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Emergency Medical Services Authority

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    My CA  
 EMSA #102
EMS SYSTEM GUIDELINES PART II:
IMPLEMENTATION RESOURCE

March 1994
EMSA #102


Prepared by:

Richard A. Narad, DPA
California State University, Chico
Northern California EMS, Inc.

Laura J. Venegas
EMS Systems Planner
California EMS Authority

Maureen McNeil
Chief, EMS Division
California EMS Authority

Support Staff
California EMS Authority

~

Joseph E. Morales, M.D., MPA
Director
California EMS Authority

Sandra R. Smoley, R.N.
Secretary
Health and Welfare Agency

Pete Wilson
Governor


EMERGENCY MEDICAL SERVICES SYSTEM GUIDELINES

EMS Planning Guidelines

Table of Contents

INTRODUCTION

1. DIVISION 2.5 UPDATE

2. EMSA INTERPRETATIONS OF DIVISION 2.5 & REGULATIONS

3. RESOURCES LIST BY SUBJECT

System Organization & Management

Staffing/Training

Communications

4. EMS AUTHORITY PUBLICATIONS

5. SUMMARIES OF NON-EMSA MATERIALS

EMS Implementation Resource Information Submittal Form

INTRODUCTION

Purpose

Part II of the Emergency Medical Services System Guidelines--Implementation Resource, is intended to assist local Emergency Medical Services (EMS) agencies in planning and implementing their systems. It expands on Part I by providing additional information and examples of the items listed in the basic System Guidelines.

Contents

The Implementation Resource includes information on the following:

  1. The annual update of Division 2.5 of the Health and Safety Code.
  2. Summaries of EMS Authority interpretations of Division 2.5 and the EMS regulations. These are organized by subject area.
  3. Areas for additional information, including but not limited to EMS Authority publications and materials submitted by local EMS agencies. These are organized by subject area.
  4. Summaries of EMS Authority publications.
  5. Summaries of non-EMS Authority materials, including information on their availability.

Process for Updating

The EMS Implementation Resource is viewed as a living document which must be constantly updated. To this end, the EMS Authority plans an annual update which will include new and replacement materials. Local EMS agencies are encouraged to submit new materials which they believe will be useful for other agencies. Use the EMS Implementation Resource Information Submittal Form for submitting updates and new material, located at the end of this document. Special project grantees will be required to include materials for the Implementation Resource describing any products developed under the grants.

How to Obtain Copies

To obtain copies of listed resource materials in Part 4 (EMS Authority Publications) and those documents in Part 3 (Cross-References of Resources with a reference number beginning with "EMSA", contact the EMS Authority.

For copies of all other resource materials in Part 3 and all documents in Part 5 (Summaries of Non-EMSA Materials) contact the local EMS agency identified on the "Source" line.

1. DIVISION 2.5 UPDATE

A compilation of the statutes of Division 2.5 of the Health and Safety Code (the EMS Statutes) is updated annually and mailed to local EMS agencies. Others may obtain a copy by writing the EMS Authority at:

Emergency Medical Services Authority
1930 9th Street, Suite 100
Sacramento, CA 95814

Regulations are found in Division 9 of Title 22 of the California Code of Regulations. Division 9. Prehospital Emergency Medical Services, includes the following chapters:

Chapter 1.Emergency Medical Services Authority and Commission on Emergency Medical Services - Conflict of Interest Code
Chapter 1.2First Aid Testing for School-Bus Drivers
Chapter 1.5First Aid Standards for Public Safety Personnel
Chapter 1.8Training Standards for Use of the Automated External Defibrillator by Non-Licensed or Non-Certified Personnel
Chapter 2.Emergency Medical Technician-I
Chapter 3.Emergency Medical Technician-II
Chapter 4.Emergency Medical Technician-P
Chapter 6.Emergency Medical Services Personnel Certification Review Process Guidelines
Chapter 7.Trauma Care Systems
Chapter 8.Prehospital EMS Aircraft Regulations
Chapter 9.Poison Control Center Regulations

Copies of the Regulations may be obtained through Barclays by writing to:

Barclays Law Publishers
P.O. Box 3066
South San Francisco, CA 94083-3066

To order by telephone call (415) 244-6611. Barclays charges for copies of regulations. Inquire for the current price.

2. EMSA INTERPRETATIONS OF DIVISION 2.5 AND REGULATIONS

Policy decisions regarding interpretations of Health and Safety Code Division 2.5 and Division 9, Title 22 Regulations are mailed to local EMS agencies as they become available. Others interested in viewing these interpretations should contact their local EMS agency.

3. RESOURCES LIST BY SUBJECT

This section identifies specific documents which may be helpful to local EMS agencies in planning, implementing, and managing their systems. The items are sorted according to applicable sections of the California EMS System Standards and Guidelines.

A reference number is shown for each item. Documents with an "EMSA #" were issued by the EMS Authority (EMSA) and are described in Section 4. Copies of these documents may be obtained by contacting the EMS Authority. Other documents are referenced by the year in which they were submitted to the Implementation Resource and are described sequentially in Section 5. These other documents may be obtained by contacting the local EMS agency identified on the "Source" line.

