Lisbon Fire Department Standard Operating Guidelines and Policies

The following content will be considered the Guideline/Standard of care for

• 
  Initial assessment findings and any subsequent changes in the patient’s condition will be documented on the EMS run report
  
• 
  Any deviation from any Guideline/Standards for Care will be documented on the EMS run report.
  
• 
  All pertinent information obtained will be documented in the appropriate section of the EMS run report.
  
• 
  A patient care report must be completed for all patients assessed by the prehospital team.
  

Acceptable charting abbreviations

__

AAA (Triple A) Abdominal Aortic Aneurysm

Abd Abdomen

ACLS Advanced Cardiac Life Support

AED Automatic External Defibrillator

AG Administrative Guideline

AHA American Heart Association

AICD Automatic Implanted Cardiac Defibrillator

AIDS Acquired Immune Deficiency Syndrome

ALS Advanced Life Support

AMA Against Medical Advice

AMI Acute Myocardial Infarction

amp Ampule

amt Amount

ant Anterior

approx Approximately

ARC Aids Related Complex

ASA Acetylsalicylic Acid (Aspirin)

ASAP As Soon As Possible

ASHD Arteriosclerotic Heart Disease

BBB Bundle Branch Block

Bilat Bilateral

Bld Blood

Bld/s Blood Sugar

BLS Basic Life Support

BSA Body Surface Area

BSI Body Substance Isolation

BVM Bag Valve Mask

c With

C Centigrade

CA Cancer, Carcinoma

CABG Coronary Artery Bypass Graft

CAD Coronary Artery Disease

card Cardiac

cath Catheter

cc Cubic Centimeter

CC Chief Complaint

Chemo Chemotherapy

CHF Congestive Heart Failure

CID Cervical Immobilizer Device

Cl Chloride

cm Centimeter

CMS Circulation, Movement, Sensation

CNS Central Nervous System

CO Carbon Monoxide

CO₂ Carbon Dioxide

CP Chest Pain

CPR Cardiopulmonary Resuscitation

CRT Capillary Refill Time

C-section Cesarean Section

C-spine Cervical Spine

CSF Cerebral Spinal Fluid

CSM Circulation, Sensation and Movement

CVA Cerebral Vascular Accident

CVP Central Venous Pressure

D&C Dilatation and Curettage

D/C Discontinue

dec Decrease

d/c Discontinue

DKA Diabetic Ketoacidosis

DOA Dead On Arrival

DOE Dyspnea on Exertion

DM Diabetes Mellitus

DNR Do Not Resuscitate

D/T Due To

Dx Diagnosis

EBL Estimated Blood Loss

ECG Electrocardiograph

ED Emergency Department

e.g. For Example

ECG Electrocardiogram

epi Epinephrine

ET Endotracheal

ETA Estimated Time of Arrival

ETOH Alcohol

eval Evaluation

exam Examination

exc. Except

F Fahrenheit

f Female

FB Foreign Body

freq Frequency

Fx Fracture

GFC Guideline for Care

GI Gastrointestinal

gm Gram

GPS Guideline for Practical Skill

gtts Drops

GYN Gynecology

HA Headache

Heent Head, Eye, Ear, Nose, Throat

HepA Hepatitis A (or HAV)

HepB Hepatitis B (or HBV)

HepC Hepatitis C (or HCV)

