Harbor: Base Hospital Resource for Physicians and MICNs

Harbor UCLA Medical Center

• This is intended as a quick reference for Harbor UCLA Base Hospital Physicians and MICNs.

Base Hospital Map in Los Angeles County

Types of Radio Calls

• Base Contact (MICN, Attending, R4, R3)
  • Including Cardiac Arrest, Pronouncement in the field, AMA
• Base Notification (MICN, Attending, R4, R3)
• Base to Base Referral (MICN or experienced Base Hospital Physician)
• 911 Interfacility Transport for Trauma (Attending must take the report and accept patient)
  • Reference No. 506, Policy VI
• 911 Interfacility Transport for STEMI (Attending must take the report and accept patient)
  • Reference No. 513.1
• Multiple Casualty Incident (MICN or experienced Base Hospital Physician)
  • Reference No. 519

Provider Codes

Common Provider Codes for Harbor UCLA Medical Center

• Most Commonly Used Provider Impression Codes
  • ABOP = Abdominal Pain/Problems
  • ETOH = Alcohol Intoxication
  • ALOC = Altered Level of Conciousness-Not Hypoglycemia or Seizure
  • PSYC = Behavioral/Psychiatric Crisis
  • BRUE = BRUE
  • CANT = Cardiac Arrest-Non-Traumatic
  • CPNC = Chest Pain-Not Cardiac
  • CPMI = Chest Pain-STEMI
  • CPSC = Chest Pain-Suspected Cardiac
  • DIZZ = Dizziness/Vertigo
  • HYPR = Hyperglycemia
  • HYTN = Hypertension
  • HYPO = Hypoglycemia
  • HOTN = Hypotension
  • SOBB = Respiratory Distress/Bronchospasm
  • RDOT = Respiratory Distress/Other
  • CHFF = Respiratory Distress/Pulmonary Edema/CHF
  • SEPI = Seizure-Postictal
  • SEPS = Sepsis
  • SHOK = Shock
  • SYNC = Syncope/Near Syncope
  • TRMA = Traumatic Injury
  • WEAK = Weakness-General
• Common Paramedic Provider Agency Codes
  • CF = Los Angeles County Fire
  • CI = Los Angeles City Fire
  • CM = Compton Fire
  • MB = Manhattan Beach Fire
  • RB = Redondo Beach Fire
  • TF = Torrance Fire
• Most Common ECG Codes
  • AFI = Atrial Fibrillation
  • ASY = Asystole
  • PEA = Pulseless Electrical Activity
  • SR = Sinus Rhythm
  • ST = Sinus Tachycardia
  • VF = Ventricular Fibrillation
  • VT = Ventricular Tachycardia
• Most Common Location Codes
  • HO = Home
  • NH = Nursing Home
  • FR = Freeway
  • ST = Street/Highway
• Most Common 9-1-1 Receiving Hospital Codes
  • CNT = Centinela Hospital
  • KFH = Kaiser South Bay
  • LCM = Providence Little Company of Mary Medical Center - Torrance
  • MHG = Gardena Memorial Hospital
  • MLK = Martin Luther King Hospital
  • TOR = Torrance Memorial

Prehospital Care Manual and Treatment Protocols

• Complete Prehospital Care Manual
• Adult and Pediatric Treatment Protocols

Specialized Care and Transport Considerations

STEMI

• Medical management according to TP 1211
• Ensure Harbor UCLA Medical Center is OPEN to STEMI by checking ReddiNet.
• Reminder to document the EKG time, Initial Rhythm, EMS Interpretation, and Software Interpretation.
• Obtain and print transmitted ECG from STEMI outlook email.
• Discuss with Attending with regard to activating Cath Lab prior to patient arrival.
• All patients in cardiac arrest should also be transported to a STEMI Receiving Center if transport time is <30 minutes.
• Destination: STEMI Receiving Center

