Opioid Withdrawal Protocol
ICEMA protocol for patient's in opioid withdrawal has been updated.
Suboxone will now be given by our pre-hospital providers as early as tomorrow 3/5/24. At this time Ontario Fire department is the only agency carrying this medication, with Rancho Cucamonga Fire department and Redlands Fire department to follow. This medication administration requires a base hospital order from a physician, and currently LLUMC is the designated base hospital to give this order. Please work with our medics who identify patients that fit the criteria for suboxone so that we can initiate care, and get them to an ED for further treatment. Please see the attached protocol.
Continuation of Care
Continuation of Care Policy is to be used for rapid transport of STEMI, Stroke, Trauma patients. This is an agreed upon policy that allows outside hospitals to bypass the transfer center and directly contact us through the radio room to let us know about a patient being sent via EMS. Please talk to the sending provider in the radio room if they are sending as continuation of care, accept the patient, and then have them call the transfer center so that it can be formally documented. This prevents delays in transfer and patient care, as we know these metrics are heavily monitored in the Stroke and STEMI world. The only time we can reject/divert these transfers is if we are on internal disaster. For example, if we already know that cardiology cannot take a STEMI patient due to no available cath lab, you may divert to the closest STEMI center. If this is done you must have a physician to physician conversation with the alternative destination. Please see the attached policy.
AMA (Patient refusal of Care)
Ensure EMS is still with the patient if they are calling to AMA the patient.
If you have any concerns with the story that EMS is giving you please speak to the patient directly on the recorded line and assess the capacity of the patient refusing care. If you have assessed the patient does not have capacity to refuse transport to the hospital inform EMS, and request law enforcement's assistance if the patient continues to refuse transport by EMS. If law enforcement is on scene and refuses to assist EMS with getting the patient on to the gurney, you can also request to speak to their supervisor via comm center.
Base Hospital Training
If you would like a refresher on base hospital training, please Dr. Downes know. He is happy to go over any questions you might have.