La. Admin. Code tit. 48 § I-6047

Current through Register Vol. 50, No. 11, November 20, 2024

Section I-6047 - Medical Protocol [Formerly section 6037]

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.

La. Admin. Code tit. 48, § I-6047

Promulgated by the Department of Health and Hospitals, Office of the Secretary, Bureau of Health Services Financing, LR 35:476 (March 2009), amended by the Department of Health and Hospitals, Bureau of Health Services Financing, LR 41:2153 (October 2015), amended by the Department of Health, Bureau of Health Services Financing, LR 42:1090 (July 2016), amended by the Department of Health, Office of Public health, Bureau of Emergency Medical Services, LR 49893 (5/1/2023).

AUTHORITY NOTE: Promulgated in accordance with R.S. 36:254, R.S. 40:1135.1 and 40:1135.2.