SYSTEM ORGANIZATION AND MANAGEMENT

Agency Administration

Title:Agreement designating Northern California Emergency Medical Services, Inc. as the "Local EMS Agency" and authorizing powers pursuant thereto
Source:Northern California EMS
Date:June 1991
Ref. No.93-1

Planning Activities

Title:Los Angeles County Trauma Systems: Blue Ribbon Advisory Committee Final Report
Source:Los Angeles County EMS
Date:August 1990
Ref. No.93-26

Regulatory Activities

Title:Provider agreements for EMT-ID, FR-D, EMT-II, and EMT-P
Source:Northern California EMS
Date:January 1992
Ref. No.93-2
Title:Base hospital/Alternative base hospital contracts
Source:Northern California EMS
Date:January 1992
Ref. No.93-3
Title:Trauma system RFP
Source:Northern California EMS
Date:February 1990
Ref. No.93-5
Title:Trauma Plan
Source:Northern California EMS
Date:November 1989
Ref. No.93-7
Title:Certificate review process
Source:Northern California EMS
Date:August 1991
Ref. No.93-10
Title:RAP--Emergency Ambulance Service
Source:San Mateo County EMS
Date:March 1990
Ref. No.93-13
Title:Emergency Ambulance Contract
Source:San Mateo County EMS
Date:January 1992
Ref. No.93-14
Title:Trauma center contract
Source:San Diego County EMS
Date:1988
Ref. No.93-18
Title:Trauma center standards for Level I
Source:San Diego County EMS
Date:1988
Ref. No.93-19
Title:Trauma center standards for Level II
Source:San Diego County EMS
Date:1988
Ref. No.93-20
Title:Trauma center standards for pediatric
Source:San Diego County EMS
Date:1988
Ref. No.93-21
Title:Trauma services hospital agreement
Source:Los Angeles County EMS
Date:October 1992
Ref. No.93-25
Title:Prehospital care policy manual
Source:Los Angeles County EMS
Date:Original January 1986 with ongoing revisions
Ref. No.93-29

System Finance

Title:Funding of Emergency Medical Services Agencies with State General Funds and Federal Block Grants
Date:December 1993
Ref. No.EMSA #104

Medical

Title:Guidelines for EMS Personnel Regarding Do Not Resuscitate (DNR) Directives
Date:March 1993
Ref. No.EMSA #111
Title:Hazardous Materials Medical Management Protocols (Second Edition)
Date:February 1991
Ref. No.EMSA #231
Title:Hazardous Materials Medical Management Protocols (Update for decontamination section of "Patient Management in the Hot Zone/Decon Area")
Date:May 1991
Ref. No.EMSA #91A
Title:Base hospital/Alternative base hospital contracts
Source:Northern California EMS
Date:January 1992
Ref. No.93-3
Title:Determination of death policy
Source:Northern California EMS
Date:January 1992
Ref. No.93-9
Title:Do not resuscitate policy
Source:Northern California EMS
Date:January 1992
Ref. No.93-11
Title:Defibrillation--Training program for EMTs and First Responders
Source:Northern California EMS
Date:October 1988
Ref. No.93-12
Title:Base hospital agreement
Source:San Diego County EMS
Date:1988
Ref. No.93-16
Title:Base hospital standards
Source:San Diego County EMS
Date:1988
Ref. No.93-17
Title:EMT-I policies and procedures
Source:San Diego County EMS
Date:1992
Ref. No.93-23
Title:EMT-P policies and procedures
Source:San Diego County EMS
Date:1992
Ref. No.93-24
Title:Base hospital treatment guidelines
Source:Los Angeles County EMS
Date:1992
Ref. No.93-27
Title:EMT-I defibrillation program
Source:Los Angeles County EMS
Date:October 1991
Ref. No.93-28
Title:Prehospital care policy manual
Source:Los Angeles County EMS
Date:Original January 1986 with ongoing revisions
Ref. No.93-29
Title:Guidelines for EMT-Paramedic Scope of Practice:
Request for Additions to the EMT-P Scope of Practice
Date:August 1991
Ref. No.EMSA #112
Title:Model Transfer Guidelines, Protocols and Model
Date:September 1991
Ref. No.EMSA #113

STAFFING/TRAINING

General

Title:Certificate review process
Source:Northern California EMS
Date:August 1991
Ref. No.93-10
Title:EMT-Paramedic Certification Test/Candidate Preparation Guide
Date:May 1991 (undergoing revisions)
Ref. No.EMSA #126

Local EMS Agency

(No references)

Dispatchers

Title:Emergency Medical Services Dispatcher Training Guidelines
Date:March 1986
Ref. No.EMSA #132

First Responders

Title:Defibrillation--Training program for EMTs and First Responders
Source:Northern California EMS
Date:October 1988
Ref. No.93-12
Title:EMT-I policies and procedures
Source:San Diego County EMS
Date:1992
Ref. No.93-23
Title:EMT-P policies and procedures
Source:San Diego County EMS
Date:1992
Ref. No. 93-24
Title:EMT-I defibrillation program
Source:Los Angeles County EMS
Date:October 1991
Ref. No.93-28
Title:Prehospital care policy manual
Source:Los Angeles County EMS
Date:Original January 1986 with ongoing revisions
Ref. No.93-29
Title:SIDS for EMS personnel (video)
Source:Los Angeles County EMS
Date:July 1991
Ref. No.93-30
Title:Advanced prehospital care curriculum
Source:Los Angeles County EMS
Date:February 1990
Ref. No.93-31
Title:Prehospital care pharmacology handbook
Source:Los Angeles County EMS
Date:June 1990 (2nd edition)
Ref. No.93-32
Title:Paramedic training manual
Source:Los Angeles County EMS
Date:1981
Ref. No.93-33
Title:EKGs: A quick reference
Source:Los Angeles County EMS
Date:1987
Ref. No.93-34
Title:EMT-I curriculum
Source:Los Angeles County EMS
Date:1989
Ref. No.93-35
Title:EMT-I Instructor Syllabus
Date:September 1985
Ref. No.EMSA #122
Title:EMT-II Instructor Syllabus
Date:June 1986
Ref. No.EMSA #123
Title:EMT-P Instructor Syllabus
Date:June 1986
Ref. No.EMSA #124

