Current through Register Vol. 50, No. 9, September 20, 2024
A. In parishes where the parish or component
medical society has established a written out-of-hospital EMS protocol for use
within its jurisdiction, the ambulance service shall follow that protocol,
and/or the protocols of the Louisiana Emergency Response Network as
applicable.
B. In parishes where
the parish or component medical society have not established a written
out-of-hospital EMS protocol for use within its jurisdiction, the EMS service
shall develop a protocol to be used by its personnel. The appropriate portions
of this protocol shall be approved by the parish or component medical
society.
C. At a minimum, protocols
shall include the care of the following conditions for adult (if applicable),
geriatric (if applicable) and pediatric (if applicable) patients:
1. abuse and neglect;
2. active seizure;
3. acute coronary syndrome (STEMI,
bradydysrhythmias, supraventricular tachycardia, suspected cardiogenic chest
pain or suspected myocardial infarction, ventricular tachycardia);
4. anaphylactic reactions;
5. behavioral health;
6. bites and envenomation;
7. burns;
8. cardiac arrest;
9. childbirth;
10. drowning;
11. eclampsia;
12. functional needs (special healthcare and
technology dependent);
13. head
injury;
14. hemorrhage (internal,
external);
15.
hyperthermia;
16.
hypoglycemia;
17. injuries from
weapons of mass destruction;
18.
mass casualty incidents;
19.
neonatal resuscitation;
20.
obstetrical emergencies;
21.
orthopedic injuries;
22. pain
management;
23. patient with
advanced directives;
24.
prehospital diversion/patient destination;
25. respiratory emergencies (distress,
failure, arrest);
26. shock
(all-inclusive);
27. stroke or
suspected stroke;
28.
sepsis;
29. suspected
poisoning/drug overdose;
30.
syncope;
31. traumatic
injuries;
32. treatment induced
unconsciousness, altered mental status, hypotension or respiratory depression
from physician ordered or protocol appropriate paramedic administered
narcotics; and
33. unconsciousness
or altered mental status;
D. The EMS service shall adopt the protocols
established by the Louisiana Emergency Response Network (LERN) or develop an
agency specific protocol with specific language related to the transportation
of the following patients:
1. Acute stroke
patients shall be transported to the closest appropriate comprehensive stroke
center, thrombectomy capable stroke center, primary stroke center, or acute
stroke ready hospital; however, acute stroke patients exhibiting signs or
symptoms of airway, breathing or circulatory compromise, or any other
potentially life-threatening emergency, as defined by protocols implemented by
the ambulance service's medical director, shall be transported to the closest
appropriate hospital capable of caring for the patient's emergency condition.
a. Acute stroke patients may also be diverted
to the closest appropriate hospital by order of LERN or online medical control
from the local facility, potential receiving facility, or medical
director.
2. Patients
suffering an acute ST elevation myocardial infarction (STEMI), occlusion
myocardial infarction (OMI), or non-occlusion myocardial infarction (NOMI)
shall be transported to the closest appropriate STEMI receiving center or, when
appropriate, a STEMI referring center.
3. In any case where the treating EMS
Practitioner's evaluation, according to protocol, indicates a potentially
unstable condition or potential medical emergency that, if traveling the extra
distance to the recommended appropriate facility could put the patient at
higher risk, the EMS Practitioner in his/her discretion may divert to the
nearest appropriate facility.
E. All protocols shall:
1. meet or exceed the requirements of these
licensing standards and all applicable federal, state, and local
laws;
2. be consistent with the
current National EMS Education Standards, the Louisiana Scope of
Practice and the rulings of the Louisiana EMS Certification
Commission;
3. be reviewed annually
by the licensed agency's medical director, or the parish medical
society;
4. be immediately
available to the department when requested for investigations and during
surveys; and
5. contain medical
directives for substitute medications during a national drug
shortages.
F. Ambulance
services are accountable for assuring compliance with applicable protocols by
their personnel. Exceptions to these protocols must be reviewed on a
case-by-case basis by the medical director.
1.
Treatment decisions shall be considered given the current health status of the
patient in conjunction with all of the associated risks factors including, but
not limited to, distance to the nearest stroke facility.
G. Ambulance services must produce, and
provide to all personnel, a policy and procedures manual governing the
service's operation and shall hold all personnel in compliance.
AUTHORITY
NOTE: Promulgated in accordance with
R.S.
36:254,
R.S.
40:1135.1 and
40:1135.2.
