HomeMy WebLinkAboutFD EMT-D Program; Michael Sexton 1991CITYOF
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SAN RAFAE L
P 0 BOX. 60 SAN R4FAEL CAL F 94 '5 PHONE 1415 45E ' 1'2
AGENDA ITEM NO.: .,.. 13
MEETING DATE: May 6., .1991
REPORT TO MAYOR AND CITY COUNCIL
SUBJECT: AGREEMENT WITH DOCTOR MICHAEL SEXTON, LIAISON PHYSICIAN FOR
EMT -D PROGRAM
SUBMITTED BY: �,1....../ ........ ...... APPROVED BY:
ROBERT E. MARCUCCI city Managor
DATE: April 19, 1991
Recommendation: It is the recommendation of the Fire Department
that the City Council authorize the City Manager
to extend the Agreement with Doctor Michael
Sexton as Liaison Physician for the EMT -D
Program for a one (1) year period.
Summary: The Fire Department's EMT -Defibrillation (EMT -D)
Program has been in operation for a year and has been
successful in saving lives from cardiac arrest. Since
the advent of Paramedic Service some eleven (11) years
ago, no medical intervention has demonstrated such an
impact in providing medical care to our residents.
The County of Marin Emergency Medical Services Agency's
guidelines requires a Liaison Physician. The role of
the Physician, which is required when implementing an
EMT -D Program, is to insure Quality Control of the
Program and the training of personnel. The EMT -D
Physician is also responsible for:
- Persons under their supervision are retrained and
periodically evaluated.
- Insuring that those persons who can not demonstr-
ate EMT -D skills be suspended from EMT -D service.
- Establish a Standard for continued proficiency of
EMT -D.
- Report in writing to the County of Marin Emergency
Medical Services Agency an Annual Report on our
EMT -D Program.
File No. .......
Council
Di5oosif a _ � �
REPORT TO MAYOR AND CITY COUNCIL / PAGE: 2
Since the initiation of our Paramedic Program in 1980,
Dr. Sexton has been associated with us as our Base
Hospital Physician at Kaiser Hospital. Dr Sexton has
agreed to continue his relationship with us as our
Liaison Physician for an additional one (1) year at
the same rate of compensation.
Though Doctor Sexton will be functioning as an Indepen-
dent Contractor for the City, Kaiser Hospital will
continue to extend their malpractice coverage to him as
their contribution to this life saving program.
Backaround: The Fire Department initiated EMT -D in 1990 to
enhance its ability to provide immediate care to
those experiencing Cardiac Arrest. All Fire
Department personnel have received training and
defibrillators were placed on all Fire Engines. In
order to implement the Program the County EMS Office
requires a Liaison Physician to insure Quality
Control of the Program
PROFESSIONAL SERVICES AGREEMENT
THIS AGREEMENT made and entered into this 6th
day of May , 1991, by and between the City of San
Rafael, a municipal corporation, hereinafter referred to as
"City" and Doctor Michael Sexton, hereinafter referred to as
"Consultant".
RECITALS
WHEREAS, City desires to implement an EMT -Defibrilla-
tion Program which requires a Liaison Physician who meets the
requirements for a Base Hospital Physician as defined in County
of Marin Emergency Medical Services Policy Reference #504.
WHEREAS, Consultant is qualified as an emergency room
physician to render such professional services as described
below, on the terms and conditions set forth herein.
NOW, THEREFORE, in consideration of the mutual covena-
nts and conditions contained herein, the parties hereby agree as
follows:
1. SCOPE OF SERVICES. Consultant agrees to perform those
services as outlined in County of Marin, Department of
Health and Human Services, EMS Agency's references,
which are attached and incorporated herein as Exhibit
A.
2. COMPENSATION. City agrees to pay Consultant a fee of
$600.00 month for the Services as outlined in Paragraph
1 above. City shall pay an additional sum of $75.00
per hour if the Consultant's services exceed eight (8)
hours in any single month.
3. INDEPENDENT CONTRACTOR. It is expressly understood and
agreed to by all parties that Consultant is an inden-
pendent Contractor and not an employee of the City.