Transport Personnel

Title:MICN general provisions
Source:Northern California EMS
Date:September 1989
Ref. No.93-8
Title:Defibrillation--Training program for EMTs and First Responders
Source:Northern California EMS
Date:October 1988
Ref. No.93-12
Title:EMT-I policies and procedures
Source:San Diego County EMS
Date:1992
Ref. No.93-23
Title:EMT-P policies and procedures
Source:San Diego County EMS
Date:1992
Ref. No.93-24
Title:EMT-I defibrillation program
Source:Los Angeles County EMS
Date:October 1991
Ref. No.93-28
Title:Prehospital care policy manual
Source:Los Angeles County EMS
Date:Original January 1986 with ongoing revisions
Ref. No.93-29
Title:SIDS for EMS personnel (video)
Source:Los Angeles County EMS
Date:July 1991
Ref. No.93-30
Title:Advanced prehospital care curriculum
Source:Los Angeles County EMS
Date:February 1990
Ref. No.93-31
Title:Prehospital care pharmacology handbook
Source:Los Angeles County EMS
Date:June 1990 (2nd edition)
Ref. No.93-32
Title:Paramedic training manual
Source:Los Angeles County EMS
Date:1981
Ref. No.93-33
Title:EKGs: A quick reference
Source:Los Angeles County EMS
Date:1987
Ref. No.93-34
Title:EMT-I Instructor Syllabus
Date:September 1985
Ref. No.EMSA #122
Title:EMT-II Instructor Syllabus
Date:June 1986
Ref. No.EMSA #123
Title:EMT-P Instructor Syllabus
Date:June 1986
Ref. No.EMSA #124

Hospital

Title: MICN general provisions
Source:Northern California EMS
Date:September 1989
Ref. No.93-8
Title:EMT-P policies and procedures
Source:San Diego County EMS
Date:1992
Ref. No.93-24
Title:Prehospital care policy manual
Source:Los Angeles County EMS
Date:Original January 1986 with ongoing revisions
Ref. No.93-29
Title:Prehospital care pharmacology handbook
Source:Los Angeles County EMS
Date:June 1990 (2nd edition)
Ref. No.93-32
Title:EKGs: A quick reference
Source:Los Angeles County EMS
Date:1987
Ref. No.93-34
Title:EMT-I curriculum
Source:Los Angeles County EMS
Date:1989
Ref. No.93-35

COMMUNICATIONS

Communications Equipment

(No references)

Public Access

(No references)

Resource Management

(No references)

RESPONSE/TRANSPORTATION

Title:Competitive Process for Creating Exclusive Operating Areas
Date:July 1985
Ref. No.EMSA #141
Title:Guidelines for Out-Of-Jurisdiction EMS Aircraft
Date:May 1986
Ref. No.EMSA #142
Title:California Air Ambulance Providers
Date:May 1991
Ref. No.EMSA #91B
Title:Provider agreements for EMT-ID, FR-D, EMT-II, and EMT-P
Source:Northern California EMS
Date:January 1992
Ref. No.93-2
Title:Air ambulance policy
Source:Northern California EMS
Date:January 1992
Ref. No.93-4
Title:Defibrillation--Training program for EMTs and First Responders
Source:Northern California EMS
Date:October 1988
Ref. No.93-12
Title:RFP--Emergency Ambulance Service
Source:San Mateo County EMS
Date:March 1990
Ref. No.93-13
Title:Emergency Ambulance Contract
Source:San Mateo County EMS
Date:January 1992
Ref. No.93-14
Title:RFP-Non emergency transport of county patients
Source:San Mateo County EMS
Date:April 1991
Ref. No.93-15
Title:EMT-I policies and procedures
Source:San Diego County EMS
Date:1992
Ref. No.93-23
Title:EMT-P policies and procedures
Source:San Diego County EMS
Date:1992
Ref. No.93-24
Title:EMT-I defibrillation program
Source:Los Angeles County EMS
Date:October 1991
Ref. No.93-28
Title:Prehospital care policy manual
Source:Los Angeles County EMS
Date:Original January 1986 with ongoing revisions
Ref. No.93-29

