To establish the requirements and responsibilities for an S-SV approved ALS Ambulance provider to provide the service of EMT-Ps monitoring nitroglycerin and/or heparin during interfacility transports.

AUTHORITY:

California Health & Safety Code, Division 2.5, Sections: 1798.200, 1798.206, 1798.214, 1797.218, 1797.220, 1798.2, 1798.170, and 1798.172.

California Code of Regulations, Title 22, Chapter 4.

POLICY:

Any ALS Ambulance providers wishing to utilize EMT-Ps to monitor nitroglycerin and/or heparin infusions during interfacility transports shall be approved by the S-SV EMS Agency.

Any ALS ambulance provider utilizing EMT-Ps to monitor nitroglycerin and/or heparin during interfacility transports shall meet all requirements set forth by State law, regulations and S-SV EMS policy.

Only those EMT-Ps who have successfully completed training program(s) approved by the S-SV EMS Agency Medical Director on nitroglycerin and heparin will be permitted to monitor them during interfacility transports.

1. EMT-P MONITORING IV NITROGLYCERIN &/OR HEPARIN PROGRAM TRAINING REQUIREMENTS:
   
   1. ALS ambulance service providers utilizing EMT-Ps to monitor intravenous infusion of heparin &/or nitroglycerin during interfacility transfers shall:
      
      1. Utilize the Monitoring IV nitroglycerin &/or heparin infusions training program approved or provided by the S-SV EMS Agency, including the final written and skills examination.
         
      2. Provide a minimum of four (4) hours of initial training in monitoring IV nitroglycerin &/or heparin infusions.
         
      3. Provide all training equipment necessary to ensure a sound EMT-P monitoring IV nitroglycerin &/or heparin training program (i.e. manikins, infusion devices, audiovisual aids, etc.).
         
      4. Utilize only physicians or RN instructors to teach the required curriculum.
         
      5. Inform the S-SV EMS Agency of all course dates, times and locations.
         
         
         
2. RECORDS/DATA COLLECTION:
   
   
   1. The EMT-P must obtain a copy of the transferring physician's orders and attach to the PCR.
      
      
   2. Patients on nitroglycerin drips will have vital signs monitored and documented every 10 minutes.
      
      
   3. Patients on heparin drips will have vital signs monitored and documented every 15 minutes.
      
   
   
3. CONTINUOUS QUALITY IMPROVEMENT (CQI)
   
   100% of calls will be audited by the provider agency. Audits will assess compliance with physician orders and regional protocols, including base hospital contact in emergency situations. Reports will be sent to the EMS Agency as requested.
   
   
4. OTHER PROGRAM REQUIREMENTS
   
   The ALS ambulance provider shall maintain a roster of all EMT-P personnel authorized to provide monitoring of infusions of IV nitroglycerin &/or heparin.
   

CROSS REFERENCES:

Reference No. 841
Subject: Intravenous infusion of heparin &/or nitroglycerin during interfacility transfers

Reference No. 442
Subject: Intravenous infusion of heparin &/or nitroglycerin during interfacility transfers: application and approval process.

Reference No. 341
Subject: Intravenous infusions of heparin &/or nitroglycerin during interfacility transfers: transferring hospital requirements.