This document summarizes revisions made to the Rhode Island Emergency Medical Services Statewide EMS Protocols from October 2016. It includes summaries of the Routine Patient Care, Documentation, Medical Control, and Biological Death and Deceased Persons protocols. A new Mobile Integrated Healthcare protocol was also added to enable EMS agencies to form partnerships to provide community-based healthcare services within their scope of practice. Requirements for establishing a Mobile Integrated Healthcare program in Rhode Island are outlined.

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

3. General Patient Care
Section 1

5. 1.01 Routine Patient Care
General Changes and Additions
• Routine Patient Care Protocol was
previously Protocol 1.1 Standard
Management of All Patients.
• Significant changes in this protocol are
in red solid rectangles and additions are
in blue dotted rectangle.
• This protocol is to be practiced by ALL
levels of care as it related to their level
of licensure, and is denoted at the
beginning of all protocols as Routine
Patient Care.

6. 1.01 Routine Patient Care
Protocol Summary
• Respond to the scene in a safe manner
• Approach the scene cautiously and
assess scene safety
• Utilize Multiple Patient Incident
Protocol if indicated
• Bring equipment to the patient
• Determine age criteria (Adult or
Pediatric)
• If trauma – Evaluate Mechanism of
Injury (MOI)
• Document Chief Complaint (CC),
History of Present Illness (HPI), Past
Medical History (PMH)
• Perform Primary Assessment
• Perform Secondary Assessment
• Treat life threatening conditions
• Assess level of pain
• Follow age-appropriate Patient
Comfort Protocols

7. 1.01 Routine Patient Care
Protocol Summary
• Provide Airway Management
• Presume Cardiac etiology in patients
with dyspnea/shortness of breath, or
chest pain/discomfort
• ALS may establish IV access in patients
that are unstable or potentially
unstable or as required for protocol
directed medication administration
• Calculations of Pediatric IV fluids
• Use of electronic Infusion Pump
• Obtain a multi-lead ECG in patients
with symptoms that suggest Cardiac
Ischemia/Infarction.
• Document ALL procedures in
Electronic Patient Care Report
• Communicate with MEDICAL CONTROL
as indicated
• Practice Safe Transport

8. 1.01 Routine Patient Care
Protocol Summary
• Practice Safe Transport of Pediatric
Patients
• Utilize warning devices and siren ONLY
when transporting patients requiring
time sensitive interventions
• Reference Pediatric systolic blood
pressure
• Face-to-face verbal report at receiving
facility
• Follow EMS Documentation Protocol
• Non-transporting RI licensed
ambulances MUST document all care

9. 1.01 Routine Patient Care

10. 1.02 Documentation
Protocol Summary
• The Documentation Protocol is new.
• ALL patient contacts in RI MUST be
documented.
• Paper documentation is
UNACCEPTABLE. Only accepted if the
electronic documentation fails.
• PCR data shall be transmitted to
Center of EMS.
• Follow recommendations for
adequate documentation.

11. 1.03 Medical Control
Protocol Summary
• Most appropriately trained/senior
highest licensed EMS provider
present at the scene is responsible for
direction.
• A private physician that is present and
assumes responsibility for care.
• Intervener physician that is present, is
appropriately identified, and assumes
responsibility for care.

12. 1.04 Biological Death and Deceased
Persons
Protocol Summary
Protocol previously known as Biological Death.
Significant change in recognition of Biological
Death and Deceased Persons:
Adult: Without vital signs and at least one
of the following:
1. Rigor Mortis – Rigid Stiffness of the body
2. Fixed lividity – See Pearls
3. Obvious injury incompatible with life (e.g.
decapitation)
4. Obvious changes of decomposition (bloating,
skin slippage, extensive green or black skin
discoloration).
Pediatric: Without vital signs and at least
one of the following:
1. Obvious injury incompatible with life (e.g.
decapitation)
2. Obvious changes of decomposition (bloating,
skin slippage, extensive green or black skin
discoloration).

13. 1.04 Biological Death and Deceased
Persons
Protocol Summary
• If the above criteria is not met, then
resuscitative care is required unless
patient has a MOLST form or
Comfort One status.
• The determination of death is not
pronouncement of death.
• After determination, Law
Enforcement is responsible.
• EMS documentation must be
accurate as to specific criteria.

14. 1.05 Mobile Integrated Healthcare
• Mobile Integrated Health is a new
program adopted by the RI Department
of Health Center for EMS.
• This protocol enables an EMS service to
form a coalition of partners for the
purpose of providing community based
health care services within scope of
practice.
• Only Advanced EMT Cardiacs and
Paramedics are license to practice
within this program.
• To establish a MIH program in RI,
interested EMS agencies must provide:
• General Project Description
• Community Needs Assessment
• Medical Direction

15. 1.05 Mobile Integrated Healthcare
• To establish a MIH program in RI,
interested EMS agencies must also
provide:
• Patient Interaction Plan that describes
EMS role with patients
• Training Plan that describes training
provided and lists objectives and
outcomes
• Quality Management Program and Data
Collection that incorporated all the
components of and EMS QM Program as
specified in Rules and Regulations
• Documentation of all instances in Patient
Care Report
• Scope and Applicability including
providing urgent follow-up care , part of a
multidisciplinary team, assessing patients
and providing on scene treatment
without transportation

16. 1.05 Mobile Integrated Healthcare
• To establish a MIH program in RI,
interested EMS agencies must also:
• Be a licensed Emergency Medical
Services Agency
• Obtain full commitment from patient’s
primary care provider
• Respect the roles within scope
• Have a process for Referral and Eligibility
Referral and Eligibility
• Referral from PCP
• Referral from ED
• Referral from Home Nursing care
provider
• EMS initiated Referral

17. 1.05 Mobile Integrated Healthcare
• To establish a MIH program in RI,
interested EMS agencies must establish
coordinated care
• If an emergency exists, then patient
needs to be transported
• MIH allows for Field Treatment without
transportation
• MIH allows for transportation to a non-
hospital facility
• At NO time should EMS practitioners
practice OUTSIDE of their SCOPE

18. Continue on to RI EMS
Protocol Education
Modules
Section 2