HHN Hand Held Nebulizer

HIV Human Immunodeficiency Virus

HOH Hard of Hearing

H&P History and Physical Examination

HPI History of the Present Illness

hr Hour

HTN Hypertension

Hx History

ICU Intensive Care Unit

IM Intramuscular

IN Intranasal

incr. Increasing

Inf. Inferior

Inj Injury

Int. Internal

IO Intraosseous

IV Intravenous

JVD Jugular Vein Distention

KED Kendrick Extrication Device

Kg Kilogram

Lt. Left

lac. Laceration

lat. Lateral

lb. Pound

LCTA Lungs Clear to Auscultation

L&D Labor and Delivery

LLQ Left Lower Quadrant

LL Left Leg

L/min Liters per Minute

LMP Last Menstrual Period

LOC Level of Consciousness

loc Loss of Consciousness

LPM Liters per Minute

LUQ Left Upper Quadrant

L-spine Lumbar Spine

m Male

MAST Medical Anti-Shock Trousers

max Maximum

mcg Microgram

MCC Motorcycle Crash

MCI Mass Casualty Incident

MD Medical Doctor

mg Milligram

MG Medical Guideline

MI Myocardial Infarction

min Minute

misc Miscellaneous

ml Milliliter

mm Millimeter

mmHG Millimeters of Mercury

mod Moderate

MOI Mechanism of Injury

mos. Months

MVA Motor Vehicle Accident

MVC Motor Vehicle Crash

N/A Not Applicable

NAD No Acute Distress

NC Nasal Cannula

neg. Negative

NG Nasogastric

NKA No Known Allergies

NKDA No Known Drug Allergies

no. Number

NPO Nothing by Mouth

NS Normal Saline

NSR Normal Sinus Rhythm

NTG Nitroglycerin

N&V Nausea and Vomiting

occ. Occasional

orientx3 Oriented to Time, Place, Person

os Mouth

p After

P Pulse

PAC Premature Atrial Complex

PASG Pneumatic Anti-Shock Garment

PE Physical Examination, Pulmonary Emboli

PERL Pupils Equal, React to Light

PERRL Pupils Equal, Round, React to Light

PJC Premature Junctional Complex

PMD Private (Personal) Medical Doctor

PMH Past Medical History

PNB Pulseless Non-Breather

PND Paroxysmal Nocturnal Dyspnea

po By Mouth (orally)

POC Position of Comfort

pos Positive

poss Possible

PRN As Necessary

pt. Patient

prox Proximal

PTA Prior to Arrival

PVC Premature Ventricular Complex

q. Every

Rt Right

re Regarding

resp Respiratory

RL Right Leg

RLQ Right Lower Quadrant

R/O Rule Out

RR Respiratory Rate

RUQ Right Upper Quadrant

Rx Treatment

s Without

SIDS Sudden Infant Death Syndrome

sig. Significant

SL Sublingual

SOB Shortness of Breath

SOC Standard of Care

SpO₂ Pulse Oximetry

SQ Subcutaneous

SubQ Subcutaneous

S/Sx Signs and Symptoms

stat Immediately

STD Sexually Transmitted Disease

Sx Symptom

Sz Seizure

TBSA Total Body Surface Area

TIA Transient Ischemic Attack

TKO To Keep Open

Tx Transport

unk Unknown

URI Upper Respiratory Infection

UTI Urinary Tract Infection

VF Ventricular Fibrillation

VS Vital Signs

w/ With

WNL Within Normal Limits

y/o Year Old

 Less than

 Greater than

 Approximately

 Increased

 Decreased

∆ Change

 Positive

 Negative

 Therefore

 Psychiatric

 Equal

The following content will be considered the Guideline/Standard of care for:

• 
  Assure scene safety and observe universal precautions. (see guideline 107)
  
• 
  Obtain general impression of the patient and conduct initial assessment of the mental status, airway, breathing and circulation.
  
• 
  Determine Nature of Illness or Mechanism of Injury
  
• 
  Determine number of patients.
  
• 
  Consider the need for manual cervical spinal stabilization.
  
• 
  Determine the need for and request additional resources.
  
• 
  Introduction of self and other members of the team to the patient and significant others in the environment as appropriate.
  
• 
  The EMT who will ultimately complete the patient care report will obtain the history.
  
• 
  The patient/historian is encouraged to describe the situation is his/her own words.
  
• 
  A general assessment of the scene will be included.
  
• 
  The history of the present illness (HPI) will include: (OPQRST)
  

• 
  Chief complaint - why did the patient/family request help at this time?
  
• 
  Onset, origin – What were you doing when the problem started?
  
• 
  Provokes – What makes the problem worse? Better?
  