The Consultant will not, at any time or in any manner,
represent that he is an employee of the City.
Page 2
4. NON -ASSIGNMENT. This Agreement contemplates the
professional and unique services of the Consultant, and
it is recognized by the parties hereto that a substan-
tial inducement to the City for entering into this
Agreement was, and is the professional reputation and
competence of the Consultant. Neither this Agreement
nor any interest therein may be assigned by the
Consultant and the Consultant shall not subcontract any
portion of the performance contemplated and provided
for herein.
5. INSURANCE. During the term of this agreement, Consul-
tant shall maintain Malpractice Insurance according to
the terms and conditions outlined in Exhibit B,
attached and incorporated by reference herein.
6. INFORMATION AND REPORTS. Consultant shall provide all
information and reports required by the County of
Marin, Department of Health and Human Services, EMS
Agency references (Exhibit A).
7. TERMINATION AND NOTICE. This Agreement may be ter-
minated by City or Consultant at any time upon sixty
(60) days written notice to all parties to this
Agreement.
TERMS OF AGREEMENT. The terms of this Agreement shall
be from April 2, 1991 to April 1. 1992
at which time it shall be renewed.
9. WHOLE AGREEMENT. This constitutes the entire Agreement
of the parties. No modification or amendment of this
Agreement shall be valid unless it is in writing and
executed by all parties.
10. ARBITRATION. Consultant and City agree to submit any
claims arising under this Agreement or any dispute
concerning the terms or provisions of this Agreement
to binding arbitration pursuant to the current provisi-
ons of the California Code of Civil Procedure and any
successor statutes. The Arbitrator is empowered to
award attorney's fees to the prevailing party.
Page 3
INWITNESS WHEREOF, the parties have executed this
Agreement as of the date first written above.
CITY OF SAN RAFAEL
By:
City y Man g
PAMELA J. NICOLAI
ATTEST:
By: I- A . -
(ti'by Clerk
JEANNE M. LEONCINI
APPROVED AS TO FORM:
City Attorney
GARY T. RAGGHIAN
DOCTOR MICHAEL SEXTON
By : � vvz�-
EXHIBIT A
COUNTY OF KARIN
DEPARTMENT OF HEALTH AND HUMAN SERVICES
EMS AGENCY
REFERENCE NO. 403.2
SUBJECT EMT -Defibrillation - Liaison Physician
AUTHORITY Title 22, Division 9, Chapter 2
California Administration Code
REQUIREMEN'T'S AND RESPONSIBILITIES OF EKT-D LIAISON PHYSICIAN
1. Requirements
The EMT -D Liaison Physician (DLP) must:
1.1 meet the requirements for a Base Hospital Physician as
defined in Policy Reference # 504.
1.2 possess a working knowledge of prehospital EMS system and,
in particular, EMS' -D systems.
1.3 make a sufficient time commitment to actively participate in
the review of individual cases and in the development and
approval of all periodic trend reports.
2. Responsibilities
The EMT -D Liaison Physician:
2.1 is responsible for the quality control of the program and
the training the personnel for whom they have agreed to
supervise in accordance with Policy Reference / 403.3
and 403.4.
2.2 is required to attend or assist instruction in, at least one
EMT -D training program.
2.3 is responsible for ensuring that persons under their
supervision are retrained, and periodically evaluated, with
sufficient frequency to maintain safe equipment operation
and effective compliance with the standing orders. This
responsibility may be delegated to qualified personnel with
EMS Agency approval.
2.4 is responsible for ensuring that persons with defibrillation
skills, under their sponsorship or direction, who
demonstrate that they are not capable of safely and
effectively carrying out the necessary duties of an EMT -D,
be suspended from EMT -D service. The Physician must
immediately notify the EMS Agency of action taken. An
Page 1 of 2
EFFECTIVE DATE AnriI 11. 19BQ APPROVED BY,
Th od re D. Hiatt D.
a o
REPLACES: NFk Marin County Health Offlcer
EMS Medical Director
COUNTY OF MARIN
DEPARTMENT OF HEALTH AND HUMAN SERVICES
EMS AGENCY
REFERENCE NO. 403.1
SUBJECT EMT -Defibrillation
AUTHORITY, Tit,. 77, r1yisinn q
ar �)
California Administration Code
4.1.3 Sufficient time for each student to practice and
satisfactorily demonstrate the required skills to
the instructor.
