To establish the initial application process and procedure for approval of S-SV ALS ambulance providers to provide the service of EMT-Ps monitoring pre-existing 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:

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

1. EMT-Ps MONITORING NITROGLYCERIN AND/OR HEPARIN INFUSIONS PROGRAM: APPLICATION FOR APPROVAL REQUIREMENTS:
   
   
   1. Any ALS ambulance provider wishing to utilize EMT-Ps to monitor pre-existing nitroglycerin and/or heparin during interfacility transports shall submit an “EMT-P monitor pre-existing nitroglycerin and/or heparin during interfacility transports: application for approval” packet to the S-SV EMS Agency.
      
      
   2. All applicant agencies shall fully complete the application packet. Incomplete applications will not be processed.
      
      The required information/documentation of a complete application includes the following:
      
      
      1. A letter of intent to provide the service of EMT-Ps monitoring pre-existing nitroglycerin and/or heparin infusions during interfacility transports. This letter shall be signed by the Chief Operations Officer and ALS Medical Director and express willingness to abide by all S-SV EMS Agency policies, procedures and program requirements.
         
         
      2. Call volume of anticipated interfacility transports that will provide the service of EMT-Ps monitoring pre-existing nitroglycerin and/or heparin infusions.
         
         
      3. Equipment identification. Identification of brand name, model # and all pertinent information for the mechanical infusion pump(s) that will be utilized by the service provider.
         
         
      4. A copy of the service providers Continuous Quality Improvement (CQI) program, including name(s) of personnel responsible for the program.
         
         
      5. Name and CV/resume of the physician or RN proposed as program instructor.
         
         
      6. Outline or description of the service provider’s plan for provision of the
         training program.
         
         
      7. ALS ambulance service provider policies and procedures relevant to paramedics monitoring pre-existing nitroglycerin and/or heparin infusions during interfacility transports.
         
         
      8. Personnel Information:
         
         
      • Number of proposed EMT-P personnel to be trained and authorized to provide monitoring of pre-existing nitroglycerin and/or heparin infusions during interfacility transports.
        
        
      • Number of ALS ambulances staffed with EMT-P personnel to be trained and authorized to provide monitoring of pre-existing nitroglycerin and/or heparin infusions during interfacility transports.
        
        
      • Proposed target date for beginning service
        
        
2. S-SV EMS AGENCY EMT-P MONITORING NITROGLYCERIN
   AND/OR HEPARIN INFUSIONS PROGRAM APPROVAL PROCESS:
   
   
   1. The S-SV EMS Agency shall notify the service provider submitting its application to provide the service of EMT-Ps monitoring pre-existing nitroglycerin and/or heparin infusions during interfacility transports approval within seven (7) days of receiving the request that:
      
      
      1. The application has been received;
         
         
      2. The application contains or does not contain the requested information; and
         
         
      3. What information, if any, is missing from the application
         
         Program approval or disapproval shall be made, in writing, to the applicant within a reasonable period of time, after receipt of all required documentation. This period shall not exceed forty-five (45) days.
         
         
3. EMT-Ps MONITORING NITROGLYCERIN AND/OR HEPARIN INFUSIONS PROGRAM IMPLEMENTATION REQUIREMENTS:
   
   
   1. Prior to implementation of an S-SV approved Program for EMT-Ps to monitor pre-existing nitroglycerin and/or heparin infusions during interfacility transports, the ALS ambulance provider shall complete the following:
      
      
      1. A list of all EMT-Ps authorized to monitor pre-existing nitroglycerin and/or heparin infusions during interfacility transports with the following:
         
         
         1. EMT-P state license number and expiration date.
            
            
         2. Proof of completion of an initial four (4) hour training program for monitoring of pre-existing nitroglycerin and/or heparin infusions during interfacility transports and successful completion of written and skill examinations.
            

CROSS REFERENCES:

Prehospital Care Policy Manual

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

Reference No. 441
Subject: Intravenous infusion of heparin &/or nitroglycerin during interfacility transfers: Service provider Requirements and Responsibilities.

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