• 
  Quality – What does it feel like? Describe the feeling, pain, etc.
  
• 
  Region/Radiation – Where is the problem located? Do you have pain or discomfort anywhere else?
  
• 
  Severity – On a scale of 0 to 10, with 0 being none and 10 being the worst, what number would you give your symptom, pain.
  
• 
  Time/Treatment – When did it start? How long have you had it? Is it there all the time or does it come and go? Has the patient done any interventions prior to EMS arrival?
  
• 
  Are there any other associated symptoms?
  

• 
  The past medical history (PMH) will include: (SAMPLE)
  

• 
  Signs and symptoms
  
• 
  Allergies
  
• 
  Medications
  
• 
  Past medical history
  
• 
  Last meal or oral intake
  
• 
  Events before the emergency
  

• 
  The physical assessment will include:
  

• 
  Mental status (alert, oriented, altered level of consciousness [LOC], coma) using AVPU scale.
  
• 
  Vital signs (respirations, pulse, blood pressure).
  
• 
  Breath sounds (clear, wet, decrease, absent, wheeze, congested).
  
• 
  ECG (unless monitoring would interfere with patient care--e.g. multiple trauma victim).
  
• 
  Pupil size and reaction (equal, reactive, midrange, dilated, pinpoint).
  
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  Skin color and temperature (Normal, hot, cool, diaphoretic, pale, flushed, cyanotic, jaundice).
  
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  Generalized complaints (weakness, nausea, vomiting, fever, dizziness, numbness, paralysis).
  

• 
  Focused assessment (head, neck, chest, abdomen, back, extremities)—Deformities, Contusions, Abrasions, Penetrations, Burns, Tenderness, Lacerations, Swelling (DCAP-BTLS)
  
• 
  Establish working assessment.
  

History and Physical Examination (cont.)

• 
  Supporting information and/or clarification is documented in the narrative section of the run report.
  
• 
  Document reason for any deviation from the Guidelines for Care.
  

Vital signs:

• 
  All patients under the care of the EMS team will have a repeat assessment and complete set of vital signs (respirations, pulse, blood pressure, level of consciousness) obtained and recorded at least every 15 minutes for a stable patient, every 5 minutes for an unstable patient.
  
• 
  Vital signs will be recorded within 5 minutes after the administration of any medication.
  

GUIDELINE/STANDARD OF CARE

The following content will be considered the Guideline/Standard of care for

• 
  Assure scene safety and observe universal precautions. (See guideline # 107))
  
• 
  Document any medication taken by the patient prior to the arrival of the EMT unit.
  
• 
  Document any known allergies to medications or food.
  
• 
  Obtain initial vital signs, repeat within 5 minutes after the administration of a medication and at a minimum of 15 minute intervals thereafter.
  
• 
  Record and monitor the electrocardiogram. (see guideline # 3009)
  
• 
  Obtain venous access if necessary. (see guideline # 3002) (For example, pediatric asthmatic who will receive only nebulized medication may not need an IV access).
  
• 
  Apply appropriate medical guideline/procedure based on the working assessment.
  
• 
  Any medication order that differs from the following usual dose should be questioned or discussed with the base station physician prior to administration.
  
• 
  For patients less than16 years of age, the pediatric dose for the medication must be calculated. Contact medical control to ascertain and/or confirm dose and volume to be administered if there are any questions or concerns.
  

The following content will be considered the Guideline/Standard of care for

• 
  Assure scene safety and observe universal precautions. (see guideline # 107)
  
• 
  If the equipment is immediately available, obtain baseline pulse oximetry (SPO₂) prior to starting oxygen
  
• 
  Administration devices:
  

• 
  Nasal cannula - 1-6 liter/minute delivering 25-40% concentration
  
• 
  Non-rebreather mask - 12-15 liter/min delivering 90+% concentration (appropriate flow to keep the reservoir bag inflated).
  
