Health, Department of

Emergency Medical Services - General

Chapter 0: Appendices A - D

Effective Date: 06/08/1998 to 01/26/2004

Rule Type: Superceded Rules & Regulations

Reference Number: 048.0023.0.06081998

APPENDIX A

EXECUTIVE ORDER No.76-4

Pursuant to the authority vested in the office of Governor of the State of Wyoming under W.S. Sections 9-32.4 and 9-160.7, I, Ed Herschler, Governor of the State of Wyoming, hereby order:

Section 1: The Wyoming Advisory Committee on Emergency Medical Services is created under the sponsorship of the Wyoming Department of Health and Social Services, Division of Health and Medical Services for the purpose of assisting the efforts of various Federal, State and local agencies, private industry, and interested citizens toward the development and implementation of an integrated, statewide program for emergency medical services. The said Committee shall stimulate the interest, planning, and development of activities which will result in the highest possible standard of medical care to victims of trauma and critical illness in Wyoming.

Section 2: The said Committee shall perform the following

1. (a) Act in an advisory capacity to the Division of Health and Medical Services and through the said Division to the Governor on all matters related to emergency medical care programs.
2. (b) Make recommendations concerning the development and implementation of statewide emergency medical care programs.
3. (c) Determine statewide emergency medical care needs and provide a broad basis for responsibility and policy decisions.
4. (d) Make recommendations concerning guidelines and standards for the delivering of emergency medical care which recognizes the concepts of the National Highway Safety Act of 1966 and the Emergency medical Services Act of 1973.
5. (e) Foster and encourage action in the interest of improved care and treatment to victims of trauma and critical illness in Wyoming.
6. (f) Coordinate the State's participation in federally supported programs related to emergency medical care and make recommendations as to the use of funds received under such programs.

Section 3. The members of the said Committee shall be appointed by the Governor and serve at his pleasure. Persons appointed to serve on the Committee shall have demonstrated an interest or involvement in emergency medical care activities. A Chairman and Vice-Chairman shall be elected from the membership of the Committee in accordance with by-laws approved by the Governor. The composition of the Committee shall be one member representing each of the following:

1. (1) Wyoming Chapter of the American Academy of Orthopaedic Surgeons
2. (2) The Wyoming Trauma Committee, American College of Surgeons.
3. (3) Wyoming Ambulance and Emergency Medical Services Association.
4. (4) Wyoming Highway Patrol.
5. (5) Wyoming Disaster and Civil Defense Agency.
6. (6) Wyoming Hospital Association.
7. (7) Wyoming Governor's Office of Highway Safety.
8. (8) Wyoming Nurses Association.
9. (9) Wyoming Office of Emergency Medical Services.
10. (10) Wyoming State Health Planning and Development Agency.

(11) Wyoming Registered Emergency Medical Technician. (12) Private Physician. (13) Private Physician. (14) Consumer from Wyoming Health System Agency. (15) Consumer from Wyoming Health System Agency. (16) Wyoming Hospital Administrator. (17) Wyoming Ambulance Operator.

Section 4. The Wyoming Department of Health and Social Services, Division of Health and Medical Services, and its responsible office, is hereby designated as the official administrative and operational agency for coordination, planning, implementation, and evaluation of the Wyoming Emergency Medical Services System.

GIVEN under my hand and the Executive Seal of the State of Wyoming this 7th day of December 1976,

APPENDIX B

EQUIPMENT REQUIREMENTS FOR AMBULANCES

The Department of Health's Office of Emergency Medical Services has established the following equipment list as the minimum necessary for ground ambulances involved in the transportation or treatment of ill or injured patients in the prehospital setting.

