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Part 3, Chapter 17: Manual Exhibit 3-17-B

Emergency medical services Standards
    1. Resource Management and Access to Care.
      1. All Emergency Medical Services (EMS) systems will provide access to EMS regardless of patient's race, sex, tribal affiliation, or ability to pay.
      2. All EMS systems will develop memorandums of agreement or understanding with appropriate adjacent or regional EMS providers which specify geographical response areas, mutual aid arrangements, and/or transfer arrangements for emergency patients, as appropriate.
      3. All EMS systems will meet or exceed State standards for EMS.
    2. Human Resources and Training.
      1. All Indian Health Service (IHS) physicians and nurses who have Emergency Department (ED) responsibilities will have, within 6 months of assignment, completed:
        1. Advanced Cardiac Life Support training.
        2. Pediatric Advanced Life Support is also endorsed and encouraged.
        3. Advanced Trauma Life Support (or comparable) training.
      2. All IHS physicians assigned as EMS Medical Directors should attend training on EMS medical direction.
      3. All individuals whose duties include ambulance transportation of the ill or injured will have, as a minimum, certification as Emergency Medical Technician Basic or Emergency Medical Technician Intermediate.
      4. Additional training is encouraged in areas of Ambulance Driving, Hazardous Materials Emergencies, Basic/Advanced Pre-hospital Trauma Life Support, Water Rescue, Rope Rescue, and/or Firefighting, as appropriate.
      5. Where appropriate, First Responders, Public Safety Officers, and Community Health Representatives who can be reasonably expected to respond to medical emergencies will, as a minimum, complete a course in First Aid, First Responder or other appropriate medical/training.
      6. The public will be encouraged to receive training and certification in Cardiopulmonary Resuscitation, Bystander Care, etc.
    3. Transportation.
      1. Ill or injured patients will be transported by the means which is most appropriate for their medical condition.  This method may be ground Basic Life Support (BLS) ambulance, Advanced Life Support (ALS) ground ambulance, air medical transport, or other appropriate method.  Each EMS system must be aware of the transportation methods available, have protocols for determining which to use, and procedures for contacting and utilizing these transportation methods.
      2. Ambulances will be safe and reliable.  All ambulances should be constructed and inspected to meet federal and/or state specifications for ambulances, even if the State does not license the ambulance service.
    4. Facilities.
      1. Seriously ill or injured patient will be delivered in a timely manner to the closest appropriate medical facility.  The initial destination need not be the final destination:  It is in some cases appropriate to deliver an emergency patient to a closer smaller facility for stabilization and subsequent transfer to a more definitive facility.
      2. Less seriously ill or injured patients will be transported to an appropriate medical facility, which will be determined by consideration of the nature of the emergency, the capabilities of the receiving facility, patient preferences, prior agreements or contractual arrangements, and other appropriate consideration.
      3. Each EMS system must be aware of the emergency medical receiving facilities available, and their capabilities and limitations.  Each system must develop protocols, procedures, and (in some cases) prior agreements with these facilities to specify which facilities to use in what circumstances.
    5. Communications, Dispatch, and Emergency Response.
      1. All Indian communities will have access to emergency medical response and transport:
        1. Desired response time:  15 minutes by a trained First Responder.
        2. Desired transport time:  within 60 minutes by certified Emergency Medical Technician (EMT) or EMT-Intermediate (except Alaska).
      2. All EMS systems will establish procedures for initial contact of EMS by individuals outside the system (e.g. 911, private citizens, public safety officers).  These procedures will be publicized as widely as possible in the community.
      3. Each EMS system will have protocols for handling of initial emergency calls, so that the emergency is addressed expeditiously and appropriately.  This may include providing emergency telephone advice, dispatching a First Responder, notifying Law Enforcement, and/or dispatching a First Responder notifying Law Enforcement, and/or dispatching an ambulance.
    6. Public Information, Education, and Injury Prevention.
      1. All programs involved in providing EMS will be actively involved in community injury prevention and substance abuse control efforts.
      2. All programs involved in providing emergency medical response will give the widest possible publicity to the proper methods of gaining initial access to EMS.
      3. All programs are encouraged to establish a formal community EMS organization which reviews and evaluates the provision of EMS services.  This serves as an important source of evaluation, input, and quality measure of the services being provided.
    7. Medical Direction.
      1. Emergency Medical Services, like all medical care, are provided under the license of a physician.  Provision of the following EMS in the IHS will be directed by an appropriately licensed physician:
        1. Design and ongoing revision of the EMS system.
        2. Training, certification and continuing education of non-physician EMS providers.
      2. Operation of the EMS system:
        1. Dispatch and response.
        2. Pre-hospital care and transportation.
        3. Emergency Department/Receiving Facility care.
        4. Interfacility Transport.
        5. Followup after definitive care.
        6. Evaluation and improvement of the EMS system.
      3. Indirect (Off-line) medical direction is exercised by the "EMS Medical Director" at all levels.  Formal authority for administrative medical direction within the IHS resides in the Chief Medical Officer at National and Area Office levels, and the Clinical Director at the local or Service Unit level.  This authority may be delegated in writing to another physician.  Tribally operated programs should have an EMS Medical Director appointed by the tribal administrative or health authority.
      4. A description of Service Unit EMS Medical Director duties is found in the text at 3-17.2D(2)1.
      5. Direct (On-line) medical direction is exercised by a licensed physician who has specific privileges to provide emergency care in an IHS facility providing EMS.
    8. Trauma Systems.
      1. All IHS medical facilities will have established protocols for transport of the critically injured to the closest appropriate facility.
      2. Emergency Medical Services systems and medical facilities should participate in state, regional, or nation-wide Trauma Registries.  The IHS recognizes that the reporting and compilation of data from a large number of sources is the foundation of prevention, public education, and improvement of patient care.
    9. Evaluation and Monitoring.
      1. All out-of-hospital and emergency facility (hospital or clinic) patient care services will be reviewed for quality on a routine (monthly) basis.
      2. All IHS EMS programs will undergo a National EMS Program Review at least every four years.  Programs may request additional reviews or focused assistance visits from the national staff.  Tribal and urban EMS programs may also request reviews or assistance visits from the national staff.
    10. Disaster Planning.
      1. Potential disaster situations should be determined locally and response plans should be developed in coordination with appropriate local organizations to provide an optimum response.