• 
  Bag-valve device with oxygen reservoir - maximum flow rate for 100% concentration
  

• 
  Flow rates:
  

• 
  Patients with a history of chronic obstructive pulmonary disease (COPD) should receive oxygen at a rate of 2 L/min above their customary amount. Level of consciousness, respiratory rate and effort must be carefully monitored and the flow rate adjusted accordingly. Patients in severe distress should receive high flow oxygen.
  
• 
  Patients who complain of chest pain should receive oxygen at a minimum of 4 L/min during initial evaluations and have flow rates increased if symptoms persist.
  
• 
  Patients with oral or nasopharyngeal airways in place should receive supplemental oxygen at no less than 4 L/min. Patients with altered levels on consciousness who require airway adjuncts may require higher flow rates.
  
• 
  Patients who are assessed in moderate respiratory distress should receive oxygen at a minimum of 6 L/min.
  
• 
  Patients who are assessed in severe respiratory distress should receive oxygen at 12-15 L/min.
  
• 
  Patients who are hypotensive secondary to trauma or who are assessed to have lost a significant amount of blood should receive oxygen at 10-15 L/min.
  
• 
  Patients who are intubated should be ventilated with a bag-valve device with oxygen reservoir attachment in use (100%).
  
• 
  Patients in cardiopulmonary arrest should be ventilated with a bag-valve device with 100% oxygen reservoir attachment in use.
  
• 
  Resuscitated cardiac arrest victims should be ventilated with a bag-valve device with 100% oxygen reservoir attachment in use.
  

• 
  Document patient’s response to oxygen therapy, including subsequent pulse oximetry (SPO₂)
  
• 
  Document any changes in the flow rate or delivery device for oxygen.
  
• 
  The base physician may order a change in the flow rate and delivery system.
  
• 
  Frequently assess and document the respiratory and circulatory systems when oxygen is in use for a patient.
  
• 
  Document reasons for any deviation from the above Guideline for Care.
  

GUIDELINE/STANDARD OF CARE

The following content will be considered the Guideline/Standard of care for

The routine medical care of a patient requesting/requiring the services of the Emergency Medical Services System will include the following:

• 
  Assure scene safety and observe universal precautions. (see guideline # 107)
  
• 
  Allow patient to assume position of comfort unless contraindicated by injuries or other medical condition.
  
• 
  Assure clear airway (see guideline # 101,201) consider potential cervical spine injury during airway maneuvers.
  
• 
  Determine the degree of respiratory distress (none/mild/moderate/severe).
  
• 
  Administer supplemental oxygen with a device and at a rate appropriate for the condition of the patient. (see guideline # 105)
  
• 
  Assure adequate respiratory exchange, ventilate with supplemental oxygen in those patients with inadequate or absent respirations, consider intubation (see guideline # 2002-2009)
  
• 
  Assess for adequate circulation to perfuse the vital organs, Begin CPR as needed.
  
• 
  Stop all obvious hemorrhage, splint major fractures (see guideline # 5001, 5003-5010).
  
• 
  Complete the history and physical assessment. (see guideline # 103, 1001)
  
• 
  Establish the working assessment(s).
  
• 
  Obtain initial vital signs and repeat at a minimum of 15 minute intervals for a stable patient, every 5 minutes for an unstable patient. (see guideline # 1002)
  
• 
  Obtain intravenous access. (see guideline # 3002-3004)
  
• 
  Monitor the electrocardiogram (see guideline # 3009).
  
• 
  Consider 12 lead ECG for all patients with chest pain (see guideline # 3008)
  
• 
  Apply appropriate medical guidelines.
  
• 
  Contact the base station physician for medical orders as necessary.
  
• 
  Provide appropriate medical care as ordered.
  
• 
  Transport to the closest, most appropriate hospital.
  
• 
  Complete a patient care report, documenting assessment and care (see guideline # 102).
  
• 
  Document reasons for deviation from the Guideline for Care.
  