4.1.4 Marin County EMS Policy and Procedure and
performance standards regulating EMT
Defibrillation.
4.2 The final written and practical evaluation.
4.3 The requirements in 4.1 and 4.2 may be waived if the
training program is provided by a College or program
approved by the Marin County EMS Agency.
5. only semi-automatic external defibrillators with rhythm
assessment through adhesive monitor/defibrillation pads are
acceptable.
6. The monitor/defibrillator must provide a computerized read out of
rhythms, times of interventions and voice tape recordings.
7. EMT -D will treat ventricular fibrillation and pulseless
ventricular tachycardia only.
8. EMT -D's will not apply the monitor/defibrillator to conscious
patients with chest pain.
9. EMT -D's will adhere to other applicable Marin County Protocols.
10. Accreditation:
10.1 The program will be accredited for one'year initially, and
reaccreditation will be according to established policies
and procedures for EMT training programs.
10.2 EMT -D's will be accredited for one year and reaccreditation
will be according to established policies and procedures.
10.3 All accreditations will be in writing from the EMS Agency.
12. The EMS Agency will report annually to the EMS Authority on the
application of the local EMT -D progran(s) and patient outcomes.
Page 2 of 2
EFFECTIVE DATE: April 13, 1989 APPROVED BY
A�e c 0. H att, M. D.
REPLACES: tD; Karin County Health Offlur`
EMS Medical Director
COUNTY OF MARIN
DEPARTMENT OF HEALTH AND HUMAN SERVICES
EMS AGENCY
REFERENCE NO. 403.2
SUBJECT EXT -Defibrillation - Liaison Physician
AUTHORITY Title 22, Division 9, Chapter 2
California Administration Code
REQUIREiCENTS AND RESPONSIBILITIES OF EMT -D LIAISON PHYSICIAN
1. Requirements
The EMT -D Liaison Physician (DLP) must:
1.1 meet the requirements for a Base Hospital Physician as
defined in Policy Reference 1 504.
1.2 possess a working knowledge of prehospital EMS system and,
in particular, EMT -D systems.
1.3 make a sufficient time commitment to actively participate in
the review of individual cases and in the development and
approval of all periodic trend reports.
2. Responsibilities
The EMT -D Liaison Physician:
2.1 is responsible for the quality control of the program and
the training the personnel for whom they have agreed to
supervise in accordance with Policy Reference 1 403.3
and 403.4.
2.2 is required to attend or assist instruction in, at least one
EMT -D training program.
2.3 is responsible for ensuring that persons under their
supervision are retrained, and periodically evaluated, with
sufficient frequency to maintain safe equipment operation
and effective compliance with the standing orders. This
responsibility may be delegated to qualified personnel with
EMS Agency approval.
2.4 is responsible for ensuring that persons with defibrillation
skills, under their sponsorship or direction, who
demonstrate that they are not capable of safely and
effectively carrying out the necessary duties of an EMT -D,
be suspended from ENT -D service. The Physician must
immediately notify the EMS Agency of action taken. An
Page 1 of 2
EFFECTIVE DATE: Anri 11 1i. 19P9 APPROVED BY� A,,
Theodore b. , M.D.
REPLACES: _ Karin County Heolth Officer
EMS Kedlcel Director
COUNTY OF MARIN
DEPARTMENT OF HEALTH AND HUMAN SERVICES
EMS AGENCY
REFERENCE NO. 403.2
SUBJECT EMT -Defibrillation - Liaison Physician
AUTHORITY Title 22, Division 9, Chapter 2
California Administration Code
organized plan of action will then be submitted, in writing,
for retraining and subsequent re-evaluation of the EMT -D.