FACILITIES/CRITICAL CARE

Title:Trauma Plan Development Guidelines
Date:April 1987
Ref. No.EMSA #151
Title:Designated Trauma Centers in California
Date:April 1993
Ref. No.EMSA #90B
Title:Base hospital/Alternative base station contracts
Source:Northern California EMS
Date:January 1992
Ref. No.93-3
Title:Trauma system RFP
Source:Northern California EMS
Date:February 1990
Ref. No.93-5
Title:Emergency Department Approved for Trauma (EDAT) application packet
Source:Northern California EMS
Date:October 1990
Ref. No.93-6
Title:Trauma Plan
Source:Northern California EMS
Date:November 1989
Ref. No.93-7
Title:Base hospital agreement
Source:San Diego County EMS
Date:1988
Ref. No.93-16
Title:Base hospital standards
Source:San Diego County EMS
Date:1988
Ref. No.93-17
Title:Trauma center contract
Source:San Diego County EMS
Date:1988
Ref. No.93-18
Title:Trauma center standards for Level I
Source:San Diego County EMS
Date:1988
Ref. No.93-19
Title:Trauma center standards for Level II
Source:San Diego County EMS
Date:1988
Ref. No.93-20
Title:Trauma center standards for pediatric
Source:San Diego County EMS
Date:1988
Ref. No.93-21
Title:EMT-I policies and procedures
Source:San Diego County EMS
Date:1992
Ref. No.93-23
Title:EMT-P policies and procedures
Source:San Diego County EMS
Date:1992
Ref. No.93-24
Title:Trauma services hospital agreement
Source:Los Angeles County EMS
Date:October 1992
Ref. No.93-25
Title:Los Angeles County Trauma Systems: Blue Ribbon Advisory Committee Final Report
Source:Los Angeles County EMS
Date:August 1990
Ref. No.93-26
Title:Prehospital care policy manual
Source:Los Angeles County EMS
Date:Original January 1986 with ongoing revisions
Ref. No.93-29

DATA COLLECTION/SYSTEM EVALUATION

Title:EMS Data System Survey
Date:June 1990
Ref. No.EMSA #90A
Title:Prehospital quality assurance system
Source:San Diego County EMS
Date:1990
Ref. No.93-22
Title:EMT-I policies and procedures
Source:San Diego County EMS
Date:1992
Ref. No.93-23
Title:EMT-P policies and procedures
Source:San Diego County EMS
Date:1992
Ref. No.93-24
Title:Emergency Medical Services Data System Standards
Date:November 1993
Ref. No.EMSA #161

PUBLIC INFORMATION AND EDUCATION

(No references)

DISASTER MEDICAL SERVICES

Title:Emergency Medical Services Authority Disaster Medical Response Plan
Date:July 1992
Ref. No.EMSA #201
Title:Annex D Emergency Medical Services Authority Contents
Date:December 1989
Ref. No.EMSA #202
Title:Casualty Collection Point Guidelines Preliminary Draft
Date:February 1989
Ref. No.EMSA #203
Title:Regional Disaster Medical Health Coordinator Procedures for Support of State Medical Response to a Catasrophic Disaster
Date:December 1985
Ref. No.EMSA #204
Title:Procedures for Acquisition for Volunteer Medical Personnel in Response to a Catastrophic Disaster
Date:August 1988
Ref. No.EMSA #205
Title:Medical Volunteer Orientation Disaster Response
Date:April 1985
Ref. No.EMSA #206
Title:Disaster Medical Supplies List
Date:February 1991
Ref. No.EMSA #211

4. EMS AUTHORITY PUBLICATIONS

This section identifies documents issued by and available from the EMS Authority.

Ref. No.EMSA #104
Title:Funding of Emergency Medical Services Agencies with State General Funds and Federal Block Grants
Date:December 1993
Synopsis:The EMS Authority has developed this policy document to convey funding criteria, eligibility requirements, and the allocation methodology to potential applicants.

The documents include EMS Authority policy on funding EMS agencies, program management and reporting requirements, budget and reporting formats.

Ref. No.EMSA #111
Title:Guidelines for EMS Personnel Regarding Do Not Resuscitate (DNR) Directives
Date:March 1993 (Revised)
Synopsis:The purpose of these guidelines is to provide assistance to local EMS agencies in developing Do No Resuscitate (DNR) policies for their jurisdictions. The recent revisions to the guidelines respond to the need for a statewide policy to allow emergency responders to honor a patient's wish to forego resuscitative attempts. Although many local EMS agencies have established policies to allow responders to honor DNR orders in the prehospital setting, there previously was not a standardized mechanism or statewide policy to honor patients' DNR directives.

The guidelines recommend the use of a standardized advanced directive form, Emergency Medical Services Prehospital Do Not Resuscitate (DNR) Form, a sample of which is included, and the optional use by the patient of a specially inscribed Medic Alert medallion or bracelet.