GUIDELINE/STANDARD OF CARE

The following content will be considered the Guideline/Standard of care for

• 
  “Gloves will be worn when it can be reasonably anticipated that the employee may have hand contact with blood, other potentially infectious materials, mucous membranes, and non-intact skin; when performing vascular access procedures and when handling or touching contaminated items or surfaces.”*
  
• 
  “Masks in combination with eye protection devices, such as goggles or glasses with solid side shields, or chin-length face shields, shall be worn whenever splashes, spray, spatter or droplets of blood or other potentially infectious materials may be generated and eye, nose, or mouth contamination can be reasonable anticipated.”*
  
• 
  “Appropriate protective clothing such as, but not limited to, gowns, aprons, lab coats, clinic jackets, or similar outer garments shall be worn in occupational exposure situations. The type and characteristics will depend upon the task and degree of exposure anticipated.”*
  

• 
  Inanimate surfaces are to be washed with a germicidal agent (quaternary ammonium compound e.g. SaniMasterIII, Hi-Tor), a Phenolic compound (e.g. Matar, SaniMaster Phenolic, Amphyl 2%,) or sodium hypochlorite (bleach) solution (mix every 24 hours) following label directions.
  
• 
  Equipment coming into contact with the patient’s mucous membranes should be disinfected according to label instructions with a glutaraldehyde (e.g. Cidex, Sonacide) or 70% isopropyl alcohol and rinsed with water before using again.
  

• 
  ”Contaminated sharps shall be discarded immediately or as soon as feasible in containers that are: closable, puncture resistant, leak-proof on sides and bottom and labeled or color coded...”*
  

• 
  Recapping of contaminated needles should not be done if safe receptacle is immediately available. If recapping at the scene must be done, it should be accomplished by placing the needle cap on a surface and “scooping” the cap with the needle, keeping hands away from the contaminated needle tip.
  
• 
  Clothing or linen contaminated with blood or body fluid (heavy enough saturation so the fluid can be squeezed out, drip off, poured off or flaked off after drying) must be placed in a leak-proof bags for transport to the point of decontamination.
  

• 
  When emergency medical response personnel or others must transport, in a closed vehicle, an individual with suspected or confirmed tuberculosis or meningitis, those personnel in the patient compartment of the vehicle must wear a high efficiency particulate air (HEPA) respirator. A simple face mask is not acceptable for EMS personnel but should be placed on the patient if it does not compromise airway monitoring.
  

All suspected exposures to potentially communicable diseases must be reported to the appropriate supervisor.

*CDC, MMWR, June 24, 1988, Vol 37, No 24: Update: Universal Precautions for Prevention of Transmission of Human Immunodeficiency Virus, Hepatitis B Virus and Other Bloodborne Pathogens in Health-Care Settings.

END

GUIDELINE/STANDARD OF CARE

The following content will be considered the Guideline/Standard of care for the patient needing:

• 
  Protect patient, family, bystanders and EMS personnel from potential harm. Obtain additional help as necessary.
  
• 
  Observe universal precautions (see guideline # 107)
  
• 
  Evaluate the situation to determine the need for police presence.
  
• 
  Do not approach an agitated and combative patient before law enforcement has gained control of the situation.
  
• 
  Assure clear airway, breathing and circulation.
  
• 
  Complete the history and physical assessment (see guideline # 103, 1001).
  
• 
  Assess the patient’s level of consciousness, level of activity, body language and affect.
  
• 
  Evaluate suicidal potential.
  
• 
  Attempt to rule out common physical causes for patient’s abnormal behavior.
  

• 
  Hypoxia
  
• 
  Hypoglycemia or other metabolic disorders
  
• 
  Head trauma
  
• 
  Alcohol intoxication
  
• 
  Substance abuse
  

• 
  Maintain non-threatening attitude toward patient. Attempt verbal de-escalation if appropriate.
  
• 
  Contact medical control for orders as needed.
  
• 
  Provide appropriate medical care as ordered.
  
• 
  Complete a patient care report, documenting all pertinent information received, procedures ordered/completed, results of interventions and changes in the patient’s condition. (see guideline # 102)
  
• 
  Documentation must include:
  

• 
  A description of the circumstances/behavior that precipitated the use of restraints (threat to self or others).
  