2.5. must establish a standard for continued proficiency of an
EMT -D. The demonstration of proficiency must be documented
at the base hospital at least every six (6) months. EMT -D
proficiency should include skills maintenance with the
ability to defibrillate correctly a defibrillation mannikin
within 90 seconds of arrival at the mannikin's side,
including pulse checks and recognition that a shock has been
delivered.
2.6. must report, in writing, to the Paramedic Advisory Committee
(PAC) on an annual basis.
EFFECTIVE DATE: April 13, 1989
REPLACES: NEW
t
Pao= -9 of 2
//
APPROVED BY---'
he ore H att. M D.
Marin County Health Offlcer�
EMS Medical Director
COUNTY OF MARIN
DEPARTMENT OF HEALTH AND HUMAN SERVICES
EMS AGENCY
REFERENCE NO. 403.3
SUBJECT EMT -Defibrillation - Quality Assurance
AUTHORITY Title 22, Division 9, Chapter 2
California Administration Code
QUALITY ASSURANCE EHT-D SERVICE
1. EHT-D quality assurance programs are required:
1.1 to assure timely and competent review of EMT -D managed
cardiac arrest cases, accurate logging of required data, and
timely accurate and informative statistical summaries of
system performance over -time, as well as recommendations, as
indicated, for modifications of system design, performance
protocols, or training standards designed to improve patient
outcome.
1.2 to collect, store and analyze, at a minimum, the following
data related to EMT -D management of cardiac arrest patients:
1.2.1 Patient Data: age: sex; whether arrest was
witnessed, or unwitnessed; distance of collapse
from ambulance; and initial cardiac rhythm.
1.2.2 EKS System Data: estimated time from collapse to
call for help; estimated time from collapse to
initiation of CPR; estimated time from collapse to
initial defibrillation; ambulance response time;
and scene to hospital transport time.
1.2.3 EHT-D Performance: accuracy of rhythm
interpretations; time from arrival to initial
defibrillation; time between defibrillation
attempts; appropriateness of management for each
rhythm encountered, and general adherence to
established protocol.
1.2.4 Patient outcovie: rhythm after each shock; return
of pulse and/or spontaneous respirations in the
field, whether the patient was admitted to the
hospital; whether the patient was discharged from
the hospital; and health status on discharge.
EFFECTIVE DATE: April 13, 1989
REPLACES: NDi
Paae 1 of 3
APPROVED BY:Oh,o>�dor'e
D. Hiatt, M.O.
Marin County Health Offl r
EKS Medical Director
COUNTY OF KARIN
DEPARTMENT OF HEALTH AND HUMAN SERVICES
EMS AGENCY
REFERENCE NO. 403.3
SUBJECT EMT -Defibrillation - Quality Assurance
AUTHORITY Title 22, Division 9, Chapter 2
California Administration Code
2. Written patient care report forms and ECG/voice recordings or
alternative forms of documentation of events, will be reviewed by
the EMT -D Liaison Physician (or other qualified personnel
designated on approval of EMS Agency), as soon as practical,
following an emergency response requiring the use of an EMT -D
skill.
3. The EMT -D Liaison Physician shall submit quarterly written
reports to the EMS Agency which will include a minimum of the
following information:
3.1 The voice/ECG recorder, or other documentation device, was
activated appropriately.
3.2 The personnel quickly and effectively set up the necessary
equipment.
3.3 The patient's pulse was checked appropriately throughout the
emergency response.
3.4 Defibrillation was performed within 90 seconds, excluding
unsafe scene or extrication problems.
3.5 The amount of time spent at the scene was appropriate.
3.6 Adequate BLS was maintained.
3.7 The assessment of the need to deliver or not deliver a shock
was correct.
3.8 Following each shock, the patient was assessed accurately,
and treated appropriately. f
3.9 The portable defibrillator was operated safely and
correctly.
3.10 The care provided was in compliance with applicable
protocols and standing orders.
4. EMS Agency Medical Director, upon cause, may disapprove the EMT -D
Service or remove certificate of individual(s) certified to
perform EMT -D.
