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Patient Care Guidelines SANDOVAL COUNTY FIRE DEPARTMENT PATIENT CARE GUIDELINES 2014-2016 PHILIP J. FROMAN, MD, FACEP SANDOVAL COUNTY MEDICAL DIRECTOR JENNA WHITE, MD SANDOVAL COUNTY ASSISTANT MEDICAL DIRECTOR REVIEWED & UPDATED BY GREGG KOTILA, EMT-P, NCEE EMS CHIEF Page 1 of 197 Updated September 22, 2014 (This page intentionally left blank) Page 2 of 197 Updated September 22, 2014 APPLICATION FOR USE OF SCFD PATIENT CARE GUIDELINES 7 SCFD APPROVED MEDICATIONS 8 SECTION 1-SYSTEM GUIDELINES 9 CONTINUOUS QUALITY IMPROVEMENT (CQI) 10 CONTROL OF PATIENT CARE (ALSO SEE THE INTERAGENCY INTERACTION GUIDELINES) 11 DOCUMENTATION OF PATIENT CARE 12 DO NOT RESUSCITATE / ADVANCED DIRECTIVES / EMS DNR 13 NEW MEXICO MOST / DEAD AT SCENE 14 DIVERSION OF EMS UNITS 15 EMERGENCY DEPARTMENT PATIENT TURNOVER / EMTALA RISK 16 HELICOPTER USAGE 17 HOSPITALS 18 INVOLUNTARY RESTRAINT & TRANSPORT 19 MENTAL HEALTH PICK-UP ORDERS 20 MEDICAL CONTROL 21 MCEP CONSULT 21 USE OF EMS CONSORTIUM EMERGENCY PHYSICIANS 21 MINOR (UNDER 18 YEARS) TRANSPORT GUIDELINES 22 OFFICE OF THE MEDICAL INVESTIGATOR 23 REFUSAL OF TREATMENT/LIABILITY RELEASE 24 REPONSE IN PRIVATELY OWNED VEHICLES (POV) 25 TRANSFER OF CARE RESPONSIBILITY & DELEGATION 27 TRANSPORT GUIDELINES 28 TRAUMA DESIGNATION ALGORITHM- ALBUQUERQUE METRO 30 CDC GUIDELINES FOR FIELD TRIAGE OF INJURED PATIENTS 32 TRAUMA & MEDICAL DESIGNATION – ST. VINCENT’S HOSPITAL 33 TRANSPORT-CAPABLE MEDICAL RESCUES 34 SECTION 2 - TREATMENT GUIDELINES 35 ASSESSMENT GUIDELINES 36 PRIMARY MANAGEMENT 37 ADMINISTERING A PATIENT’S OWN MEDICATIONS 39 EASY IO GUIDELINES 40 AIRWAY MANAGEMENT 41 AIRWAY MANAGEMENT - INTUBATION 42 AIRWAY MANAGEMENT (TRAUMA PATIENT) 43 CRICOTHYROTOMY – VERTICAL APPROACH 44 CONTINUOUS POSITIVE AIRWAY PRESSURE USE 45 MEDICAL EMERGENCIES 46 PAIN MANAGEMENT 47 ABDOMINAL PAIN / FLANK PAIN 49 ACUTE MOUNTAIN SICKNESS (AMS) 50 AIRWAY OBSTRUCTION 51 ALLERGIC REACTIONS & ANAPHYLAXIS 52 Page 3 of 197 Updated September 22, 2014 ALTERED MENTAL STATUS – DEPRESSED LEVEL OF RESPONSE 54 ALTERED MENTAL STATUS – AGITATION 56 APPARENT LIFE THREATENING EVENT (ALTE) 57 CARBON MONOXIDE INHALATION POISONING 58 CROUP 60 DIABETIC EMERGENCIES 61 EPIGLOTTITIS 62 EXTRA-PYRAMIDAL REACTIONS 63 FAINTING / SYNCOPE 64 FEVER 65 HYPERVENTILATION SYNDROME 66 NARCOTIC OVERDOSE (KNOWN OR SUSPECTED) 67 NAUSEA 68 ORGANOPHOSPHATE EXPOSURE 69 POISONING / OVERDOSE / TOXIC INGESTION 70 PSYCHIATRIC EMERGENCIES 71 RESPIRATORY DISTRESS – ASTHMA 72 RESPIRATORY DISTRESS – COPD/PNEUMONIA 74 SEIZURES / CONVULSIONS 75 SEPSIS / SEPTIC SHOCK 76 STROKE – CEREBROVASCULAR ACCIDENT 77 LOS ANGELES PREHOSPITAL STROKE SCREEN SCORE SHEET 78 TRICYLIC ANTIDEPRESSANT OVERDOSE 79 UNCONSCIOUS / UNRESPONSIVE 80 VACCINATIONS 81 CARDIAC EMERGENCIES 82 GENERAL GUIDELINES 83 CHEST PAIN /SUSPECTED MYOCARDIAL INFARCTION 84 ATRIAL FIBRILLATION/FLUTTER, SYMPTOMATIC 85 BRADYCARDIA, SYMPTOMATIC 86 SUPRAVENTRICULAR TACHYCARDIA 87 CARDIOGENIC SHOCK 88 PULMONARY EDEMA & CONGESTIVE HEART FAILURE 89 VENTRICULAR TACHYCARDIA, STABLE 90 VENTRICULAR TACHYCARDIA, UNSTABLE 91 CARDIAC ARREST (NON TRAUMATIC)– ADULT & PEDIATRIC 92 VENTRICULAR FIBRILLATION & PULSELESS VENTRICULAR TACHYCARDIA 94 ASYSTOLE 