Ref. No.EMSA #112
Title:Guidelines for EMT-Paramedic Scope of Practice: Request for Additions to the EMT-P Scope of Practice
Date:August 1991
Synopsis:This document contains guidelines for when a request for approval of undefined scope of practice is necessary.
Ref. No.EMSA #113
Title:Model Transfer Guidelines, Protocols and Model Transfer Agreements
Date:September 1991
Synopsis:Developed under a special project grant, this document presents guidelines and standards for the interfacility transfer of patients for use by local EMS agencies wishing to implement such guidelines. Model transfer agreements are included as well as an initial analysis of a statewide survey on the number, kinds, and extent of existing transfer guidelines and agreements.
Ref. No.EMSA #121
Title:Approved Prehospital Care Training Programs
Date:January 1993
Synopsis:This document is a compilation of the approved prehospital care training programs for EMT-I, EMT-II, EMT-Paramedic, and MICN in the State of California.
Ref. No.EMSA #126
Title:EMT-Paramedic Certification Test Candidate Preparation Guide
Date:May 1991 (under revision)
Synopsis: This document provides an overview of the California EMT-P examination process. A study guide and sample questions are provided to help prepare the candidate for the certification exam.
Ref. No.EMSA #132
Title:Emergency Medical Services Dispatcher Training Guidelines
Date:March 1986
Synopsis:These guidelines were developed to assist local EMS agencies and dispatching services with the development of a training program for an Emergency Medical Dispatcher (EMD) program. This document addresses the role of the EMD, the various levels (there are three) of emergency medical dispatching, and training unit guidelines. There are ten training units: medical dispatcher orientation, basic telecommunications, obtaining information from caller, use of medical dispatch priority reference system, providing pre-arrivalinstructions, medical/legal considerations, allocation of local EMS resources, practical lab, multi-casualty incidents and disaster procedures, and written and practical testing. Each unit has a recommended allocated time for teaching, a goal, and performance objectives.
Ref. No.EMSA #141
Title:Competitive Process For Creating Exclusive Operating Areas
Date:July 1985
Synopsis:This document outlines the process for creating exclusive EMS operating service areas, using Division 2.5 of the California Health and Safety Code and the Emergency Medical Services Plan as references. A description of when a competitive process is/is not required is provided.

In the event an Invitation for Proposal (IFP) is required, this document outlines recommended procedures, including protocol for formal advertising, the responders conference, IFP content, submission of proposals, receipt and evaluation of the proposals, and rejection of proposals. Contract issues such as award and length are also reviewed, in addition to protocol for award protests and cancellation of the procurement process.

Ref. No.EMSA #142
Title:Guidelines for Out-Of-Jurisdiction EMS Aircraft
Date:May 1986
Synopsis:These guidelines address the development of agreements for airborne prehospital response. These agreements should be developed between the requesting EMS agency and the air ambulance or air rescue provider or the local EMS agency in the area of origin. Individuals should use the Prehospital EMS Aircraft Regulations (Air Regs.) when developing such agreements. The necessary issues to be addressed are noted in the guidelines.

For EMS aircraft that are used on a sporadic basis, the guidelines recommend a mutual aid or continuation of call agreement be developed between the requesting EMS agency and the provider of the EMS air service. Again, applicable sections of the Air Regs. are specified for the development of such agreements.

Ref. No.EMSA #151
Title:Trauma Plan Development Guidelines
Date:April 1987
Synopsis:These guidelines provide EMS agencies with the minimum requirements (as put forth in the Trauma Regulations) for preparation of trauma planning documents to be submitted to the State EMS Authority. The document is broken into eight sections: Plan Summary (which includes Trauma System Criteria and Plan Details), Organizational Structure, Trauma System Design and Policy Development, Objectives, Proposed Actions and Implementation Schedule, Fiscal Impact of the System, Local Approval, Data Collection, and Trauma System Evaluation. These guidelines provide a comprehensive tool for the development of trauma planning documents. It may be of assistance to have the Trauma Regulations available for reference when reviewing this document.
Ref. No.EMSA #161
Title:Emergency Medical Services Data System Standards
Date:November 1993
Synopsis:The Emergency Medical Services Data System Standards is a compilation of five products: the Standard Prehospital Data Element List, the Standard Prehospital Data Element Dictionary, the local EMS Agency Data System Recommendations, the local EMS Agency Reporting, Recommentations, and the EMS Authority Aggregate Data Report.
Ref. No.EMSA #201
Title:Emergency Medical Services Authority Disaster Medical Response Plan
Date:July 1992
Synopsis:The Emergency Medical Services Authority (EMSA) is the state agency charged with coordinating the state emergency medical response to a disaster. The purpose of this plan is to describe the policies and general procedures governing the Authority's response to major disasters creating mass casualties. To provide context, the plan details the roles and responsibilities of local, state, and private agencies and organizations. It also describes the structure, concepts, and policies under which the response will operate.

Although this plan defines a disaster medical response system, the EMS Authority recognized that circumstances may require deviation from this plan. This document should serve as a template for development of both state and local plans and procedures.

This plan does not apply to day-to-day emergencies. It addresses the large scale event which overwhelms, or potentially overwhelms, the response capacity of a local jurisdiction. Except where noted, this plan is concerned with the response of the EMS Authority to a catastrophic, or potentially catastrophic disaster. Although an earthquake is the most likely hazard to create a disaster of catastrophic impact, other events, such as hazardous materials releases, explosions, and dam failures also might create massive numbers of casualties.

Ref. No.EMSA #202
Title:Annex D Emergency Medical Services Authority Contents
Date:December 1989
Synopsis:This annex presents general concepts and policies to be followed in provideing disaster medical services to people during each operational phase of a natural of technological emergency. It describes California's disaster medical care system and assigns state agency responsibilities.
Ref. No.EMSA #203
Title:Casualty Collection Point Guidelines Preliminary Draft
Date:February 1989
Synopsis:These guidelines are meant to promote minimal standardization of Casualty Collection Points (CCPs) in the event of a disaster requiring a State medical response. Although the designation, establishment, and operation of CCPs are county responsibilities, standardization is necessary to ensure coordination of State and local responses. These guidelines also discuss CCP operations, including use, site designation, and setup issues.

