Deployment and Autoinjector Use (7/25)

SECTION IV	Pediatric Treatment Protocols
S-160	Airway Obstruction (7/25)
S-161	Altered Neurologic Function (Non-Traumatic) (7/25)
S-162	Allergic Reaction / Anaphylaxis (7/25)
S-163	CPR / Arrhythmias (7/25)
S-164	Envenomation Injuries (7/24)
S-165	Poisoning / Overdose (7/25)
S-166	Obstetrical Emergencies / Newborn Deliveries (7/25)
S-166A	Out of Hospital Birth Report (7/24) Download Fillable PDF
S-167	Respiratory Distress (7/25)
S-168	Shock (7/25)
S-169	Trauma (7/25)
S-170	Burns (7/25)
S-172	BRUE (Brief, Resolved, Unexplained Event) (7/25)
S-173	Pain Management (7/25)
S-174	Abdominal Discomfort / GI / GU (Non-Traumatic) (7/24)
S-175	Psychiatric / Behavioral Emergencies (7/25)
S-176	Environmental Exposure (7/25)
S-177	Sepsis (7/24)

200 - Air Medical

A-200 Air Medical Treatment Protocol Unified Scope of Practice for California (7/25)

300 - Education

P-300	Paramedic Training Program Student Eligibility (7/15)
P-301	Paramedic Training Program Requirements and Procedures for Approval/Reapproval (7/25)
P-302	Guidelines for Placement of Paramedic Interns in San Diego County (7/18)
P-303	Mobile Intensive Care Nurse Authorization/Reauthorization (7/25)
P-305	Paramedic Accreditation/Reaccreditation (7/25)
S-306	Emergency Medical Services Continuing Education (2/26)
S-308	Public Safety First Aid Training Programs (7/25)
S-308A	Public Safety First Aid Training Programs (Application Form) (7/17)
B-326	EMT-Basic Optional Skills Student Eligibility (5/09)
B-351	EMT Training Programs (7/25)
B-352	EMT Certification/Renewal (7/18)
B-353	EMT Out-of-County Status (7/25)
B-360	Advanced EMT Training Programs (7/25)
B-361	Advanced EMT Certification/Renewal (7/18)

400 - Medical Control

S-400	Management of Controlled Drugs for ALS Agencies (7/25)
P-401	Paramedic Scope of Practice (7/25)
S-402	Prehospital Determination of Death (7/25)
P-403	Physician on Scene (7/14)
P-403A	Note to Physician on Involvement with EMT-Paramedics
P-405	Communications Failure (7/25)
P-405A	Communications Failure Form (7/24) Download Fillable PDF
S-407	Triage to Appropriate Facility (7/07)
P-410	San Diego County Special Assignment - Paramedic (7/25)
S-411	Reporting of Suspected Child, Dependent Adult, or Elder Abuse/Neglect (7/24)
S-411A	Mandated Reporter Flowchart (7/25)
S-412	Prehospital Treatment and Transportation of Adults - Refusal of Care or Suggested Destination, Release (7/25)
S-413	Triage, Multiple/Mass Casualty Incidents, Annex D (7/19)
S-414	Do Not Resuscitate - DNR/End of Life Option (Aid-In-Dying Drug) (7/19)
S-415	Base Hospital Contact/Patient Transportation and Report - Emergency Patients (7/25)
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 (7/25)
P-430	Special Assignment - Fireline Paramedic (7/25)
B-450	EMT Scope of Practice (7/25)
B-451	Advanced EMT Scope of Practice (7/25)
T-460	Identification of the Trauma Center Patient (7/18)
T-460A	Trauma Decision Algorithm (7/24)
A-475	Air Medical Support Utilization (7/25)
S-476	Emergency Medical Services at Special Events (7/25)

600 - Data Collection

S-601	Documentation Standards and Transferral of Prehospital Care Record (PCR) Information (7/25)
S-602	EMS Provider Data Submission Process (7/25)
S-603	System Management and Support During Downtime (7/25)
S-610	Ambulance Patient Offload Time Standard (7/24) Transfer of Patient Care Guidelines (7/24)
S-620	LEMSA Data Use and Standards (2/26)

700 - Base Hospital/Trauma Center

P-701	Paramedic Base Hospital Designation (7/25)
P-702	De-designation of a 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 (7/24)
T-711	De-designation of a Trauma Center (7/21)
T-712	Trauma Center Bypass (7/18)
T-716	Repatriation 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 (7/25)
T-719	Trauma Provider Marketing and Advertising (7/21)

800 - Service Provider Agency

P-801	Designation of Providers of Advanced Life Support Service (7/25)
S-803	Recovery of Prehospital Patient Care Reusable Equipment (7/19)
S-804	First Responder Inventory (7/25)
P-805	ALS First Responder Units (7/25)
B-808	Advanced EMT 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)
S-835	Requirements for Ground Critical Care Transport Services (7/07)
S-836	Critical Care Transport Unit Inventory (7/24)
S-837	Public Safety First Aid Optional Skills Provider Designation (7/25)
N-840	Non-Emergency Medical Transport Wheelchair/Gurney Van Provider's Permit Application Process (7/15)
N-841	Non-Emergency Medical Transport Wheelchair/Gurney Van Service Requirements (7/15)
B-850	Basic Life Support Ambulance Service Provider Requirements (7/15)
A-875	Prehospital EMS Aircraft Classification (7/25)
A-876	Air Ambulance Dispatch Center Designation/Dispatch of Air Ambulance (7/25)
A-877	Air Ambulance Service Provider Authorization (7/25)
S-880	Ground Ambulance EMS Radios (7/17)
S-881	Hospital EMS Radios (7/17)
S-882	Emergency Medical Dispatch Programs (7/24)
S-882A	Emergency Medical Dispatch Plan Template (7/24)

2026 - 2027 Prehospital Policies and Protocols

All policies and protocols take effect July 1, 2026