95 PULSELESS ELECTRICAL ACTIVITY 96 CARDIAC ARREST – HYPOTHERMIA 97 PEDIATRIC ASYSTOLE 98 PEDIATRIC BRADYCARDIA 99 PEDIATRIC PULSELESS ELECTRICAL ACTIVITY 100 Page 4 of 197 Updated September 22, 2014 PEDIATRIC SUPRAVENTRICULAR TACHYCARDIA 101 PEDIATRIC VENTRICULAR FIBRILLATION & PULSELESS VENTRICULAR TACHYCARDIA 102 PEDIATRIC VENTRICULAR TACHYCARDIA 103 NEONATAL RESUSCITATION 104 OBSTETRIC/GYNECOLOGICAL EMERGENCIES 105 CHILDBIRTH – ASSISTING WITH A FIELD DELIVERY 106 CHILDBIRTH, ABNORMAL 108 CHILDBIRTH, FULL BREECH DELIVERY 108 CHILDBIRTH - LIMB PRESENTATION 109 CHILDBIRTH - PROLAPSED CORD 109 CHILDBIRTH - WRAPPED (NUCHAL) CORD 110 CHILDBIRTH – SHOULDER DYSTOCIA 110 CHILDBIRTH – HEAVY VAGINAL BLEEDING (POSTPARTUM HEMORRHAGE) FOLLOWING DELIVERY 112 PREECLAMPSIA – MILD AND SEVERE 113 ECLAMPSIA 114 ECTOPIC PREGNANCY 115 TRAUMA EMERGENCIES 116 TOURNIQUET 117 ASSAULT / SEXUAL ASSAULT (CRIMINAL SEXUAL PENETRATION AND/OR ASSAULT) 118 BITES: ANIMAL/INSECT/SNAKE/HUMAN 119 BURNS 120 BURNS WITH DELAYED RESPONSE AND OR TRANSPORT 122 FRACTURES - EXTREMITY 123 FROSTBITE 124 EYE INJURIES 125 HEAD INJURY – INCREASING INTRACRANIAL PRESSURE 126 HYPERTHERMIA 127 HYPOTENSION AND SHOCK 128 HYPOTHERMIA EMERGIENCIES 129 SPINAL MOTION RESTRICTION 130 TRAUMA – AMPUTATIONS 131 TRAUMA – BLUNT & MULTI-SYSTEMS 132 TRAUMA – PENETRATING 133 APPENDIX A – SPECIAL SITUATIONS 134 THE "NO GUIDELINE” - GUIDELINE 135 EMERGENCY INCIDENT REHABILITATION 136 TASER PROBE REMOVAL 137 CRITERIA FOR TRAUMA TEAM ACTIVATION 138 TRAUMA STAT ACTIVATION FOR CHRISTUS ST. VINCENT HOSPITAL – SANTA FE 139 MULTICASUALTY INCIDENT – MCI 140 START TRIAGE 141 MCI DISTRIBUTION MATRIX 142 SANDOVAL COUNTY - INTERAGENCY INTERACTION GUIDELINES 143 Page 5 of 197 Updated September 22, 2014 CRUSH INJURY / CRUSH SYNDROME 144 CYANIDE POISONING GUIDELINE 145 DOPAMINE DRIP RATE CHART 146 DRUG FORMULARY 147 NEW MEXICO SCOPE OF PRACTICE – EMS FIRST RESPONDER 189 NEW MEXICO SCOPE OF PRACTICE - EMT-BASIC 190 NEW MEXICO SCOPE OF PRACTICE - EMT-INTERMEDIATE 192 NEW MEXICO SCOPE OF PRACTICE – EMT-PARAMEDIC 195 Page 6 of 197 Updated September 22, 2014 Application for Use of SCFD Patient Care Guidelines The following Patient Care Guidelines are intended to be used by all personnel representing the Sandoval County Fire Department including but not limited to: all Command, career, part time and volunteer staff. These Guidelines in their entirety are for the career staff to use in the course of their patient care. Advanced EMS providers in the volunteer districts will be able to perform within these treatment guidelines based on 1) their level of activity outside of Sandoval County, 2) the Medical Director’s approval to perform those skills/treatments and, 3) signed documentation from the Medical Director for the EMS provider to perform skills/treatments as outlined in the New Mexico Scope of Practice for the level of licensure for that provider. If a district does not have the equipment that is identified in the treatment guidelines, then they will not be expected to perform those procedures. The same goes for the medications in the treatment guidelines, some of the controlled substances will not be made available to the volunteer districts. Sandoval County Fire