• 
  A statements that the patient’s significant others were informed of the reasons for the restraints and that their application was for the safety of the patient/bystanders/personnel and not as punishment for antisocial behavior.
  
• 
  A statement that no other less restrictive measure appeared appropriate and/or other measures were tried and failed.
  
• 
  The time of applications of the restraint device and its removal, if appropriate.
  
• 
  The position in which the patient was restrained and transported.
  
• 
  The type of restraint used.
  
• 
  Vital signs and/or observational status and condition of the patient every 5 minutes.
  
• 
  Any medication that may have been used during the process.
  

• 
  Guidelines for application by EMS personnel include:
  

• 
  BLS providers should consider paramedic response to scene or intercept
  
• 
  Physical restraints should be used as a method of last resort when verbal control is ineffective.
  
• 
  Restraint equipment applied by EMS personnel must be padded, soft restraints and allow for quick release.
  
• 
  Spider and 9-foot straps may be used to restrain a patient in addition to the padded soft restraints as long as they do not restrict breathing efforts.
  

• 
  Restraints must be applied in such a manner that complete monitoring of vital signs is possible.
  
• 
  Restraints must not cause vascular, respiratory or neurological compromise.
  
• 
  Any device used to prevent patient spitting must allow for clear visualization of the airway (spit mask, mosquito netting, etc.)
  

• 
  EMS personnel may NOT use:
  

• 
  Hard plastic ties or any restraint device that requires a key to remove.
  
• 
  Backboard or scoop stretcher to “sandwich” the patient.
  
• 
  Restraints that secure the patient’s hands and feet behind the back (“hog-tie”).
  
• 
  Any method or material applied in a manner that could cause vascular, respiratory or neurological compromise
  

• 
  For restraint devices applied by law enforcement officers:
  

• 
  The restraints and position must provide sufficient slack in the device to allow the patient to straighten the abdomen and chest to take full tidal volume in.
  
• 
  An officer must be present with the patient AT ALL TIMES at the scene as well as in the patient compartment of the ambulance during transport.
  

• 
  Patients may NOT be transported in the prone position. A left lateral lying position should be used whenever possible. The position of transport may not compromise respiratory or circulatory systems and must not interfere with necessary medical treatment.
  
• 
  Restrained extremities should be evaluated for pulse quality, capillary refill time, color, nerve and motor function every 10-15 minutes. Restraints must be adjusted if compromise of any those functions is discovered.
  
• 
  Once restrained, the patient may never be left alone and unsupervised by medical personnel.
  
• 
  For those patients requiring medical care, transport should be made to the closest, most appropriate hospital.
  

• 
  Do not attempt IV until the patient is cooperative or effectively restrained to limit danger to patient or rescuer
  
• 
  Consider IV 0.9% NS at a KVO rate
  
• 
  If signs of hyperthermia or hypovolemias are present, administer 1 liter of normal saline wide open for adult patients. See pediatric IV guidelines if appropriate.
  
• 
  Contact medical control if additional IV fluid is needed and consider second IV.
  

• 
  Review symptoms of Excited Delirium (including but not limited to:)
  

• 
  Rapid onset of violent behavior, lack of clothing, breaking glass
  
• 
  Possible associated use of stimulant drugs (amphetamines, cocaine, etc.)
  
• 
  History of schizophrenia or bipolar disorder
  
• 
  Possible sudden withdrawal from psychiatric medications
  
• 
  Extremely diaphoretic or extremely hot and dry skin
  
• 
  “Superhuman strength”
  
• 
  “Insensitivity to pain”
  

• 
  Medication Administration (per local medical control)
  

• 
  Consider Geodon 10-20 mg IM (see drug profile 049)
  
• 
  Consider smaller dose for elderly patients or smaller individuals (less than120 pounds)
  
• 
  If absolutely necessary, it may be injected through clothing
  
• 
  Contact medical control if:
  
  • 
    Any questions
    
  • 
    If additional dose of Geodon is needed
    
  • 
    If a benzodiazepine is also needed (i.e. Versed 5 mg IM)(see drug profile 023)
    

• 
  Consider lessening physical restraint if chemical restraint is effective
  
• 
  Obtain 12 lead ECG as soon as possible
  
• 
  Continue to monitor or over-sedation and medication complications per proper medication guideline.
  

