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APR 18 `i989 <br />RoR 76 PAGE 637 <br />1. Standing Order Medical Protocols related to Resuscitation <br />of the Terminally I11. <br />Response: The EMS Director and Medical Director refuse to <br />change this Medical Protocol inasmuch as the law <br />is quite explicit in requirements. Chapter 765, <br />Florida Statutes sets the criteria for DNR <br />authority as well as Chapter 401 provides for <br />criminal penalties for failure to treat. <br />Memorandum from the County Attorney's Office <br />supports the EMS Director's position and HRS has <br />formally approved the protocol. It is beyond an <br />EMT and drivers realm of authority to make the <br />determination as to when to treat since that is a <br />paramedic function. Case law was also provided by <br />the County Attorney's Office in support of the EMS <br />Director's position in this matter. <br />2. Geographically pre -determined transport locations. <br />Response: Trauma Transport legislation was passed by the State <br />in 1988 requiring transport of patients to the <br />nearest medical facility. Protocols require <br />emergency medical patients north of CR 510 to be <br />transported to Humana Hospital Sebastian. Those <br />medical emergency patients south of CR 510 are <br />transported to Indian River Memorial Hospital. This <br />approach is supported by the County Attorney's <br />Office, HRS, and the Risk Manager. It suffices to <br />say that when a patient is stabilized and life is <br />not threatened, the patient can travel to any <br />medical facility of their choice. The County ALS <br />service does not respond to non -emergency medical <br />events as there are available transport companies <br />locally for that purpose. <br />3. Driver/Paramedic responsibilities during response to <br />emergency scene. <br />Response: The policy in this regard has not been altered. <br />The EMS Director did issue a clarification of the <br />policy in layman's language so that it could be <br />easily understood and adhered to. This issue <br />surfaced to a large degree due to the fact that the <br />EMS Director would no longer permit the Squad to <br />allow drivers who had not had a recognized 16 hour <br />Emergency Vehicle Operator's Course to drive the <br />Squad vehicles. What was found was drivers <br />operating emergency vehicles with from no training <br />to approximately one and one half hours of training <br />creating a violation of 10D-66 and Chapter 401, <br />Florida Statutes. Further, some drivers reportedly <br />did not have CPR and first aid training as required <br />by law. Each of these deficiencies would have <br />resulted in civil fines or penalties for the County <br />ALS service if HRS had inspected the service <br />location. <br />The above issues were discussed in detail at an EMS staff meeting on <br />March 31, 1989, with all providers being present. Not one of the other <br />providers agreed with Fellsmere regarding the above referenced matters. <br />It was apparent that past emotional events in the lives of the two <br />Fellsmere members had some impact on their feelings as relates to <br />treatment -of terminally ill patients. The EMS Director's approach <br />to development and requiring adherence to the medical protocols has to <br />be for the good of the overall system while at the same time assuring a <br />standard of patient care in a timely manner. <br />48 <br />