Stroke

• Medical management according to TP 1232
• On all patients exhibiting local neurologic signs, paramedics perform an mLAPSS assessment. If mLAPSS is positive, it is followed by a calculation of a LAMS score and documentation of LKWT (Last Known Well Time).
  • 1. Modified Los Angeles Prehospital Stroke Screen (mLAPSS)
    • The mLAPSS is positive if ALL of the following criteria are met:
      • No history of seizures or epilepsy
      • Age 40 years or older
      • At baseline, patient is not wheelchair bound or bedridden
      • Blood glucose between 60 and 400 mg/dL
      • Obvious asymmetry-unilateral weakness with any of the following motor exams:
        • Facial Smile/Grimace
        • Arm Strength
        • Grip Strength
  • If mLAPSS positive --> 2. Calculate Los Angeles Motor Score (LAMS)
    • Facial Droop
      • Absent = 0
      • Present = 1
    • Arm Drift
      • Absent = 0
      • Drifts down = 1
      • Falls rapidly = 2
    • Grip Strength
      • Normal = 0
      • Weak grip = 1
      • No grip = 2
  • If mLAPSS positive --> 3. Document LKWT
• Destination:
  • If mLAPSS positive, LAMS 4-5, LKWT < 24 hours --> Transport to Comprehensive Stroke Center if within 30 min
  • If mLAPSS positive, LAMS ≤ 3, LKWT < 24 hours --> Transport to closest Stroke Center (Primary or Comprehensive)
  • mLAPSS negative but acute stroke suspected --> Transport destination is at discretion of Base Hospital

Trauma

• Medical management according to TP 1244 for adults, TP 1244-P for pediatrics.
• Any patient that meets trauma criteria or is deemed by provider judgment to meet trauma criteria should be transported to the nearest adult or pediatric trauma center.
  • Trauma criteria can be found on the Base Contact Form under the TRAUMA and MECHANISM Sections. Patients are classified as a trauma patient if any of the red boxes are checked.
• Pediatric Trauma Center Criteria
  • Children >15 years old cannot go to an adult trauma center
• Destination: Adult or Pediatric Trauma Center

Trauma Traige Decision Scheme

Burns

• Medical management according to TP 1220 for adults and TP 1220-P for pediatrics.
• If a burn patient meets Trauma Center criteria, then transport to Trauma Center.
• If NO SIGNS OF TRAUMA, consider transport to directly to a burn center if they meet these criteria:
  • ≥ 15 years with 2nd and 3rd degree burn ≥ 20% TBSA
  • ≤ 14 years with 2nd and 3rd degree burn ≥ 10% TBSA
• If the patient does not meet burn center criteria and has NO SIGNS OF TRAUMA, transport to Most Accessible Receiving Center (MAR)
• Destination: Burn center, Trauma center, or MAR

Types of Destinations/Receiving Centers

• MAR = Most Accessible Receiving
• TC = Trauma Center
• EDAP = Emergency Department Approved for Pediatrics
  • Think of an EDAP as a MAR for children approved to care for children ≤ 14 years old.
• PMC = Pediatric Medical Center
  • Approved to care for critically ill children ≤ 14 years old.
• PTC = Pediatric Trauma Center
  • Approved to care for children ≤ 14 years old who meet trauma criteria.
• Perinatal Center
  • Basic ED with 24/7 Obestrical services approved to care for pregnant patients >20 weeks gestation.
• SRC = STEMI Receiving Center
• PSC = Primary Stroke Center
  • Able to care for most ischemic strokes.
• CSC = Comprehensive Stroke Center
  • Able to care for all ischemic and hemorrhagic stroke cases with 24/7 neurosurgery and capable of performing minimally invasive catheter-based procedures including thrombectomy for large vessel occlusion strokes.

911 IFT

• 911 Trauma Re-Triage
• STEMI Transfer

ReddiNet

• A designated emergency and disaster communication system established for hospitals within Los Angeles County.
• Allows Los Angeles County hospitals to request diversion status, manage MCIs, and report bed availibility.
• It is the responsibility of each hospital to ensure ReddiNet remains up to date and online at all times.
• Diversion requests Categories
  • Hospitals may request ED Sat in 1 hour increments if unable to care for ALS patients. BLS traffic is not diverted.
    • See Ref No. 503
  • May also request diversion for CT Scanner, Trauma,

Base Contact Form Documentation Reminders

• GEN INFO Section
  • Document Time in Military Time
  • Document Weight in Kgs
    • It is ok to approximate weight by dividing lbs by 2 (ex. If medics state the patient is 100lbs, you can respond: "To confirm the patient is 100lbs or approximately 50kgs").
• ASSESSMENT Section
  • Ask providers to obtain family contact information and/or bring along DNR/AHCD/POLST if relevant.
• PHYSICAL Section
  • Document capnography # for all patients receiving positive pressure.
• VITALS & TXS Section
  • Document a pain level when ordering PRN analgesia (ex. Morphine 4mg IV PRN pain >5/10).
• ECG Section
  • Document the time that ECG was taken.
• ARREST Section
  • Ensure Time of Resus D/C is documented when relevant.

Base Contact Form