These guidelines describe a fully functional, full purpose CCP. Depending on the magnitude of a disaster and the availability of resources, a jurisdiction may decide that CCPs are not an appropriate disaster response strategy. Instead, the jurisdiction may choose to implement short-term staging areas or other alternatives. In those instances, these guidelines may still prove useful for those more limited operations.

[Note that the central theme of this document is that CCPs are a response strategy of last resort. We encourage planning for other types of operations as well, recognizing that CCPs may neither be feasible nor appropriate for all types of disasters or response environments.]

Ref. No.EMSA #204
Title:Regional Disaster Medical/Health Coordinator Procedures for Support of State Medical Response to a Castastrophic Disaster
Date:December 1985
Synopsis:These procedures have been developed to assist Regional Disaster Medical/Health Coordinators (RDMHCs) and county health officers in unaffected areas of California to provide medical mutual aid as part of the state's overall medical response to a catastrophe. These procedures, based on the concept paper, "The Role and Responsibilities of Regional Disaster Medical/Health Coordinators" specify how the Medical Annex to the State's Earthquake Response Plan, Plan Caldera (the state volcano response plan), and the California Emergency Plan will be implemented at the regional level. They are intended to be specific enough to assist RDMHCs with designing and implementing systems to support an effective disaster medical response yet flexible enough to allow for the wide variety of EMS systems now in place in California. (RDMHCs in affected areas would not be called upon to participate since they would be coordinating the disaster response for their own counties.)

A catastrophic event, such as a Great Earthquake in Southern California, could result in tens of thousands of casualties and billions of dollars in property damage. The coordinated assistance of the unaffected areas of the state and the nation would be required to meet the needs of the disaster victims. These procedures assume that California public officials and private businesses will, without hesitation, give the highest priority to providing this assistance.

Ref. No.EMSA #205
Title:Procedures for Acquisition for Volunteer Medical Personnel In Response to a Catastrophic Disaster
Date:August 1988
Synopsis:These procedures were developed for Regional Disaster Medical/Health Coordinators and County Health Officers to help them locate volunteer medical personnel following a disaster. Following a list of assumptions about the prospective scenario, the Procedures discuss how the volunteer medical personnel should be utilized, planning protocols, and procedures. Additionally, the Procedures address the role of the hospitals and ambulance companies, noting the importance of use of those outside of the disaster areas and their responsibilities as participants in the disaster recovery process.
Ref. No.EMSA #206
Title:Medical Volunteer Orientation Disaster Response
Date:April 1985
Synopsis:This document addresses organization of medical disaster volunteers. It contains information such as responsibilities of potentially involved state agencies. Specific to volunteers, it discusses potential assignments for volunteers, shifts and how to recognize signs of stress in overworked volunteers and what to do about them as well as functions of volunteers on-site, at casualty collection points, and at Disaster Support Area (DSA) (Los Alamitos) and Satellite DSA's (MEDSATS). This orientation packet concludes, with guidelines, as to how to deal with miscellaneous considerations (i.e. type and severity of injuries of waiting casualties, time considerations), safety considerations (i.e. aftershocks or downed power lines, and limited water supply). Sample forms are attached.
Ref. No.EMSA #211
Title:Disaster Medical Supplies List
Date:February 1991
Synopsis:This is a standard listing of medical supplies and equipment that the State will deliver into an area impacted by a catastrophic disaster.
Ref. No.EMSA #231
Title:Hazardous Materials Medical Management Protocols (Second Edition)
Date:February 1991
Synopsis:These protocols are provided as guidelines to inform health care providers as to how to manage medical problems instigated by exposure to hazardous materials. The EMT's role and training requirements are addressed. Federal Occupational Safety and Health Administration (OSHA) has requirements for training, and California OSHA is following suit in Title 8 of the California Code of Regulations. These standards are enforced by California OSHA. It is recommended that agencies remain aware of these requirements in addition to those set forth in this document. This document does not address radioactive materials.

Secondary contamination is a concern that is analyzed in this document. Substances of high risk and low risk for secondary contamination are outlined, and suggestions for reducing risk are given. These are a supplement to the basic decontamination protocols which deal with proper attire, and evaluation and treatment of victims. A section devoted to prehospital care is provided, dealing with field response (including organization of incident area), hazard information about specific chemicals, prehospital provider protection (including EMS vehicle equipment for hazardous material incidents), prehospital decontamination and triage, and decontamination of prehospital personnel.

Protocols are also provided for emergency department care, addressing preplanning and risk assessment, how to handle the contaminated victim, protective clothing for personnel, decontamination and medical management of the victim, and decontamination of personnel and clean up. Suggested equipment lists are also provided.

These protocols conclude with a listing of sources for acute hazards information and protocols for hazardous materials medical management of unknown chemicals and the most common chemicals.

Ref. No.EMSA #90A
Title:Emergency Medical Services Data System Survey
Date:June 1990
Synopsis:This document is produced as a result of a study of EMS data handling capability in local EMS agencies in California. It addresses issues and concerns for data handling capabilities revealed by the study. The areas involved are: EMS data source documents (patient care records and dispatch records, base hospital/on-line medical control, and trauma), EMS agency budget and hardware allocation for data processing, utilization of the data, patient care report forms (data elements), fatal accident report system, and EMS sensitivity index.

