Introduction

The Medical Direction Team (MDT) approved these guidelines for use by the BioTel Emergency Medical Service (EMS) System. Personnel must have a current EMS certification with the Texas Department of Health and be in good standing with the BioTel MDT to operate under these guidelines.

The Guideline Committee developed these treatment guidelines from nationally recognized standards and the latest scientific literature, where possible. They are in accordance with currently accepted medical practices advocated by the American Heart Association (AHA), American College of Emergency Physicians (ACEP), National Association of EMTs (NAEMT), National Association of Emergency Medical ServicePhysicians
(NAEMSP), North Central Texas Trauma Region Advisory Council (NCTTRAC), and others.

If treatment ambiguity existed after a review of published research literature, review articles, and standard texts, the Committee used a panel consensus process for guidance. The panel included representatives from the University of Texas Southwestern Medical Center at Dallas, Parkland Memorial Hospital, Children’s Medical Center, BioTel, and administrative and field personnel from each member fire department. These guidelines will become the standards of care for the BioTel EMS System.

When providing care in the field, medics must differentiate guidelines from standing orders. A guideline is a preauthorized course of care for use by prehospital providers when managing patients. Guidelines represent the overall steps in patient care management for every patient contact. Guidelines may overlap with one another (e.g., a patient in respiratory distress who also has bradycardia). Paramedics should prioritize treatment priorities for these individual patients based on sound clinical judgment in conjunction with medical control, as necessary.

Standing orders are those components of prehospital care the provider initiates before establishing communications with BioTel. This is acceptable under the legal concept of delegated practice. Each guideline specifies a point when medics should contact BioTel for consultation, if needed. Earlier contact is always possible if questions, problems, or unusual cases exist.

The rules and guidelines for patient management emphasize those findings with the potential for adverse outcome to the patient. Documentation should be sufficient to reflect the clinical decision making process.

In general, these guidelines imply a specific sequence of care. However, it is impossible to incorporate all potential variables into this guideline manual. Therefore, each individual responder must determine the appropriate sequence for performing the treatment recommendations for each patient. In addition, because of unusual circumstances encountered in emergency work, the clinical judgment exercised by field paramedics in
conjunction with on-line medical control may call for variation from the established guidelines from time to time.

BioTel Treatment Guidelines Committee - Kenny Navarro, Chair

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