Basic Life Support

Airway Management and Ventilation:

1. abOxygen tank - fixed (minimum capacity of 3,000 liters with reduction gauge and flowmeter) and portable with regulator.
2. abOxygen masks in infant, child and adult sizes.
3. abNasal cannulas in child and adult sizes.
4. abOral airways; infant, child and adult sizes.
5. abNasopharyngeal airways with lubricant; infant, child and adult sizes.
6. abSelf-inflating resuscitation bags; with oxygen reservoir. Infant, child and adult sizes
7. abMasks for use with resuscitation bags; neonate, infant, child and adult sizes.
8. abOxygen connecting tubing.
9. abPortable suction unit with various tonsillar and flexible suction catheters.
10. abBite sticks.

Patient Assessment:

1. abBlood pressure cuff, infant, child and adult.
2. abStethoscope.
3. abFlashlight/penlight (with extra batteries and bulb).
4. abThermometer with low temperature capacity.

Obstetrics:

1. abSterile pre-assembled delivery kit.
2. abThermal absorbent blanket and head cover.

Immobilization:

1. abTraction splint - child and adult.
2. abFirm upper and lower extremity splints to include joint above and below injury, rigid with padding.
3. abBackboard; short and long with appropriate securing straps, with padding available for children.
4. abRigid cervical collars; for children >2 years old; infant, child, small, medium, large adult.
5. abNeck immobilization device (firm padding or commercial product).
6. abTriangular bandages.
7. abScoop type stretcher.

Personal Protection:

1. abInfectious disease prevention materials - gloves - goggles or face shield - masks - gowns - appropriate disinfectants.
2. abShoe covers.
3. abSharp object disposable containers.
4. abAntiseptic hand wipes
5. abHearing protection
6. abHEPA mask
7. abAppropriate mask with one-way valve & appropriate filter
8. abTraffic safety vest

Bandaging:

1. abBurn package - includes sterile sheets or towels for children.
2. abSterile trauma dressings of various sizes.
3. abSterile gauze rolls of various sizes.
4. abAdhesive tape in various sizes.
5. abElastic bandages in various sizes.

Communications:

1. abTwo-way communication equipment between dispatcher, ambulance and medical facility.

Other:

1. abSterile saline irrigation fluid.

2. abBandage/trauma shears.

3. abDisposable basins or emesis bags.
4. abDisposable bedpan and urinal.
5. abStretcher, main; shall be four-wheeled elevating cot for primary patient with appropriate patient restraining device.
6. abSyrup of ipecac/activated charcoal.
7. abPatient restraints.
8. abSugar cubes or hypertonic sugar solution.
9. abCold packs.
10. abBlankets.
11. abDisaster tags.
12. abWarning flares and/or signal devices.
13. abFire extinguisher.

Optional: Recommended but not mandatory.

1. abPneumatic anti-shock garment (PASG) - dictated by physician medical director's protocol.
2. abAutomated external defibrillator (AED) - strongly recommended for systems that lack immediate response from an advanced life support service.
3. abLength-based tape or chart for pediatric equipment sizing.
4. abPulse oximetry.
5. abProtective helmet(s).
6. abProtective coat with reflective materials.
7. abScissors capable of cutting heavy metal.
8. abPediatric transport chair.
9. abRing cutter.
10. abTweezers.
11. abPortable first aid kits for treating patients away from the ambulance.
12. abEye wash.
13. abSelf-assisted medications as outlined in the basic EMT curriculum - ambulance service's physician medical director must authorize ambulance service to carry.
14. abPediatric Trauma Score reference chart
15. abSmall stuffed toy

It is recommended that pediatric equipment be maintained separately from the adult equipment.

Advanced Life Support

(in addition to Basic Life Support equipment)

Airway Management and Ventilation:

1. abLaryngoscope handle with extra batteries and bulbs; pediatric and adult.
2. abLaryngoscope blades - sizes 0, 1 and 2 straight - sizes 3 and 4 straight or curved.
3. abEndotracheal tubes (minimum of 2 each size) - sizes 2.5 to 5.0 mm uncuffed - 5.5 to 8.0 mm cuffed.

4. abStylettes for endotracheal tubes; pediatric and adult.