Page 2 of 3
EFFECTIVE DATE: April 13, 1989 APPROVED BY:,u-�t-�,
Theodore D. Hiatt, Fl.�
REPLACES: _LIDti Karin County Health Offldr
EMS Medical Director
COUNTY OF KARIN
EXERGENCY MEDICAL SERVICES AGENCY
ENT DEFIBRILLATION PROGRAM DATA COLLECTION FORM
This data collection form is
to be completed by the EMT -D whenever
a
defibrillator is applied to
a patient in accordance to Policy
Reference No. 403. The requested
information is to be submitted to
the
Base Hospital along with the
written patient care report forms and
ECG/voice recordings for review
by the EMT -D Liaison Physician.
Patient Data:
Patient Age Sex
Initial Rhythm
Arrest: Home Other
Witnessed Unwitnessed
Aprox. Distance of Collapse
From*Ambulance ft.
EMS System Data:
Authorization Number
Defib Unit
Estimated Time From Collapse
to Call For Help
min
Estimated Time From Collapse
to Initiation of CPR
min
Estimated Time From Collapse
to Initial Defibrillation
min
Ambulance Response Time
min Hospital Transport Time
min
(To be completed by the Base Hospital)
EXT -D Performance:
Time From Arrival to Initial Defibrillation min
Time Between Defibrillation Attempts: 1st to 2nd series min
2nd to 3rd series min
Was the Management for Each Rhythm Encountered Appropriate?
Was Established Protocol Adhered To? Number of Shocks:
Scene
Were Rhythm Interpretations Accurate? Enroute
Comment
Patient outcome:
Rhythm After Each Shock
Return of Pulse and/or Respirations In The Field?
Patient Admitted? Patient Discharged from Hospital?
Health Status on Discharge
Page 3 of 3
COUNTY OF MARIN
DEPARTMENT OF HEALTH AND HUMAN SERVICES
EMS AGENCY
REFERENCE NO. 403.4
SUBJECT EMT -Defibrillation - Performance
Standards
AUTHORITY Title 22, Division 9, Chapter 2
California Administration Code
PERFORMANCE STANDARDS FOR EMT -D's
1. The EMT -D will perform emergency cardiac care in accordance with
standing orders developed and/or approved by the EMS Agency
Medical Director.
2. The EMT -D will be able to recognize that a patient is in cardiac
arrest and that CPR and immediate application of the automatic
defibrillator is required.
3. The EMT -D will be able to perform Basic Life Support in
accordance with American Heart Association Standards.
4. The EMT -D will be able to set up the defibrillator correctly.
5. The EMT -D will be able to record on the cassette voice/ECG
recorder.
6. The EMT -D will be able to correctly apply the defibrillator pads.
7. The EMT -D will be able to deliver shocks for ventricular
fibrillation in the shortest time possible following their
arrival at the scene, ideally within 90 seconds.
8. The EMT -D will be able to ensure that the patient is not in
contact with rescuers or bystanders prior to delivering a shock.
9. The EMT -D will be able to recognize that a shock was delivered to
the patient.
10. The EMT -D will deliver no more that the number of shocks allowed
in the standing orders. t
11. The EMT -D will be able to provide supportive care to a patient
who has been successfully defibrillated.
12. The EMT -D will be able to immediately recognize and respond, in
accordance with the standing orders, to patients who
refibrillate, whether at the scene or during transports.
13. The EMT -D will be able to prepare the patient for transport to
the medical facility.
Page 1 of 2
EFFECTIVE DATE:April 13, 1989 �.•_(�/��/jj
APPROVED BY �X/•
'Theodore D. Hiatt, M.D.
REPLACES: NEW Marin County Health Offl r
EMS Medical Director
COUNTY OF KARIN
DEPARTMENT OF HEALTH AND HUKAN SERVICES
EKS AGENCY
REFERENCE NO_ 403.4
SUBJECT EMT -Defibrillation - Perfornance
Standards
AUTHORITY Title 22, Division 9, Chapter 2
California Administration Code
14. The EMT -D will be able to communicate pertinent medical
19. EMT -D proficiency should include skills maintenance with the
ability to defibrillate correctly a defibrillation mannikin
within 90 seconds of arrival at the mannikin's side, including
pulse checks and recognition that a shock has been delivered.
