Implementation of standing field treatment protocols in an urban EMS system

The objective was to describe our experience with implementation of standin g field treatment protocols (SFTP) in a large, urban EMS system, A prospect ive, consecutive observational study examining the first 21 days of impleme ntation of SFTPs in the City of Los Angeles, California, SFTPs were develop ed for 7 medical chief complaints and all major trauma patients. There were 13,586 EMS incidents, of which 4,037 (30%) received ALS treatment, SFTPs w ere used on 2,177 of these incidents, representing 54% of all ALS runs and 16% of all EMS incidents. The most frequently used SFTPs were for altered l evel of consciousness (29%), and chest pain (25%), The most common errors f ound were failure to document reassessment of the patient after each medica tion administration (45% fallout rate), and failure to document and attach a copy of the ECG to the EMS report (40%), The mean fallout rate for failur e to establish or attempt IV access, administer oxygen, or provide cardiac monitoring was 7%, Out of 1,450 incidents with outcome data provided by the receiving hospitals, only 3 cases (2%) involved incorrect treatment, with an additional 2 involving the unnecessary use of lidocaine, None of these i nstances resulted in adverse effects or complications, SFTPs were integrate d into a large EMS system with few procedural errors or adverse outcomes, ( Am J Emerg Med 2001;19:280-283 Copyright (C) 2001 by W.B. Saunders Company) .