districts that wish to carry narcotics/controlled substances will have to obtain the Knox MedVault locking system prior to being able to store or use controlled substances. In line with New Mexico EMS Regulations, any EMS provider wishing to perform skills identified as requiring “Service Medical Director Approval”, will have a signed authorization form on file prior to performing any of those skills/treatments and will also have a signed acknowledgement of understanding of receiving a copy of the most current copy of the Sandoval County Fire Department treatment guidelines. Page 7 of 197 Updated September 22, 2014 SCFD Approved Medications Medication FR EMTB EMTI EMTP NAAK (Nerve Agent Antidote Kit) X X X X Acetylsalicylic Acid (ASA, Aspirin) X X X X Oxygen X X X X Oral Glucose X X X X Albuterol X X X X Ipratropium X X X X Epinephrine 1:1,000 (Adrenaline) X X X X Acetaminophen X X X Naloxone X X X Dextrose (D50; D25; D10) X X Epinephrine 1:10,000 X X Nitroglycerin X X Morphine Sulfate X X Fentanyl Citrate X X Diphenhydramine X X Glucagon X X Ondansetron X X 0.9% Sodium Chloride X X Lidocaine (For IO Administration Only) X X Hydroxocobalamin X X Adenosine X Atropine Sulfate X Calcium Chloride X Dexamethasone X Dopamine Hydrochloride X Furosemide X Lidocaine X Magnesium Sulfate X Oxytocin X Phenylephrine nasal spray X Sodium Bicarbonate X Tetracaine Opthalmic solution X Diazepam X Midazolam X Cordarone (Amiodarone) X Levophed (Norepineprine) X Page 8 of 197 Updated September 22, 2014 SECTION 1-SYSTEM GUIDELINES STATEMENT OF PURPOSE These Guidelines are designed to guide the practice of the on-duty career and volunteer emergency medical service personnel within the primary jurisdictions and districts of Sandoval County. These guidelines are to be used by all licensed EMS responders functioning within the Sandoval County Fire Department. An effort has been made to coordinate the EMS guidelines used throughout the County. When differences between guidelines arise in mutual aid situations, EMS personnel should function according to the guidelines of the EMT in charge of patient care. Although the Sandoval County EMS Guidelines define who is in charge of each patient encounter, it may sometimes be helpful to contact on-line medical control in order to resolve conflicts between providers or agencies. Every attempt must be made to provide the best patient care possible in spite of disagreements. DISCLAIMER Every attempt has been made to reflect sound medical guidelines and guidelines based on currently accepted standards of care for out-of-hospital emergency medicine. The working group urges the reader to speak to their respective service point of contact for any specific questions that may arise. The working group assumes no responsibility directly or indirectly for this document. It is the reader’s responsibility to stay informed of any new changes or recommendations made at the state or service level. Activities of EMS personnel must be in compliance with all applicable federal, state, county and local laws and regulations including as applicable: NM Dept. of Health 7.27.2 NMAC, Licensing of Emergency Medical Services Personnel, NM Dept.
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