EFFECTIVE DATE: April 13, 1989
REPLACES: NEW
r
Page 2 of 2
APPROVED BY �!, S
he ore D. Hiatt, M.D.
Karin County Health Officer
EMS Medical Director
information to the receiving medical facility via radio.
15.
The EMT -D
will be able to record the pertinent events of the
emergency
response on the patients prehospital care report form.
16.
The EMT -D
will be able to prepare the monitor/defibrillator, and
voice/ECG
recorder or other documentation device for patient care
following
each use.
17.
The EMT -D
will be able to maintain the monitor/defibrillator and
voice/ECG
recorder or other documentation device in accordance
with manufacturer's recommendations.
18.
The EMT -D
will maintain continued proficiency in the standards
outlined in this policy. The EMT -D must demonstrate proficiency
at least every six (6) months.
19. EMT -D proficiency should include skills maintenance with the
ability to defibrillate correctly a defibrillation mannikin
within 90 seconds of arrival at the mannikin's side, including
pulse checks and recognition that a shock has been delivered.
EFFECTIVE DATE: April 13, 1989
REPLACES: NEW
r
Page 2 of 2
APPROVED BY �!, S
he ore D. Hiatt, M.D.
Karin County Health Officer
EMS Medical Director
COUNTY OF MARIN
DEPARTMENT OF HEALTH AND HUMAN SERVICES
EMS AGENCY
REFERENCE NO. 403.5
SUBJECT EMT -Defibrillation - Transport Units
AUTHORITY Title 22, Division 9, Chapter 2
California Administration Code
EXT -D PROTOCOL: CARDIAC ARREST
TRANSPORT UNITS
.�
�• ,1 _
* 0 - I
Not hypothermic
Patient older than 12 years of age
Body weight over 80 pounds (36 Kg)
IF TRAUMA:
Prepare patient for immediate transport. As time permits, prior to
paramedic arrival, may initiate defibrillation protocol.
PROCEDURE:
1. Initiate CPR/Set up defibrillator.
(If alone, do not start chest compressions)
2. Have machine analyze rhythm,
If machine determines that a shock is necessary,
Press button to shock patient. Stand clear.
3. Check carotid pulse and have machine analyze rhythm.
If machine determines that a shock is necessary,
Press button to shock patient. Stand clear.
t '
4. Check carotid pulse and have machine analyze rhythm.
If machine determines that a shock is necessary,
Press button to shock patient. Stand clear.
5. If the patient remains unconscious and pulseless
after the third shock, repeat a series of 3 shocks.
6. If the patient remains unconscious and pulseless after
the sixth shock, -- REGARDLESS OF THE RHYTHM-- Continue CPR
and Transport without delay.*
Page 1 of 2
EFFECTIVE DATE: April 13, 1989 APPROVED BY /
e ore D. H •tt,� M.
REPLACES: NEW Marin County Health Offl
EMS Medical Director
COUNTY OF MAKIN
DEPARTMENT OF HEALTH AND HUMAN SERVICES
EMS AGENCY
REFERENCE NO. 403.5
SUBJECT EMI -Defibrillation - Transport Units
AUTHORITY Title 22, Division 9, Chapter 2
California Administration Code
If after any of the shocks, the rhythm has changed and there is a
pulse, maintain airway and breathing, maintain oxygenation, check B/P
and transport.*
7. If patient returns to a pulseless state,
stop ambulance, have machine analyze rhythm.
8. If shockable rhythm has occurred, and have not arrived at
hospital, repeat a series of. three shocks.
9. May stop, analyze and do shock series twice.
10. No more than 9 shock/defibrillations may be given per call.
11.1 Do CPR for one minute and re-evaluate.
Check pulse and have machine analyze rhythm.
11.2 If unshockable rhythm remains, continue CPR and transport.*
11.3 If shockable, follow shock series as above.
11.4 If pulse returns, maintain airway and breathing, maintain
oxygenation, check B/P and transport.*
* Transport to hospital may be delayed if the ETA of a paramedic
unit to the scene is less than the total transport time to the
hospital. Must also consider rendezvous with the paramedic unit
after transport has been initiated.
