SOP Draft 2011
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Region IX SOPS/SMOs Table of Contents 2016 Edition GENERAL PATIENT MANAGEMENT Burns 44-45 Introduction 1 Chest trauma 46 EMS Scopes of Practice 2 Eye emergencies / Facial trauma 47 General Patient Assessment/IMC 3-4 Head trauma 48 Emergency drug alternatives 5 Musculoskeletal trauma 49 OLMC Report/Handover Reports 6 Spine trauma/Equipment removal guidelines 50-51 Withholding or Withdrawing Resuscitation 7-8 Multiple Patient Incidents (NR) 52 Elderly patients 9 START & JumpSTART 53 Extremely obese patients 10 Hazardous Materials Incidents 54 RESPIRATORY Chemical Agents 55 Airway obstruction 11 Active Shooter Response 56-57 Drug Assisted Intubation (NR- Expanded Scope) 12 Widespread disease outbreak 58 Allergic Reaction/Anaphylactic Shock 13 Abuse and Maltreatment: Domestic/Sexual/Elder 59 Asthma/COPD 14 Trauma in pregnancy 60 Pts w/ tracheostomy (adult or peds) 15 OB CARDIAC Childbirth 61 Acute Coronary Syndromes 16 Newborn and post-partum care 62 Bradycardia with a Pulse 17 Delivery complications 63 Narrow QRS Complex Tachycardia 18 Newborn resuscitation 64 Wide Complex Tachycardia with a Pulse 19 OB complications 65 Ventricular fibrillation/pulseless VT 20 PEDS Asystole/PEA 21 Peds initial medical care 66 Heart Failure/Pulmonary Edema/Cardiogenic Shock 22 Peds IMC - GCS 67 Left ventricular assist device 23 Peds Secondary assessment/sedation/VS 68-69 MEDICAL Special Healthcare needs 70 Acute Abdominal/Flank Pain 24 Peds Airway Adjuncts (NR) 71 Dialysis/Chronic Renal Failure 24 Peds Respiratory: FBO; Arrest, SIDS, BRUE 72-73 Alcohol Intoxication/Withdrawal 25 Peds Anaphylaxis / Asthma / Croup/ Epiglottitis / RSV 74-76 Altered Mental Status/Syncope & Presyncope 26 Peds cardiac SOPs 77-80 Drug Overdose/Poisoning 27 Peds medical SOPs 81-86 Carbon monoxide (HBO)/Cyanide exposure 28 Peds ITC/Trauma score/Trauma SOPs/Abuse 87-89 Environmental emergencies: Cold related 29 APPENDIX 90-112 Environmental emergencies: Submersion 30 CPR: Quality criteria; peds defib table 90 Environmental emergencies: Heat related 31 Drug appendix 91-100 Glucose/Diabetes Emergencies 32 Peds DRUG calculations 101-102 Hypertension/Hypertensive crisis 33 Fentanyl/Ketamine Drug dosing / med routes 103 Psych/Behavioral Emerg/Agitated/Violent Pts 34-35 QT intervals; 12-lead changes in AMI 104 Stroke – Transport algorithm 36-37 Medical abbreviations 105-106 Seizures 38 Differential of COPD/HF; CPAP ................................ 107 Shock differential – Hypovolemic / Septic 39 Biologic, Nuclear, Incendiary & Chem agents ......... 108 TRAUMA (adult and peds) Bioterrorist Agents ..................................................... 109 Initial trauma care (ITC)/GCS/RTS 40-41 Chemical Terrorism Agents ....................................... 110 Triage & transport criteria (table) 42 Hospital Designations for Specialty Transports ........ 111 Cardiac Arrest due to Trauma 43 Pain scales ................................................................. 112 Conducted electrical weapon (Taser) 43 Introduction Assumptions 1. All EMS personnel will function within their scope of practice as defined by the Illinois EMS Act, IDPH Rules and Regulations, Illinois Dept of Financial and Professional Regulation, and practice privileges authorized by the EMS MD of the System in which they are working. 2. These SOPs shall be evidence-based and revised as standards of practice or clinical practice guidelines change. They include recommendations from the National Association of EMS Physicians (NAEMSP) (National Model EMS Clinical Guidelines), Am Heart Association (AHA) (CPR, ACLS/PALS), Am College of Surgeons (ACS) (ATLS & PHTLS), Am College of Emergency Physicians (ACEP) (ITLS), Brain Trauma Foundation, Centers for Disease Control and Prevention (CDC), Dept. of Health & Human Services, EMS for Children (EMSC); the National EMS Education Standards, Scope of Practice Model and National EMS Core Content. 3. Italicized options within a protocol may not be used in all Systems. Refer to the System-specific SOP documents. Those marked NR are non-region protocols that may or may not be adopted by each System or substituted with a System-specific document. 4. Levels of acuity: Definitions match Model of Clinical Practice of Emergency Medicine; in the Ntl EMS Core Content: Acuity level is essential for identifying care priorities in EMS setting. They are coded to NEMSIS standards and should be documented as such in the PCR/EHR. CRITICAL pts are TIME-SENSITIVE with black box notations in the SOPs. CRITICAL: Symptoms of a life threatening illness or injury with a high probability of mortality if immediate intervention is not begun to prevent further airway, respiratory, hemodynamic and/or neurologic instability. EMERGENT: Symptoms of illness or injury may progress in severity or result in complications w/ a high probability for morbidity if treatment is not begun quickly. These may be identified as time-sensitive on a case by case basis. LOWER ACUITY: Symptoms of an illness or injury that have a low probability of progression to more serious disease or development of complications. 