5. abMagill forceps - pediatric and adult.

6. abLubricating jelly (water soluble).
7. abNasogastric tubes - pediatric sizes 5F and 8F - adult sizes 14F, 16F, and 18F.
8. abEnd-tidal CO2 detectors or esophageal detector devices (EDD).

Monitor/Defibrillator:

1. abPortable, battery-operated, cardiac monitoring defibrillator with recorder, quick-look paddles or hands-free patches, pediatric and adult electrodes and paddles, with capability to provide electrical discharge (below 25 watt-seconds).

Vascular Access:

1. abIntravenous catheters, 14g - 22g.
2. abIntraosseous needles of choice.
3. abTourniquets/rubber bands (constricting bands).
4. abSyringes of various sizes including tuberculin.
5. abNeedles; sizes 14g - 24g.
6. abBlood sample tubes; adult and pediatric.
7. abIntravenous administration sets; microdrip, macrodrip, pediatric burette infusion set, and in-line blood pump (as differentiated from intravenous tubing with an in-line blood filter.
8. abIntravenous arm boards; adult and pediatric.

Medications: The Division shall maintain separate lists of approved medications for the EMT-Intermediate and paramedic ambulance services. The following medications may pertain to either level of service depending on authorization by the Board.

1. abAdenosine.
2. abAlbuterol or other authorized inhaled bronchodilator.
3. abAtropine sulfate.
4. abBretylium tosylate.
5. abCrystalloid solution (lactated Ringer's solution or normal saline).
6. abDextrose 50% in water (plus sterile diluent or Dextrose 25% in water for pediatric patient).
7. abDopamine
8. abEpinephrine; 1:1,000 (1mg/ml) and 1:10,000 (0.1 mg/ml).
9. abFurosemide.
10. abIntravenous diazepam or other authorized antiepileptic.
11. abIntravenous/intramuscular analgesic.
12. abLidocaine.
13. abNaloxone.
14. abNitroglycerine tablets or spray.
15. abSodium chloride - bacteriostatic, for injection.
16. abWater - bacteriostatic, for injection.

Other:

1. abLength-based tape or chart for equipment sizing and medication dosage.
2. abProvodine-iodine prep pads.
3. abAlcohol prep pads.
4. abFinger stick blood glucose reagent strips with analyzer.
5. abNebulizer

It is recommended that pediatric medications/equipment be maintained separately from the adult medications/equipment.

APPENDIX C

Ambulance Safety Inspection Form

(insert form)

APPENDIX D

ARTICLE 2. CARDIOPULMONARY RESUSCITATION DIRECTIVES

Effective dates. - Laws 1993, ch. 108, § 2., makes the act effective immediately upon completion of all acts necessary for a bill to become law as provided by art. 4, § 8, Wyo Const. Approved February 25, 1993.

§ 35-22-201. Definitions.

(a) As used in this article, unless the context otherwise requires:

(i) 'Cardiopulmonary resuscitation' means measures to restore cardiac function or to support breathing in the event of respiratory or cardiac arrest or malfunction. 'Cardiopulmonary resuscitation' includes, but is not limited to, chest compression, delivering electric shock to the chest, or manual or mechanical methods to assist breathing;

(ii) 'Cardiopulmonary resuscitation directive' means an advance medical directive pertaining to the administration of cardiopulmonary resuscitation;

(iii) 'Emergency medical service personnel' means any emergency medical technician at any level who is certified by the department of health. 'Emergency medical service personnel' includes a first responder certified by the department of health. (Laws 1993, ch. 108, § 1.)

Editor's notes. - There is no subsection (b) in this section as it appears in the 1993 printed act.

§ 35-22-202. Cardiopulmonary resuscitation directives; who may execute.

Any adult who has the decisional capacity to provide informed consent to or refusal of medical treatment or any other person who is, pursuant to the laws of this state or any other state, authorized to make medical treatment decisions on behalf of a person who hicks such decisional capacity, may execute a cardiopulmonary resuscitation directive. (Laws 1993, ch. 108, § 1.)

§ 35-22-203. Cardiopulmonary resuscitation directive forms; duties of department of health.

(a) On or before January 1, 1994, the state department of health shall promulgate rules and protocols for the implementation of cardiopulmonary resuscitation directives by emergency medical personnel. The protocols adopted shall include uniform methods of identifying persons who have executed a cardiopulmonary resuscitation directive. Protocols adopted by the department of health shall include methods for rapid identification of persons who have executed a cardiopulmonary resuscitation directive, controlled distribution of the methods of identifying persons who have executed a cardiopulmonary resuscitation directive, and the information described in subsection (b) of this section. Nothing in this subsection shall be construed to restrict any other manner in which a person may make a cardiopulmonary resuscitation directive.

(b) Cardiopulmonary resuscitation directive protocols to be adopted by the state department of health shall, at a minimum, require the following information concerning the person who is the subject of the cardiopulmonary resuscitation directive:

(i) The person's name, date of birth and sex;

(ii) The person's eye and hair color;

(iii) The person's race or ethnic background;

(iv) If applicable, the name of a hospice program in which the person is enrolled;

(v) The name, address and telephone number of the person's attending physician; (vi) The person's signature or mark or, if applicable, the signature of a person authorized by this article to execute a cardiopulmonary resuscitation directive; (vii) The date on which the cardiopulmonary resuscitation directive was signed; (viii) The person's directive concerning the administration of cardiopulmonary resuscitation, countersigned by the person's attending physician. (Laws 1993, ch. 108, § 1.)

§ 35-22-204. Duty to comply with cardiopulmonary resuscitation directive; immunity; effect on criminal charges against another person.

(a) Emergency medical service personnel, health care providers and health care facilities shall comply with a person's cardiopulmonary resuscitation directive that is apparent and immediately available. Any emergency medical service personnel, health care provider, health care facility or any other person who, in good faith, complies with a cardiopulmonary resuscitation directive which is perceived to be valid shall not be subject to civil or criminal liability or regulatory sanction for such compliance.

(b) Compliance by emergency medical service personnel, health care providers or health care facilities with a cardiopulmonary resuscitation directive shall not affect the criminal prosecution of any person otherwise charged with the commission of a criminal act.

(c) In the absence of a cardiopulmonary resuscitation directive, a person's consent to cardiopulmonary resuscitation shall be presumed. (Laws 1993, ch. 108, § 1.)

§ 35-22-205. Effect of declaration after inpatient admission.

A cardiopulmonary resuscitation directive for any person who is admitted to a health care facility shall be implemented as a physician's order concerning resuscitation as directed by the person in the cardiopulmonary resuscitation directive, pending further physicians' orders. (Laws 1993, ch. 108, § 1.)

§ 35-22-206. Effect of cardiopulmonary resuscitation directive; absence; on life, or health insurance.

Neither a cardiopulmonary resuscitation directive nor the failure of a person to execute one shall affect, impair or modify any contract of life or health insurance or annuity or be the basis for any delay in issuing or refusing to issue an annuity or policy of life or health insurance or any increase of a premium therefor. (Laws 1993, ch. 108, § 1.)

§ 35-22-207. Revocation of cardiopulmonary resuscitation directive.

A cardiopulmonary resuscitation directive may be revoked at any time by the person who is the subject of the directive or by any other person who is, pursuant to the laws of this state or any other state, authorized to make medical treatment decisions on behalf of the person who is the subject of the directive. (Laws 1993, ch. 108, § 1.)

§ 35-22-208. Effect of article on euthanasia; mercy killing; construction of statute.

Nothing in this article shall be construed as condoning, authorizing or approving euthanasia or mercy killing. In addition, the legislature does not intend that this article be construed as permitting any affirmative or deliberate act to end a person's life, except to permit natural death as provided by this article. (Laws 1993, ch. 108, § 1.)