EFFECTIVE DATE: April 13, 1989
REPLACES: NEw
T
Page 2 of 2
APPROVED BY:
Theodore D. Hiatt, M.D.
Marin County Health OfflcAr
EMS Medical Director
COUNTY OF KARIN
DEPARTMENT OF HEALTH AND HUMAN SERVICES
EMS AGENCY
CONFIRM:
REFERENCE N0. 403.6
SUBJECT EMT-Defibrillatinn - Nan-Tranamrt flnit
AUTHORITY Title 22, Division 9, Chapter 2
California Administration Code
EMI' -D PROTOCOL: CARDIAC ARREST
NON -TRANSPORT UNITS
Not hypothermic
Patient older than 12 years of age
Body weight over 80 pounds (36 Kg)
IF TRAUMA:
Prepare patient for immediate transport. As time permits, prior to
paramedic arrival, may initiate defibrillation protocol.
1. Initiate CPR/Set up defibrillator.
(If alone, do not start chest compressions)
2. Have machine analyze rhythm.
If machine determines that a shock is necessary,
Press button to shock patient. Stand clear.
3. Check carotid pulse and have machine analyze rhythm.
If machine determines that a shock is necessary,
Press button to shock patient. Stand clear.
4. Check carotid pulse and have machine analyze rhythm.
If machine determines that a shock is necesshry,
Press button to shock patient. Stand clear.
5. If the patient remains unconscious and pulseless after the third
shock, -- Repeat the series of three shocks, twice or until
Paramedics arrive.
If after any of the shocks, the rhythm has changed and there is a
pulse, maintain airway and breathing, maintain oxygenation, check B/P.
EFFECTIVE DATE: April 13, 1989
REPLACES: NEW
Paqe 1 of 2
APPROVED BY
eodore D. �18ttK.D.
Marin County Health Officbr
EMS Medical Director
COUNTY OF KARIN
DEPARTMENT OF HEALTH AND HUMAN SERVICES
EMS AGENCY
REFERENCE NO. 403.6
SUBJECT EMI' -Defibrillation - Non -Transport Unj
AUTHORITY Title 22, Division 9, Chapter 2
California Administration Code
6. If patient returns to a pulseless state:
6.1 have machine analyze rhythm.
6.2 if shockable rhythm has occurred, repeat a series
of three shocks.
7. If the initial rhythm is NOT•SHOCKABLE.
7.1 do CPR for one minute and re-evaluate.
7.2 check pulse and have machine analyze rhythm.
7.3 if unshockable rhythm remains, continue CPR until paramedics
arrive.
7.4 if shockable, follow shock series as above.
7.5 if pulse returns, maintain airway and breathing, maintain
oxygenation, check B/P
May analyze and do shock series a total of three times.
No more than nine (9) shocks may be given per call.
EFFECTIVE DATE: April 13, 1969
REPLACES: NEW
t
Page 2 of 2
APPROVED BY•
e� ore•tt,D.
Marin County Health Offl r
EMS Medical Director
COUNTY OF MARIN
DEPARTMENT OF HEALTH AND HUMAN SERVICES
EMS AGENCY
REFERENCE N0. 504
SUBJECT BASE HOSPITAL PHYSICIAN REQUIREMENTS
AUTHORITY HEALTH OFFICER
BASE HOSPITAL PHYSICIAN REQUIREMENTS
I. PURPOSE
The Base Hospital is responsible for the direct medical control
of EMT -P personnel in the prehospital setting as well as
retrospectively through review and audit of prehospital patient
care. The Base Hospital Physician is an essential component in
an EMS system whose goal is the delivery of quality prehospital
patient care.