• 
  Document reasons for any deviation from the preceding guideline/standard.
  

GUIDELINE/STANDARD OF CARE

The following content will be considered the Guideline/Standard of care for any patient who is a candidate to sign a release or refusal of treatment form:

• 
  Assure scene safety and observe universal precautions (see guideline # 107)
  
• 
  Complete the history and physical assessment (see guideline # 103, 1001).
  
• 
  Assess the patient’s level of consciousness, level of activity, body language and affect.
  
• 
  In order to sign a release or refuse care, the patient must be able to demonstrate decision-making capacity:
  

• 
  Demonstrate the ability to communicate and understand information
  
• 
  Demonstrate the ability to reason and deliberate
  
• 
  Appreciate the current situation and its risks and consequences if treatment if refused
  
• 
  Be logically consistent
  
• 
  Not be homicidal or suicidal
  

• 
  For the patient who is refusing care and/or transport, ascertain:
  

• 
  There is no history of or present altered level of consciousness.
  
• 
  There is no significant or suspected head injury.
  
• 
  The patient is presently oriented to time, place and person.
  
• 
  There is no suspected alcohol or drug ingestion by exam or history.
  
• 
  The patient can ambulate without difficulty.
  

• 
  There is an obligation to treat and transport, if possible, any patient who shows an altered level of consciousness secondary to an injury, hypoxia, hypoglycemia, a mind-altering substance or psychosis. These individuals should not be considered able to sign a release.
  
• 
  Only an adult patient (age 18 years or older), guardian, adult caregiver (relative, friend, police officer or EMT), agent (durable power of attorney for health care), or legally emancipated minor may sign a release form. The EMT must be comfortable with this arrangement. If the EMT has reservations about the responsible party, law enforcement can be notified to assist.
  
• 
  Information must be given to the person refusing care about the consequences, including (they must receive discharge instructions):
  

• 
  They have the right to refuse treatment and/or transport.
  
• 
  They are aware of the potential consequences of refusal of care.
  
• 
  Medical examination and/or treatment by a physician is highly recommended.
  
• 
  Ambulance transport is strongly recommended.
  
• 
  The condition may worsen or further injury may occur.
  
• 
  Disability or death could occur from the illness or injury.
  
• 
  Transport by means other than ambulance could be hazardous.
  
• 
  If treatment or transport if refused but later desired, the patient should immediately call 9-1-1 and the EMS system will respond to render care and transport.
  

• 
  Contact should be made with medical control if there is any question about the patient’s ability to understand the consequences of his/her decision.
  

• 
  Complete a patient care report, documenting all pertinent information given to the patient, situation of the original response, information given to the patient (all patients must receive discharge instructions), and conditions under which the patient was left. (see guideline # 102)
  
• 
  Two sets of vital signs are preferred to document a stable trend
  
• 
  A signature of the patient and witness(es) on a refusal of care form may be appropriate.
  

Refusal of Care (cont.)

• 
  Uninjured Minor – Adult guardian telephone approval for release is acceptable as long as there is a responsible adult present to whom the minor can be released and both the patient’s guardian and the EMT feel comfortable with the arrangement. If the patent’s adult guardian is not available, an adult caregiver may substitute.
  
• 
  Uninjured adult with possible mind-altering substance – If the patient shows no altered level of consciousness, has normal speech and stable gait and can demonstrate decision-making capacity (as above), they may be signed out to a responsible adult who is not under the influence of a mind-altering substance. Often time, Law enforcement is able to assist in convincing these patients to allow transport to the hospital.
  

xx Fire Department

xx, WI xxxxx

GUIDELINE/STANDARD OF CARE

The following content will be considered the Guideline/Standard for: