PROTOCOL TABLE OF CONTENTS

Transcription

1 PROTOCOL TABLE OF CONTENTS Section I Adult Treatment Protocols 1-1 Abdominal Pain Non Traumatic 1-2 Adult Trauma 1-3 Altered Mental Status 1-4 Anaphylaxis/Allergic Reaction 1-5 Burns 1-6 Cerebrovascular Accident (CVA, Stroke) 1-7 Drowning/Near Drowning/Submersion 1-8 General Pre-hospital Care 1-9 Heat Emergencies 1-10 Hypothermia/Frostbite 1-11 Nausea/Vomiting 1-12 Obstetrical Emergencies 1-13 Poisoning/Overdose 1-14 Psychiatric Emergencies 1-15 Respiratory Distress 1-16 Seizures 1-17 Sepsis 1-18 Shock 1-19 Soft Tissue & Orthopedic Injuries 1-20 Spinal Injury Assessment 1-21 Syncope 1-22 Excited Delirium Section II Adult Cardiac Protocols 2-1 Asystole/Pulseless Electrical Activity 2-2 Bradycardia 2-3 Cardiac Arrest General 2-4 Cardiac Arrest Return of Spontaneous Circulation (ROSC) 2-5 Chest Pain Acute Coronary Syndrome 2-6 Hypothermia Cardiac Arrest 2-7 Pulmonary Edema/CHF 2-8 Tachycardia 2-9 V-Fib Pulseless Ventricular Tachycardia Section III Pediatric Treatment Protocols 3-1 Pediatric Altered Mental Status 3-2 Pediatric Anaphylaxis/Allergic Reaction 3-3 Pediatric Assessment & Treatment 3-4 Pediatric Bronchospasm 3-5 Pediatric Burns 3-6 Pediatric Drowning / Near Drowning / Submersion 3-7 Pediatric Fever 3-8 Pediatric Nausea & Vomiting 3-9 Pediatric Newborn Assessment, Treatment and Resuscitation 3-10 Pediatric Poisoning/Overdose 3-11 Pediatric Respiratory Distress, Failure, or Arrest 3-12 Pediatric Seizures 3-13 Pediatric Shock 3-14 Pediatric Trauma Section IV Pediatric Cardiac Protocols 4-1 Pediatric Asystole / Pulseless Electrical Activity 4-2 Pediatric Bradycardia 4-3 Pediatric Cardiac Arrest General 4-4 Pediatric Narrow Complex Tachycardia 2013 Table of Contents and Index v.0828 Page 1 of 11

2 PROTOCOL TABLE OF CONTENTS Section IV Pediatric Cardiac Protocols (continued) 4-5 Pediatric V-Fib Pulseless Ventricular Tachycardia 4-6 Pediatric Wide Complex Tachycardia Section V Procedures Protocols Lead ECG 5-2 Abuse and Neglect (Suspected) 5-3 Adrenal Crisis 5-4 Assault and Sexual Assault 5-5 Automatic External Defibrillator (AED) 5-6 Contaminated Patient 5-7 CPAP/BiPAP Administration (Optional) 5-8 Dead on Scene 5-8(S) Dead on Scene - Supplement 5-9 Do-Not-Resuscitate 5-10 Electrical Therapy 5-11 Emergency Airway Procedure 5-12 EMS Immunization & TB Testing 5-13 Epi-Pen Procedure 5-14 Helmet Removal 5-15 Impedence threshold Device (ITD) (Optional) 5-16 Intranasal Medication Administration (Optional) 5-17 Medication Shortage (Optional) 5-18 Nebulized Bronchodilators 5-19 Oxygenation Administration 5-20 Pain Management 5-21 Patient Assessment 5-22 Patient Care Record & Electronic Documentation & EMS Information 5-23 Patient Restraint 5-24 Patient Sedation 5-25 Pleural Decompression 5-26 Refusal of Care; Adult & Minor 5-27 Spinal Immobilization 5-28 Suspected Pandemic Influenza 5-29 Termination of Resuscitation 5-30 Tourniquet Application 5-31 Vagal Maneuvers 5-32 Vascular Access & IV Fluid Therapy 5-33 Waveform Capnography (Capnometry and Capnography) 5-34 IV Ancillary Supply Exchange 5-35 Southeast Michigan Medication Exchange and Replacement Protocol 5-36 General Crush Syndrome 5-37 Epi-Pen Exchange 5-38 D50 Shortage Protocol Section VI System Protocols 6-1 Cancellation/Downgrade of Call Policy 6-2 Communicable Disease 6-4 Complaint Investigation & Resolution 6-6 Disciplinary Action Appeal 6-7 Documentation Procedure 6-8 Due Process & Disciplinary Procedures 6-10 Health Insurance Portability Accountability Act (HIPAA) 6-12 Infection Control Policy 6-13 Intercept Policy 6-14 Inter-facility Patient Transfers, Critical Care Patient Transports (Optional) 6-15 Latex Sensitivity Procedure 6-16 Licensure Level Requirement of Attendant during Transport (Optional) 2013 Table of Contents and Index v.0828 Page 2 of 11

3 PROTOCOL TABLE OF CONTENTS Section VI System Protocols (continued) 6-18 Medical Control Privileges 6-24 Quality Improvement Program 6-25 Responsibilities of the Participants in the MCA System 6-26 Violent/Hazardous/Chemical Scene 6-28 Access to the HEMS Communication System 6-29 Additional Equipment and Training 6-30 Adult Trauma/Trauma Burn Transportation 6-31 Coordination of Services and Ambulance Transportation Agreement, Monroe County and Wayne County Medical Control Authorities 6-32 Emergency Facilities Limitation Policy 6-33 EMS Communications Interoperability 6-34 EMS Operations at a Crime Scene 6-35 EPCR/PCR and Transfer of Care 6-36 General Considerations 6-37 HEMS Addendum Operationalized Mass Casualty Incidents 6-38 Hospice Patient Coordination of Services 6-39 Integrated Agency/System Quality Improvement (QI) Plan 6-40 Medical Response to a Crime Scene 6-41 Nitroglycerin and Heparin Drip Interfacility Protocols 6-42 Operation of Mike/Echo Unit 6-43 Pediatric Trauma/Trauma Burn Transportation 6-44 Pre-Hospital/Emergency Department (ED) Management of Psychiatric Patients 6-45 Pre-Hospital Equipment Responsibility 6-46 Scene and Patient Management Policy 6-47 System Participation Criteria for Adult and Pediatric Trauma and Trauma Burn Facilities 6-48 System Participation Criteria for Cardiac (Interventional) Hospitals 6-49 Transport of Patients with Suspected Acute Myocardial Infarction 6-50 Transportation of Patients General Medical 6-51 Use of Helicopter Ambulance in the Field 6-52 Use of Lights and Siren Section VII CBRNE Protocols 7-1 Chemical Exposure 7-2 CHEMPACK 7-3 Cyanide Exposure 7-3(S) Cyanide Exposure Supplemental Protocol for Use of Cyanokit 7-4 General CBRNE Identification of Agents 7-5 MEDDRUN 7-6 Nerve Agent/Organophosphate Pesticide Exposure Treatment 7-8 Incidents Involving Suspicious Powders 7-9 Hazardous Material Procedure 7-10 Hazardous Materials Medical Treatment 7-11 Radiation Emergency Procedure Section VIII HazMat Team Protocols 8-1 General HAZMAT Materials Treatment 8-2 Ammonia (Liquid & Gas) 8-3 Asphyxiants - Simple 8-4 Chlorine and Related Compounds 8-5 Corrosive Agents 8-6 Cyanide Exposure 8-7 HAZMAT Eye Irrigation 8-8 Hydrocarbons and Halogenated Hydrocarbons 8-9 Hydrogen Fluoride 8-10 Hydrogen Sulfide, Sulfides and Mercaptans 8-11 Methemoglobinemia 8-12 Organophosphate Poisoning 2013 Table of Contents and Index v.0828 Page 3 of 11

4 PROTOCOL TABLE OF CONTENTS Section VIII HazMat Team Protocols (continued) 8-13 Hazardous Materials Medication Box and Exchange Procedure 8-14 Cyanokit Medication Pack Exchange Procedure and Use Replacement Form Section IX Facility and Service Participation Guidelines 9-1 EMS Agency Criteria for MCR Endorsement 9-2 EMS Agency Annual Letter of Compliance 9-3 Application for Optional 12 Lead Program Lead Supplemental Letter of Compliance 9-5 Optional Inter-Facility Critical Care Transport Application 9-6 Critical Care Supplemental Letter of Compliance 9-7 Helicopter Agency Criteria for MCR Endorsement 9-8 Helicopter Agency Annual Letter of Compliance 9-9 Emergency Medical Dispatch Provider Criteria for Endorsement 9-10 Emergency Medical Dispatch Provider Annual Letter of Compliance 9-11 Online Medical Control Hospital Criteria for MCR Endorsement 9-12 Online Medical Control Hospital Annual Letter of Compliance 9-13 Non Medical Control Care Facility Criteria for MCR Endorsement 9-14 Protocol for Designation of Non Medical Control Care Facilities 9-15 Non-Medical Control Care Facility Annual Letter of Compliance 9-16 Wayne County Hospitals & Health Care Organizations Mutual Aid Assistance Agreement and SOP 9-18 Life Support Unit Personnel Staffing Requirement Section X HEMS MCA Reference Documents Only 10-1 Hospital Emergency Department Capability Definitions 10-2 HEMS Abbreviations Guide 10-3 Electronic PCR Fax/E Mail Transmission Routes 10-4 Phone Numbers For DHS And Protective Services 2013 Table of Contents and Index v.0828 Page 4 of 11

5 PROTOCOL INDEX PROTOCOL NAME NUMBER 12 Lead ECG Lead Supplemental Letter of Compliance 9-4 Abdominal Pain Non Traumatic 1-1 Abuse and Neglect (Suspected) 5-2 Access to the HEMS Communication System 6-28 Additional Equipment and Training 6-29 Adrenal Crisis 5-3 Adult Trauma 1-2 Adult Trauma/Trauma Burn Transportation 6-30 Altered Mental Status 1-3 Ammonia (Liquid & Gas) 8-2 Anaphylaxis/Allergic Reaction 1-4 Application for Optional 12 Lead Program 9-3 Asphyxiants - Simple 8-3 Assault and Sexual Assault 5-4 Asystole/Pulseless Electrical Activity 2-1 Automatic External Defibrillator (AED) 5-5 Bradycardia 2-2 Burns 1-5 Cancellation/Downgrade of Call Policy 6-1 Cardiac Arrest General 2-3 Cardiac Arrest Return of Spontaneous Circulation (ROSC) 2-4 Cerebrovascular Accident (CVA, Stroke) 1-6 Chemical Exposure 7-1 CHEMPACK 7-2 Chest Pain Acute Coronary Syndrome 2-5 Chlorine and Related Compounds 8-4 Communicable Disease 6-2 Complaint Investigation & Resolution 6-4 Contaminated Patient 5-6 Coordination of Service and Transportation Agreement Between Monroe County and WCMCA 9-18 Coordination of Services and Ambulance Transportation Agreement, Monroe County and Wayne 6-31 Corrosive Agents 8-5 CPAP/BiPAP Administration (Optional) 5-7 Crieteria for Designation of Online Medical Control Hospitals 9-12 Critical Care Supplemental Letter of Compliance 9-6 Cyanide Exposure 7-3 Cyanide Exposure 8-6 Cyanide Exposure Supplemental Protocol for Use of Cyanokit 7-3(S) Cyanokit Medication Pack Exchange Procedure and Use Replacement Form 8-14 D50 Shortage Protocol 5-38 Dead on Scene 5-8 Dead on Scene - Supplement 5-8(S) Disciplinary Action Appeal 6-6 Documentation Procedure 6-7 Do-Not-Resuscitate 5-9 Drowning/Near Drowning/Submersion 1-7 Due Process & Disciplinary Procedures 6-8 Electrical Therapy 5-10 Electronic PCR Fax/E Mail Transmission Routes 10-3 Emergency Airway Procedure 5-11 Emergency Facilities Limitation Policy 6-32 Emergency Medical Dispatch Provider Annual Letter of Compliance 9-10 Emergency Medical Dispatch Provider Criteria for Endorsement 9-9 EMS Agency Annual Letter of Compliance 9-2 EMS Agency Criteria for MCR Endorsement 9-1 EMS Communications Interoperability 6-33 EMS Immunization & TB Testing 5-12 EMS Operations at a Crime Scene 6-34 EPCR/PCR and Transfer of Care 6-35 Epi-Pen Exchange 5-37 Epi-Pen Procedure 5-13 Excited Delirium 1-22 General CBRNE Identification of Agents 7-4 General Considerations 6-36 General Crush Injury Table of Contents and Index v.0828 Page 5 of 11

6 PROTOCOL INDEX General HAZMAT Materials Treatment 8-1 General Pre-hospital Care 1-8 Hazardous Material Procedure 7-9 Hazardous Materials Medical Treatment 7-10 Hazardous Materials Medication Box and Exchange Procedure 8-13 HAZMAT Eye Irrigation 8-7 Health Insurance Portability Accountability Act (HIPAA) 6-10 Heat Emergencies 1-9 Helicopter Agency Annual Letter of Compliance 9-8 Helicopter Agency Criteria for MCR Endorsement 9-7 Helmet Removal 5-14 HEMS Abbreviations Guide 10-2 HEMS Addendum Operationalized Mass Casualty Incidents 6-37 Hospice Patient Coordination of Services 6-38 Hospital Emergency Department Capability Definitions 10-1 Hydrocarbons and Halogenated Hydrocarbons 8-8 Hydrogen Fluoride 8-9 Hydrogen Sulfide, Sulfides and Mercaptans 8-10 Hypothermia Cardiac Arrest 2-6 Hypothermia/Frostbite 1-10 Impedence threshold Device (ITD) (Optional) 5-15 Incidents Involving Suspicious Powders 7-8 Infection Control Policy 6-12 Integrated Agency/System Quality Improvement (QI) Plan 6-39 Intercept Policy 6-13 Inter-facility Patient Transfers, Critical Care Patient Transports (Optional) 6-14 Intranasal Medication Administration (Optional) 5-16 IV Ancillary Supply Exchange 5-34 Latex Sensitivity Procedure 6-15 Licensure Level Requirement of Attendant during Transport (Optional) 6-16 Life Support Unit Personnel Staffing Requirement 9-19 MEDDRUN 7-5 Medical Control Privileges 6-18 Medical Response to a Crime Scene 6-40 Medication Shortage (Optional) 5-17 Methemoglobinemia 8-11 Nausea/Vomiting 1-11 Nebulized Bronchodilators 5-18 Nerve Agent/Organophosphate Pesticide Exposure Treatment 7-6 Nitroglycerin and Heparin Drip Interfacility Protocols 6-41 Non Medical Control Care Facility Criteria for MCR Endorsement 9-14 Non-Medical Control Care Facility Annual Letter of Compliance 9-16 Obstetrical Emergencies 1-12 Online Medical Control Hospital Annual Letter of Compliance 9-13 Online Medical Control Hospital Criteria for MCR Endorsement 9-11 Operation of Mike/Echo Unit 6-42 Optional Inter-Facility Critical Care Transport Application 9-5 Organophosphate Poisoning 8-12 Oxygenation Administration 5-19 Pain Management 5-20 Patient Assessment 5-21 Patient Care Record & Electronic Documentation & EMS Information 5-22 Patient Restraint 5-23 Patient Sedation 5-24 Pediatric Altered Mental Status 3-1 Pediatric Anaphylaxis/Allergic Reaction 3-2 Pediatric Assessment & Treatment 3-3 Pediatric Asystole / Pulseless Electrical Activity 4-1 Pediatric Bradycardia 4-2 Pediatric Bronchospasm 3-4 Pediatric Burns 3-5 Pediatric Cardiac Arrest General 4-3 Pediatric Drowning / Near Drowning / Submersion 3-6 Pediatric Fever 3-7 Pediatric Narrow Complex Tachycardia 4-4 Pediatric Nausea & Vomiting 3-8 Pediatric Newborn Assessment, Treatment and Resuscitation Table of Contents and Index v.0828 Page 6 of 11

7 PROTOCOL INDEX Pediatric Poisoning/Overdose 3-10 Pediatric Respiratory Distress, Failure, or Arrest 3-11 Pediatric Seizures 3-12 Pediatric Shock 3-13 Pediatric Trauma 3-14 Pediatric Trauma/Trauma Burn Transportation 6-43 Pediatric V-Fib Pulseless Ventricular Tachycardia 4-5 Pediatric Wide Complex Tachycardia 4-6 Phone Numbers For DHS And Protective Services 10-4 Pleural Decompression 5-25 Poisoning/Overdose 1-13 Pre-Hospital Equipment Responsibility 6-44 Pre-Hospital/Emergency Department (ED) Management of Psychiatric Patients 6-45 Protocol for Designation of Non Medical Control Care Facilities 9-15 Psychiatric Emergencies 1-14 Pulmonary Edema/CHF 2-7 Quality Improvement Program 6-24 Radiation Emergency Procedure 7-11 Refusal of Care; Adult & Minor 5-26 Respiratory Distress 1-15 Responsibilities of the Participants in the MCA System 6-25 Scene and Patient Management Policy 6-46 Seizures 1-16 Sepsis Table of Contents and Index v.0828 Page 7 of 11

8 Old Table of Contents Section I System Protocols 1-1 General Considerations 1-2 Transportation of Patients General Medical 1-3 Adult Trauma/Trauma Burn Transportation 1-4 Pediatric Trauma/Trauma Burn Transportation 1-5 System Participation Criteria for Adult and Pediatric Trauma and Trauma Burn Facilities 1-6 Transport of Patients with Suspected Acute Myocardial Infarction 1-7 System Participation Criteria for Cardiac (Interventional) Hospitals 1-8 Pre-Hospital/Emergency Department (ED) Management of Psychiatric Patients 1-9 Patient Care Record, Electronic Documentation & EMS Information System (State 6-18) 1-10 EPCR/PCR and Transfer of Care 1-11 Procedures for Handling EMS Incidents 1-12 Use of Helicopter Ambulance in the Field 1-13 Emergency Facilities Limitation Policy 1-14 Scene and Patient Management Policy 1-15 Pre-Hospital Equipment Responsibility 1-16 Use of Lights and Siren 1-17 Operation of Mike/Echo Unit 1-18 Health Insurance Portability Accountability Act (HIPAA) (State 6-9) 1-19 Infection Control (State 6-11) 1-20 Latex Sensitivity (State 6-14) 1-21 Responsibilities of the Participants in the MCA System (State 6-25) 1-22 Access to the HEMS Communication System 1-23 EMS Communications Interoperability 1-24 Additional Equipment and Training 1-25 EMS Operations at a Crime Scene 1-26 Medical Response to a Crime Scene Section II Michigan Treatment & Procedure Protocols Adult Treatment Protocols 1-1 Abdominal Pain Non Traumatic 1-2 Adult Trauma 1-3 Altered Mental Status 1-4 Anaphylaxis/Allergic Reaction 1-5 Burns 1-6 Cerebrovascular Accident (CVA, Stroke) 1-7 Drowning/Near Drowning/Submersion 1-8 General Pre-hospital Care 1-9 Heat Emergencies 1-10 Hyporthermia Cardiac Arrest 1-11 Hypothermia/Frostbite 1-12 Nausea/Vomiting 1-13 Non-Cardiac Chest Pain 1-14 Obstetrical Emergencies 1-15 Poisoning/Overdose 1-16 Psychiatric Emergencies 1-17 Respiratory Distress 1-18 Seizures 1-19 Shock 1-20 Soft Tissue 1-21 Spinal Injury Assessment 1-22 Syncope Adult Cardiac Protocols 2013 Table of Contents and Index v.0828 Page 8 of 11

9 Old Table of Contents 2-1 Asystole 2-2 Bradycardia 2-3 Cardiac Arrest General 2-4 Chest Pain Acute Coronary Syndrome 2-5 Narrow Complex Tachycardia 2-6 Pulmonary Edema/CHF 2-7 V-Fib Pulseless Tachycardia 2-8 Wide Complex Tachycardia Pediatric Treatment Protocols 3-1 Pediatric Altered Mental Status 3-2 Pediatric Anaphylaxis/Allergic Reaction 3-3 Pediatric Assessment & Treatment 3-4 Pediatric Bronchospasm 3-5 Pediatric Burns 3-6 Pediatric Drowning / Near Drowning / Submersion 3-7 Pediatric Newborn Assessment, Treatment and Resuscitation 3-8 Pediatric Poisoning/Overdose 3-9 Pediatric Respiratory Distress, Failure, or Arrest 3-10 Pediatric Seizures 3-11 Pediatric Shock 3-12 Pediatric Trauma 3-13 Pediatric Fever Pediatric Cardiac Protocols 4-1 Pediatric Asystole 4-2 Pediatric Bradycardia 4-3 Pediatric Cardiac Arrest General 4-4 Pediatric Narrow Complex Tachycardia 4-5 Pediatric V-Fib Pulseless Tachycardia 4-6 Pediatric Wide Complex Tachycardia Procedures Protocols Lead ECG 5-2 Abuse and Neglect 5-3 Assault/Sexual Assault 5-4 Automatic External Defibrillator 5-5 Contaminated Patient 5-6 CPAP/BiPAP Administration 5-7 Dead on Scene 5-8 Do-Not-Resuscitate 5-9 Electrical Therapy 5-10 Emergency Airway Procedure 5-11 EMS Immunization 5-12 Epi-Pen 5-13 Helmet Removal - Blank For Future Protocol 5-14 Blank - For Future Protocol 5-15 Nebulized Bronchodilators 5-16 Obstructed Airway 5-17 Pain Management 5-18 Patient Assessment 5-19 Patient Sedation 5-20 Physical Patient Restraint 5-21 Pleural Decompression 5-22 Refusal of Care; Adult & Minor 5-23 Refusal of Care Form 5-24 Spinal Immobilization 2013 Table of Contents and Index v.0828 Page 9 of 11

10 Old Table of Contents 5-25 Blank - For Future Protocol 5-26S Termination of Resuscitation Supplemental 5-26 Termination of Resuscitation 5-27 Tourniquet Application 5-28 Vagal Maneuvers 5-29 Vascular Access 5-30 Waveform Capnography 5-31 Impedence Threshold Devise (ITD) (Optional) 5-32 IV Ancillary Supply Exchange 5-33 Southeast Michigan Medication Exchange and Replacement Protocol Section III HEMS-Mass Casualty Incidents 3-1 Mass Casualty Incidents (State 6-15) 3-2 HEMS Addendum Opeationalized Mass Casualty Incidents Section IV Facility and Service Participation Guidelines 4-1 EMS Agency Criteria for MCR Endorsement 4-2 EMS Agency Annual Letter of Compliance 4-3 Application for Optional 12 Lead Program Lead Supplemental Letter of Compliance 4-5 Optional Inter-Facility Critical Care Transport Application 4-6 Critical Care Supplemental Letter of Compliance 4-7 Helicopter Agency Criteria for MCR Endorsement 4-8 Helicopter Agency Annual Letter of Compliance 4-9 Emergency Medical Dispatch Provider Criteria for Endorsement 4-10 Emergency Medical Dispatch Provider Annual Letter of Compliance 4-11 Online Medical Control Hospital Criteria for MCR Endorsement 4-12 Protocol for Designation of On-Line Medical Control Hospitals 4-13 Online Medical Control Hospital Annual Letter of Compliance 4-14 Non Medical Control Care Facility Criteria for MCR Endorsement 4-15 Protocol for Designation of Non Medical Control Care Facilities 4-16 Non Medical Control Care Facility Annual Letter of Compliance Section V HazMat Team Protocols 5-1 General Hazardous Materials Treatment 5-2 Ammonia (Liquid & Gas) 5-3 Cyanide Poisoning 5-4 Eye Irrigation 5-5 Hydrogen Fluoride 5-6 Hydrogen Sulfide, Sulfides and Mercaptans 5-7 Methemoglobinemia 5-8 Organophosphate Poisoning 5-9 Sodium Hydroxide 5-10 Chlorine and Related Compounds 5-11 Hazardous Materials Medication Box and Exchange Procedure Section VI Hospice Procedure 6-1 Hospice Patient Coordination of Services Section VII 2013 Table of Contents and Index v.0828 Page 10 of 11

11 Old Table of Contents CBRNE Protocols 7-1 Chemical Exposure 7-2 CHEMPACK 7-3 Communicable Disease 7-4 Cyanide 7-5 General CBRNE 7-6 MEDDRUN 7-7 Nerve Agent 7-8 Incidents Involving Suspicious Powders 7-9 Hazardous Material Procedure 7-10 Hazardous Materials Medical Treatment 7-11 Radiation Emergency Procedure Section VIII Quality Improvement 8-1 Integrated Agency/System Quality Improvement (QI) Plan 8-2 Quality Improvement Program (State 6-23) Section IX Interzone Policies 9-1 Wayne County Hospitals & Health Care Organizations Mutual Aid Assistance Agreement and SOP 9-2 Coordination of Service and Transportation Agreement Between Monroe County and WCMCA Section X Patient Transfers 10-1 Inter-facility Patient Transfers, Critical Care Patient Transports (Optional) (State 6-13) 10-2 Nitroglycerin and Heparin Drip Interfacility Protocols Section XI HEMS MCA Reference Documents Only 11-1 Hospital Emergency Department Capability Definitions 11-2 HEMS Abbreviations Guide 11-3 Electronic PCR Fax/E Mail Transmission Routes 11-4 Phone Numbers For DHS And Protective Services 2013 Table of Contents and Index v.0828 Page 11 of 11