INTRODUCTION

The purpose of this protocol is to set forth New York City Regional guidelines for the coordination of prehospital resources at the scene when multiple emergency medical service (ems) agencies are present. The protocol addresses who has the authority to determine:

• who will provide patient care;
• who will accompany the patient;
• which ambulance(s) will provide transport;
• the hospital destination(s); and
• the need for additional resources.

All providers must properly and reasonably identify themselves and their certification levels. The provider must provide his/her name, organization name, and provider number (shield or NYS DOH certification number). Written identification is preferable.

All providers present at an incident must function as part of a response by the ems agency with which they are affiliated and remain within their scope of training and practice.

The ems agency must be authorized to provide prehospital care within the New York City region and operate under regionally approved protocols specific to the agency's approved level(s) of care.

The highest level prehospital emergency medical provider from the ems agency that first establishes patient contact at the scene assumes the role of primary care provider. S/he retains responsibility for patient care, until relinquished to a prehospital emergency medical provider from another ems agency as determined by patient condition/medical necessity, mutual consent, operational necessity, or patient request.

If a primary ALS care provider assumes control of the patient from a BLS level provider, the BLS provider should assist in the delivery of patient care as requested until such time as the primary ALS care provider determines that assistance is no longer required.

In cardiac arrest situations, EMT-D or CFR-D units will be considered a higher level of patient care provider over units which are not equipped with defibrillators.

Decisions related to coordination of prehospital resources are the responsibility of the highest level prehospital provider from the ems agency whose unit first arrives at the scene.

Higher level prehospital providers may assume responsibility for coordination of prehospital resources if they assume responsibility for patient care.

Responsibility for coordination of prehospital resources may be relinquished to later arriving prehospital providers based on mutual consent.

When a NYC "911 System" participating ems agency is not the first ems agency on the scene and is not acting in the role of primary care provider, it shall act as an operational resource for:

• information regarding hospital diversions, specialty referral center bed availability and other specialized resources; and
• Incident scene safety (e.g., environmental conditions, crowd/traffic control in the absence of NYPD, potentially dangerous patient to self and/or others).

• Multiple Casualty Incidents (MCIs);
• Unscheduled Medevac Transports;
• Hazardous Materials situations which require decontamination;
• Fires/Crimes in Progress; or
• Unusual public health or safety emergencies.

MCIs are generally defined as five (5) or more patients with the potential need for extraordinary resources. However, the criteria for the definition of MCIs are not primarily dependent upon the number of patients.

The Regional Emergency Medical Services Council of New York City and the NYC*EMS should include all ems agencies participating in MCIs into MCI planning, and should coordinate training in MCIs for all participating ems agencies.

The primary care provider who is responsible for patient care will determine who accompanies the patient. In all practical circumstances the number of individuals in the patient compartment, excluding the patient, shall not exceed four (4). However, the primary care provider who is responsible for patient care makes the ultimate decision regarding who is in the patient compartment.

Each ems agency shall develop guidelines, policies and procedures to ensure the implementation of this protocol. Evaluation of the effectiveness of the protocol shall be ongoing as part of each ems agency's QA processes and integrated into system-wide QA activities pursuant to Article 30.

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