Recommendations are made based upon the findings of the study. They address EMS-Management Information Systems (MIS) data elements (including critical time elements, patient information, care given, etc.), and reports for local EMS agencies. An extensive section of sample summary output reports is attached, including an

appendix with data survey forms used in the study, and local EMS agency activities indexed by type of local EMS agency.

Ref. No.EMSA #90B
Title:Designated Trauma Centers in California
Date:April 1993
Synopsis: This document is devoted to location of designated trauma centers, including county and address, type of care provided (pediatric or level), and bed capacity.
Ref. No.EMSA #91A
Title:Hazardous Materials Medical Management Protocols (Update for Decontamination Section of Patient Management in the Hot Zone/Decon Area)
Date:May 1991
Synopsis: This is an update, providing clarification for some of the chemicals referred to in this section.
Ref. No.EMSA #91B
Title:California Air Ambulance Providers
Date:May 1991
Synopsis:This is a directory of all Air Ambulance Providers in California. Information provided includes: County, name, location, address, telephone, equipment type, identification (ID) number, and capabilities.

5. SUMMARIES OF NON-EMSA MATERIALS

This section identifies documents available from local EMS agencies. Contact the local EMS identified on the "Source" line for a copy.

Ref. No.93-1
Title:Agreement designating Northern California Emergency Medical Services, Inc. as the "Local EMS Agency" and authorizing powers pursuant thereto
Source:Northern California (Nor Cal) EMS
Date:June 1991
Availability:Document is available for $10.00 from Nor Cal EMS.
Synopsis:These documents define the local EMS agency responsibilities delegated to Nor Cal EMS. Each county delegating responsibilities has a separate agreement with the agency.
Ref. No.93-2
Title:Provider agreements for EMT-ID, FR-D, EMT-II, and EMT-P
Source:Northern California EMS
Date:January 1992
Availability:Document is available for $10.00 from Nor Cal EMS.
Synopsis:These documents authorize prehospital providers to utilize personnel accredited in the use of automatic defibrillators or to utilize EMT-II or EMT-P personnel.

The document is signed by the local EMS agency, the provider agency, and the assigned base hospital.

Ref. No.93-3
Title:Base hospital/Alternative base hospital contracts
Source:Northern California EMS
Date:January 1992
Availability:Document is available for $10.00 from Nor Cal EMS.
Synopsis: These documents define the responsibilities of a base hospital in directing the medical control of prehospital advanced life support (ALS) providers.
Ref. No.93-4
Title:Air ambulance policy
Source:Northern California EMS
Date:January 1992
Availability:Document is available for $10.00 from Nor Cal EMS.
Synopsis: This policy provides a description of the aircraft classifications, fee structure, dispatch center requirements, cancellation procedure, medical control requirements, record keeping, advertising, required equipment, and the application procedure for air ambulance service provider authorization.
Ref. No.93-5
Title:Trauma system RFP
Source:Northern California EMS
Date:February 1990
Availability:Document is available for $25.00 from Nor Cal EMS.
Synopsis: This document provides an overview of the Trauma Care System Plan, general information and instructions for application, the request for proposals process, trauma center standards, legal requirements, and contract provisions.
Ref. No.93-6
Title:Emergency Department Approved for Trauma (EDAT) application packet
Source:Northern California EMS
Date:October 1990
Availability:Document is available for $ 25.00 from Nor Cal EMS. May be available on disk.
Synopsis: This document provides an overview of the EDAT concept and how it applies to the overall trauma system. It gives a description of the EDAT approval process, the application requirements, and the standards to be met by Basic and Standby EDATs.
Ref. No.93-7
Title:Trauma Plan
Source:Northern California EMS
Date:November 1989
Availability:Document is available for $ 25.00 from Nor Cal EMS.
Synopsis:This document contains a plan summary, identifies the organizational structure, provides an overview of the trauma care system design and policy development. It defines the objectives, the designation process, and the implementation schedule. It describes the local approval process, delineates the required data collection process, and contains the evaluation methodologies to provide quality improvement.
Ref. No.93-8
Title:MICN general provisions
Source:Northern California EMS
Date:September 1989
Availability:Document is available for $10.00 from Nor Cal EMS.
Synopsis: Document includes:

Mobile Intensive Care Nurse (MICN) scope of practice field and base

authorization requirements,

Training standards,

Protocols/standardized procedure, and

Reauthorization requirements.

Ref. No.93-9
Title:Determination of death policy
Source:Northern California EMS
Date:January 1992
Availability:Document is available for $10.00 from Nor Cal EMS.
Synopsis:Describes criteria for determining patients who are not viable candidates for resuscitation.
Ref. No.93-10
Title:Certificate review process
Source:Northern California EMS
Date:August 1991
Availability:Document is available for $10.00 from Nor Cal EMS.
Synopsis: Describes process for any/all negative certificate actions.
Ref. No.93-11
Title:Do Not Resuscitate policy
Source:Northern California EMS
Date:January 1992
Availability:Document is available for $10.00 from Nor Cal EMS.
Synopsis:Describes acceptable criteria to withhold resuscitation in prehospital situations (patient terminal illness).
Ref. No.93-12
Title:Defibrillation--Training program for EMTs and First Responders
Source:Northern California EMS
Date:October 1988
Availability:Document is available for $10.00 from Nor Cal EMS.
Synopsis:Includes learning objectives and presentation outline for topics
  1. Cardiac anatomy and physiology
  2. Cardiac electrophysiology
  3. EKG monitoring
  4. EKG analysis
  5. Defibrillator operation
  6. Dysrhythmia recognition
  7. Defibrillation
  8. Medical control

Also includes policies for operation, continuing education, and remediation.