5. Stable: Ability to maintain a steady state of equilibrium with VS that support adequate oxygenation, ventilation, perfusion, & mentation Guidelines 1. Abandonment: EMS personnel shall not knowingly abandon a patient. Abandonment is the unilateral termination of a health professional-patient relationship and/or the unreasonable discontinuation of care by the health care provider when there is still a need for continuing medical attention, contrary to the patient’s will, and/or without the patient’s knowledge. Abandonment for our purposes includes executing an inappropriate refusal, releasing a patient to a less qualified individual, or discontinuing needed medical monitoring before patient care is assumed by other professionals of equal or greater licensure than the level of care required by the patient. 2. Bus Accident: Refer to Region policy. 3. Consent: Decisional adults must consent to treatment. Consent must be informed or clearly implied via verbal agreement to the treatment or gestures indicating their desire for treatment. A patient's lack of refusal or physical resistance or withdrawal will be taken as consent. 4. Consent (Implied): Patients who are unconscious or otherwise so incapacitated that they cannot comply with the above provisions and do not exhibit the ability to make sound judgments, will be treated under implied consent. Patients who are obviously impaired with altered judgment who are unable to understand their decisions, have slurred speech, and/or ataxia; those suffering from mental illness; those who have made suicidal statements (to EMS personnel or persons physically present at the scene who will attest to the statements on a petition form) are to be treated under the doctrine of implied consent. They are not allowed to refuse treatment or transport. 5. Expanded scope: Expanded scope of practice is System specific as approved by IDPH. See System SOPs and policies. 6. Minors: Patients who are minors (<18) should have consent of a parent or guardian obtained prior to treatment unless they qualify as an emancipated minor or qualify for care under implied consent under the Emergency Doctrine. See System-specific policies regarding notification of parent or guardian if they are not immediately available. 7. Refusals: Patients who are judged to be legally and mentally decisional have the right to refuse any and all treatment. Patients who are non-decisional may not consent to or refuse treatment. (See System-specific policies) 8. Treatment of prisoners: Prisoners should be transported under the custody of a law enforcement officer for a medical screening exam at the officer's request. The officer should accompany the prisoner in the ambulance. Note the officer's name and badge number on the PCR/EHR. EMS personnel are not responsible for the secured custody of prisoners. If a prisoner has been placed in handcuffs, the officer is still responsible for the prisoner. If the officer does not accompany the patient in the ambulance, he or she must follow the ambulance in their vehicle during EMS transport but EMS personnel must be given the handcuff key. 9. Lights and sirens: Routine use of lights and sirens is not warranted. Pursuant to Illinois Vehicle Code Section 625 ILCS 5/11-1421, the use of visual and audible warning devices from the scene to the hospital is authorized by the EMS MDs for time sensitive patients and in accordance with System policy, unless contraindicated per individual SOP. 10. Selection of receiving healthcare facility: See Initial Medical and Initial Trauma Care and local System policies. Region IX FINAL 10-27-16 Page 1 EMS Scopes of Practice Includes IDPH additional Standards exceeding the National EMS Education Standards and National Scope of Practice Model as adopted by Region IX EMS MDs See local policies/ EMR EMT [BLS] Paramedic/PHRN [ALS] procedures for details • Apply an appropriate pulse • Blood chemistry analysis (point of care • Capnography monitoring Monitoring oximetry (SpO2 ) sensor testing • Interpret SpO2 findings • Blood glucose monitoring • ECG rhythm & 12 L interpretation • BLS airway access: • Obstructed airway maneuvers • Magill forceps for airway FB removal position, OPA/NPA • Oral suctioning • Stoma suctioning • Pulse oximetry • Tracheal-bronchial suctioning • Tracheostomy tube replacement Airway/ventilatory of an already intubated pt. through a stoma management • Capnography monitoring • Intubation: Adult & peds (bougie) Oxygen delivery • O2: