This document summarizes changes made to the Special Situations section of Rhode Island's statewide EMS protocols. There are now 7 protocols in this section, covering scenarios like multiple patient incidents, helicopter transport, end of life planning, refusal of care, interfacility transport, patients in police custody, and specialized patient care. Key changes include incorporating new triage guidelines, expanding timeframes for helicopter transport, affirming that medical orders for life sustaining treatment must be followed by EMS, and adding protocols for patients exposed to chemical sprays or experiencing excited delirium.

2. Rhode Island
Emergency Medical Services
Statewide EMS Protocols
October 2016
Rhode Island Department of Health

3. Special Situations
Section 6

5. Special Situations
General Changes and Additions
• This section has 7 protocols.

6. Medical Protocol
New Protocol Previous Protocol
Previous Protocol
Section
6.01 Multiple Patient Incident 6.6 Major Incident Special Situations
6.02 Helicopter Emergency Medical Services (HEMS) 6.1 Air Ambulance (Helicopter) Special Situations
6.03 Medical Orders for Life Sustaining Treatment /
Comfort 1 6.3 Comfort 1 Special Situations
6.04 Refusal of Patient Care NEW – not in previous version
6.05 Interfacility Transport 6.5 Interfacility Transfer Special Situations
6.06 Patient in Police Custody 5.3 Patient Subdued by Taser® Traumatic Injuries
6.07 Specialized Patient Care 6.8 Specialized Patient Care Special Situations

7. 6.01 Multiple Patient Incident
Protocol Summary
• Replaces RIEMS Protocol 6.6 entitled
“Major Incident”.
• This protocol is for all levels of care.
• Incorporates the START/Jump START
triage algorithm.

8. 6.01 Multiple Patient Incident
Protocol Summary
• Unlike the former Major Incident
protocol the Multiple Patient
Incident (MPI) protocol is all-hazards
centric rather than terror/CBRNE
focused.
• Promotes municipally-driven MCI
planning to support this protocol.

9. 6.02 Helicopter Emergency Medical
Services (HEMS)
Protocol Summary
• Replaces RIEMS Protocol 6.1 entitled
“Air Ambulances (Helicopter)”. This
protocol is for all levels of care.
• Increases the from scene to ED
transport timeframe from 30
minutes to > 45 minutes.
• Highlights the fact that helicopter to
scene travel time and ground
transport to a suitable landing zone
need to be factored when
determining actual patient travel
time to a hospital facility.

10. 6.03 Medical Orders for Life Sustaining
Treatment (MOLST) and Comfort 1
Protocol Summary
• Replaces RIEMS Protocol 6.3 entitled
“Comfort1”.
• Protocol is for all levels of care.
• Affirms that an appropriately
executed MOLST applies in and out
of hospital/care facility settings and
is to be followed by EMS.
• For patients with appropriately
executed Comfort 1 documentation,
the individual’s palliative care
measures (to include manual airway
management, suctioning, etc.) are to
be applied.

11. MOLST Form

12. 6.04 Refusal of Patient Care/Transport
Protocol Summary
• New protocol for all levels of care.
• Sets standards and provisions for
what is considered to be competent
and acceptable standards a patient
refusal.

13. 6.04 Refusal of Patient Care/Transport
Protocol Summary
Evidence of altered mental status,
including from alcohol intoxication,
makes the patient unable to
competently refuse transport and care.
The altered mental status may be from a
medical emergency and requires
hospital evaluation.

14. 6.05 Interfacility Transport

15. 6.06 Patient in Police Custody
Protocol Summary
• Replaces RIEMS Protocol 5.3 entitled
“Patient Subdued by Taser®”.
• This protocol is for all levels of care.
• Added to the previous protocol that
was limited to conductive energy
weapons (Taser), this protocol now
includes persons exposed to
OC/Cap-Stun spray.
• Added protocols relative to persons
suffering from excited delirium.

16. 6.07 Specialized Patient Care
Protocol Summary
• This protocol is for all levels of care.
• Routine Patient Care
• Attempt to contact most
knowledgeable person
• Emergency Care Plan
• Follow ECP
• Transport Patient

17. Continue on to RI EMS
Procedure Protocol
Module
Section 7