Ref. No.93-13
Title:RFP--Emergency Ambulance Service
Source:San Mateo County EMS
Date:March 1990
Availability:Document is available for $0.05 per page (appx. 75 pages) from San Mateo County EMS.
Synopsis: Request for proposals for performance-based ambulance contract.
Ref. No.93-14
Title:Emergency Ambulance Contract
Source:San Mateo County EMS
Date:January 1992
Availability:Document is available for $0.05 per page (appx. 93 pages) from San Mateo County EMS. Also available on disk.
Synopsis:Performance-based contract. Includes use of County's dispatch center with a fee paid by contractor.
Ref. No.93-15
Title:RFP-Non emergency transport of county patients
Source:San Mateo County EMS
Date:April 1991
Availability:Document is available for $0.05 per page (appx. 40 pages) from San Mateo County EMS. Also available on disk.
Synopsis: Request for proposals for transport of 5150 patients and other county patients.
Ref. No.93-16
Title:Base hospital agreement
Source:San Diego County EMS
Date:1988
Availability:Document is available for $0.10 per page (appx. 11 pages) from San Diego County EMS.
Synopsis: Contract for base hospital status. Useful for those wanting to contract with base hospitals.
Ref. No.93-17
Title:Base hospital standards
Source:San Diego County EMS
Date:1988
Availability:Document is available for $0.10 per page (4 pages) from San Diego County EMS.
Synopsis: Standards for base hospital status. Useful for those wanting to contract with base hospitals.
Ref. No.93-18
Title:Trauma center contract
Source:San Diego County EMS
Date:1988
Availability:Document is available for $0.10 per page (10 pages) from San Diego County EMS.
Synopsis:Contract sample for trauma center. Useful for those wanting to contract with hospitals for trauma status.
Ref. No.93-19
Title:Trauma center standards for Level I
Source:San Diego County EMS
Date:1988
Availability:Document is available for $0.10 per page (16 pages) from San Diego County EMS.
Synopsis: Standards for trauma center. Useful for those wanting to contract for trauma status.
Ref. No.93-20
Title:Trauma center standards for Level II
Source:San Diego County EMS
Date:1988
Availability:Document is available for $0.10 per page (10 pages) from San Diego County EMS.
Synopsis:Standards for trauma center. Useful for those wanting to contract for trauma status.
Ref. No.93-21
Title:Trauma center standards for pediatric
Source:San Diego County EMS
Date:1988
Availability:Document is available for $0.10 per page (17 pages) from San Diego County EMS.
Synopsis: Standards for pediatric trauma center. Useful for those wanting to contract with pediatric hospitals for trauma status.
Ref. No.93-22
Title:Prehospital quality assurance system
Source:San Diego County EMS
Date:1990
Availability:Document is available for $0.10 per page (7 pages) from San Diego County EMS.
Synopsis: An overview of the Quality Assurance (QA) system design and process. Monitoring activities of QA oversight and brief discussion of committee meetings. Useful for those wanting to establish a QA program.
Ref. No.93-23
Title:EMT-I policies and procedures
Source:San Diego County EMS
Date:1992
Availability:Document is available for $0.10 per page (appx. 69 pages) from San Diego County EMS.
Synopsis: Polices and procedures establishing EMT-I system.
Ref. No.93-24
Title:EMT-P policies and procedures
Source:San Diego County EMS
Date:1992
Availability:Document is available for $0.10 per page (150 pages) from San Diego County EMS.
Synopsis: Polices and procedures establishing EMT-P system.
Ref. No.93-25
Title:Trauma services hospital agreement
Source:Los Angeles County EMS
Date:October 1992
Availability:Document is available on disk from Los Angeles County EMS.
Synopsis: This document is the contractual agreement between the County and designated trauma care centers. It specifies the standards and requirements for Level I and II trauma hospitals and reflects state requirements.
Ref. No.93-26
Title:Los Angeles County Trauma Systems: Blue Ribbon Advisory Committee Final Report
Source:Los Angeles County EMS
Date:August 1990
Availability:Document is available at no cost from Los Angeles County EMS.
Synopsis:Document summarizes recommendations and comments of the interdisciplinary planning retreat. It includes discussion of medical, economic, and societal issues, as well as strategies and tactics for addressing problem areas.
Ref. No.93-27
Title:Base hospital treatment guidelines
Source:Los Angeles County EMS
Date:1992
Availability:Document is available for $15.00 from Los Angeles County EMS.
Synopsis:This document consists of sign/symptom-based field testament protocols in an easy-to-use "at the radio" format.
Ref. No.93-28
Title:EMT-I defibrillation program
Source:Los Angeles County EMS
Date:October 1991
Availability:Document is available at no cost from Los Angeles County EMS.
Synopsis: This is a complete document outlining the L.A. County EMS Agency's EMT-I Defibrillation Program including the training program, policies, protocols, and requirements.
Ref. No.93-29
Title:Prehospital care policy manual
Source:Los Angeles County EMS
Date:Original January 1986 with ongoing revisions
Availability:Document is available for $22.00 from Los Angeles County EMS.
Synopsis: This document is L.A. County EMS Agency's policy and procedure manual for all prehospital care