II. BASE HOSPITAL PHYSICIAN REQUIREMENTS
All Base Hospital physicians must meet the following minimum
requirements:
1. Board Certified, or Prepared in Emergency Medicine;
2. Current certification as an ACLS provider according to the
standards of the American Heart Association;
3. Complete an orientation to the Marin County EMS System and
the functions and responsibilities of the Base Hospital as
defined in Policy Reference #503, Base Hospital Minimum
Requirements. Such orientation is to be provided by the Base
Hospital Medical Director;
4. Complete an observation on an ALS unit, in Marin County,
consisting of direct observation of an ALS patient contact or
a minimum of 6 hours; and
5. Attendance at two (2) hours of prehospital care tape audit
(Run Review) per year.
EFFECTIVE DATE: June 9, 1988
REPLACES: April 22, 1985
i l 1
APPROVED BY•
e ore D. Hiatt, M.D.
Karin County Health Offlcar
EKS Medical Director
COUNTY OF MARIN
DEPARTMENT OF HEALTH AND HUMAN SERVICES
EMS AGENCY
REFERENCE NO. 504
SUBJECT Base Hospital Physician Requirement:
AUTHORITY Health Officer
BASE HOSPITAL PHYSICIAN REQUIREMENTS - Continued
B. In addition to "A" above, all full time Base Station Hospital
physicians must meet the following:
1. Board certification or eligibility in:
a. Family Practice
or
b. Surgery
or
c. Medicine
or
2. Board certification or eligibility in Emergency Medicine
or
3. Equivalent of two years of full time ED experience (2880
hours); and
4. a. Attendance at two Run Reviews per year;
b. Successful completion of the CAL/ACEP Base Station
Physician Course, or equivalent training, within
eighteen months of hire (currently employed full
time physicians must meet this requirement by
January 1985; and
c. Emergency Board eligibility by July, 1986;
d. Emergency Board certification by July, 1988.
IV. Base Station Hospital Physician Staffing Requirements
A. All Base Station Hospitals must be staffed twenty-four hours
per day by a full time or active ED physician.
B. All Base Station Hospitals must be staffed 90% of the time
by full time ED physicians.
Page 2 of 2
EFFECTIVE DATE: At) ri1 22, 1985 APPROVED BY:
4heodore Hiatt, M.D.
Marin County Health Officer
EMS Medical Director
EYHIBIT B
-Memo--for Record
DATE:* March 20, 1990
Subject: Liabilitv Coveraae While Working for the
San Rafael Fire Department
I was contacted by the Fire Chief Bob Marcucci last week
discussing his inability to find a malpractice carrier to provide
coverage for Dr. Sexton while Dr. Sexton trains paramedics and
firemen. I have discussed this requirement with legal counsel,
Bill Petrick, and he and I both agree that the liability is
minimal in view of the public service nature of the work. The
Medical Group will agree to assume any liability that arises out
of Dr. Sexton's work with the Fire Department. I communicated
this decision today to Chief Marcucci.
Richard E\Gi t, M.D., F.A.C.S.
Physician-inlchief
REG/dj
fl��;• Vy.W ,.'� �� l� Tom.
cc:-M1,chaeaSexto ; L)'. '
Personnel File
William Petrick
t
RESOLUTION NO. 8389
A RESOLUTION AUTHORIZING THE CITY MANAGER TO
SIGN AN AGREEMENT WITH DOCTOR MICHAEL SEXTON
FOR SERVICES AS LIAISON PHYSICIAN FOR
THE EMT -DEFIBRILLATION PROGRAM
(4/2/91 - 4/1/92)
RESOLVED, that the City Council of the City of San
Rafael, does hereby, authorize City Manager Pamela Nicolai to
sign an Agreement with Doctor Michael Sexton for Services as the
Liaison Physician for the Fire Department EMT -Defibrillation
Program, copy of which is attached and by reference made a part
hereof.
I, JEANNE M. LEONCINI, Clerk of the City of San Rafael,
hereby certify that the foregoing Resolution was duly and
regularly introduced and adopted at a regular meeting of the City
Council
of said City held
on Mondav
, the
6th
day of
Mav
, 1991, by
the following
vote, to wit:
AYES: COUNCILMEMBER: Boro, Breiner, Shippey, Thayer & Mayor Mulryan
NOES: COUNCILMEMBER: None
ABSENT: COUNCILMEMBER: None
JE67XQ. LEONCIM, City C erk
I
