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Ruslana Boshirova Альянс пианистов @ValLisitsa ООО Минздрав округа Лос-Анджелес - службам скорой помощи: В связи с отсутствием мест из-за ковида, если по прибытию скорой помощи у пострадавшего отсутствует пульс, ограничить усилия по реанимации на месте 10 минутами. По истечению времени констатировать смерть, в больницу не везти. EMERGENCY MEDICAL SERVICES AGENCY Los Angeles County Board of Supervisors Hilda L Solis Firs) District Holly J. Mitchell Second District Sheila Kuehl Third District Janice Hahn Fourth District Kathryn Barger Fifth District Cathy Chidester Director Marianne Gausche-Hill, MD Medical Director 10100 Pioneer Boulevard, Suite 200 Santa Fe Springs, CA 90670 Tel: (562)378-1500 Fax:(562)941-5635 To advance the health of our communities by ensuring quality emergency and disaster medical services. ” December 28, 2020 TO: FROM: Distribution Marianne Gausche-Hill, MD Medical Director, EMS Agenc; VIA E-MAIL SUBJECT: REVISED: EMS TRANSPORT OF PATIENTS IN TRAUMATIC AND NONTRAUMATIC CARDIAC ARREST (DIRECTIVE #6) Effective immediately, due to the severe impact of the COVID-19 pandemic on EMS and 9-1-1 Receiving Hospitals, adult patients (18 years of age or older) in blunt traumatic and nontraumatic out-of-hospital cardiac arrest (OHCA) shall not be transported if return of spontaneous circulation (ROSC) is not achieved in the field. Please see below for specific guidance according to the mechanism of the arrest. Note that this directive supersedes Reference 814, Determination/Pronouncement of Death in the Field. Nontraumatic OHCA: For patients who do not meet Ref 814 criteria for immediate determination of death, EMS shall continue to initiate resuscitation and manage OHCA per TP 1210, Cardiac Arrest-Non-Traumatic. Resuscitation shall be continued for a minimum of 20 minutes or until futility is reached. For patients who do not meet Termination of Resuscitation (TOR) criteria Ref II A, paramedics will continue to consult with the Base Physician regarding the duration of the resuscitation prior to pronouncement. Patients who do not achieve field ROSC and maintain spontaneous perfusion after initiation of post-ROSC care (minimum 5 minutes), shall not be transported. This does not apply to patients in persistent ventricular fibrillation who meet criteria for the ECMO pilot. Blunt and Penetrating Traumatic Full Arrest: Patients in traumatic full arrest who meet current Ref 814 criteria for determination of death shall not be resuscitated and shall be determined dead on scene and not transported. Patients who do not meet Ref 814 criteria should receive on scene resuscitation and interventions to address any potential immediately reversible causes, i.e., bilateral needle thoracostomies, tourniquet placement, fluid resuscitation and defibrillation of shockable rhythm, per TP 1243 Traumatic Arrest. EMS Directive #6 December 28,2020 Page 2 For penetrating torso trauma only, paramedics will contact the Trauma Center while initiating resuscitation to determine if immediate transport is advised. All other patients who do not achieve ROSC within 10 minutes of on scene interventions should be determined dead on scene and not transported. Patients for whom there are scene safety issues may be transported. EMS should continue to transport patients who arrest en route to the receiving facility. For patients who are transported, usual destination policies apply. If you have any questions or concerns, feel free to contact me at (562) 378-1600 or MGausche-Hill@dhs.lacountv.aov. Distribution: Fire Chief, Each Public EMS Provider Agency CEO, Ambulance Companies Medical Director, Each EMS Provider Agency Paramedic Coordinator, Each EMS Provider Agency Hospital Association Southern California CEO, Each 9-1-1 Receiving Hospitals ED Medical Directors, Each 9-1-1 Receiving Hospitals Prehospital Care Coordinator, Each Base Hospital Prehospital Base Physician, Each Base Hospital
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