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Regional Paramedic Protocols Region V Medical Advisory Committee 2006 Revision V – 15 NOV 2008 Charlotte Hungerford Hospital Danbury Hospital New Milford Hospital Sharon Hospital Saint Mary’s Hospital Waterbury Hospital 1 15 NOV 2008 Revision V Table of Contents Preamble, Disclaimers, Mission Statement……………………..…………………… ……... 3-5 Chapter 1 - General Guidelines…………………………………..………………….…..…... 6 Primary Paramedic Care 7 Patient Assessment 8 Patient Care Reports 9 On-Line Medical Oversight / Communications 10 Release of Patient Care to BLS 11 Refusal of Medical Assistance 12-3 Chapter 2 - Airway Management…………………………………..…………………………. 14 Complete Airway Obstruction 15 Oxygen Therapy 16 Orotracheal Intubation 17-8 Bougie Intubation Stylet 19 Nasotracheal Intubation 20 Medication Facilitated Intubation 21-4 Rapid Sequence Intubation 25-8 Chapter 3 - Alternative Airway Management…………………………..…………………… 29 Laryngeal Mask Airway 30 Combitube 31 Needle Cricothyrotomy 32-3 Chapter 4 - Respiratory Emergencies………………………………….……………………..34 Acute Pulmonary Edema 35 Reactive Airway Disease 36 Exacerbation of COPD 37 CPAP Utilization 38-9 Chapter 5 - ACLS Algorithms……………………………………………..…………………… 40 Adult BLS Guidelines 41 Pulseless Arrest Algorithm 42 Bradycardia 43 Tachycardia 44 Chapter 6 - Cardiac Emergencies……………………….…………………………………….45 Acute Coronary Syndromes 46 Suspected Ischemic Chest Pain 47 12 lead EKG 48 Cardiogenic Shock 49 Chapter 7 - Altered Mental Status………………………………...…………………………... 50 Cerebrovascular Accident / Stroke / Intracranial Bleed 51 Hypoglycemia–Hyperglycemia 52 Opiate Overdose 53 Toxicology 54-5 Seizures 56 Sepsis / Fever 57 Coma of Unknown Etiology 58 Mucosal Medication Administration 59 Chapter 8 - Environmental Emergencies……………………..……………………………... 60 Allergic Reaction 61 Anaphylaxis 62 Cold Emergencies 63 Hypothermic Arrest 64 Heat Emergencies 65 Near Drowning 66 Chapter 9 - General Medical Emergencies……………………..…………………………... 67 Acute Abdomen 68 Gastrointestinal Bleeding 69 Psychiatric Emergencies 70 Dystonic Reactions 71 2 15 NOV 2008 Revision V Pain Management for Procedures 72 Intraosseous Access via EZ-IO™ 73-4 Chapter 10 - Adult Trauma Care………………………………..…………………………….. 75 Injured Patient Triage Protocol 76 Trauma Alert Criteria 77-8 Assessment & Treatment of the Trauma Patient 79-82 Spinal Assessment and Immobilization Criteria 83 Isolated Trauma Pain Management 84 Burn Management 85-9 Chapter 11 - OB-GYN / Neonatal Resuscitation………………………………...……………90 Pre-eclampsia and Eclampsia 91 Antepartum Hemorrhage 92 Trauma in Pregnancy 93 Emergent Childbirth 94 Neonatal Assessment & Treatment 95 Delivery Complications 96 Postpartum Maternal Care 97 Chapter 12 - Pediatrics……………………………………………………………….………... 98 Primary Paramedic Pediatric Assessment and Care 99 Pediatric Development and Vital Signs by Age 100-2 Pediatric Airway Management 103 Pediatric Respiratory Distress 104 Pediatric Asthma 105 Pediatric Suspected Croup or Epiglottitis 106 Pediatric Allergic Reaction 107 Pediatric Anaphylaxis 108 Pediatric Pulseless Arrest 109 Pediatric Bradycardia 110 Pediatric Tachycardia 111 Pediatric Altered Mental Status / Hypoglycemia / Coma 112 Pediatric Seizures / Status Epilepticus 113 Pediatric Rectal Diazepam Administration 114 Pediatric Trauma Injured Patient Triage Protocol 116-9 Pediatric Burns 120 Pharmacology……………………………………………………………………………………. 121-56 Release Notes……………………………………………………………………………………. 157 3 15 NOV 2008 Revision V 4 15 NOV 2008 Revision V Mission Statement For the Region V Medical Advisory Committee Clinical Coordinators Sub-Committee The mission of the Clinical Coordinators Sub-Committee on regionalization is to facilitate uniform medical oversight of EMS through a cooperative committee represented by all sponsor hospitals in the region. Under the auspices of the Medical Advisory Committee, and working in collaboration with the EMS providers, the sub-committee will standardize the EMS practices and policies for all of the services and providers sponsored by the hospitals in EMS Region V. Sponsor Hospital Specific Guidelines While every effort has been made to regionalize our guidelines, there are certain treatment modalities available that are sponsor hospital specific. Throughout these protocols if a treatment is sponsor hospital specific the name of the sponsor hospital is listed under the main heading for that treatment. This does not indicate the receiving hospital, but your service’s medical oversight sponsor hospital. If you are unsure, please check with you service prior to initiation of patient care. Important Caution Information contained in these protocols is compiled from sources believed to be reliable and accurate, however, this cannot be guaranteed. Despite our best efforts there may be typographical errors and/or omissions. The Region V EMS Council and the Members of the Medical Advisory Committee are not liable for any loss or damage that may result from these errors or omissions. Online Medical Oversight It is agreed upon that Region V prehospital providers will contact the Region V receiving hospital to obtaining patient care orders. This does not apply for specialty care procedures where indicated by guideline. When transporting to a hospital outside of Region V, prehospital providers must contact their Region V Sponsor Hospital for Medical Oversight. Communication Failure In the event of complete communication failure, these protocols will act as the parameters for pre- hospital patient care. If communication failure occurs the Paramedic may follow the guidelines through standing orders only to render appropriate and timely emergency care to the patient. Upon arrival at the receiving hospital the Paramedic will immediately complete an incident report relating to the communication failure. This incident report must be filed with the Paramedic’s sponsor hospital EMS Coordinator along with a copy of the patient care report within 24hr of the event. 5 15 NOV 2008 Revision V Chapter 1 General Guidelines Primary Paramedic Care 7 Patient Assessment 8 Patient Care Reports 9 On-Line Medical Oversight / Communications 10 Release of Patient Care to BLS 11 Refusal of Medical Assistance 12-3 6 15 NOV 2008 Revision V Primary Paramedic Care 1) Assess / Address Airway, Breathing, Circulation according to current ECC Guidelines with Cervical Spine Protection per NHTSA Standards where indicated. 2) Place patient in position of comfort unless otherwise indicated. 3) Initiate Basic Life Support (BLS) Care and Oxygen Therapy per current NHTSA Standards or regional guideline. 4) Perform Patient Assessment (see patient assessment guideline). 5) Obtain and record Baseline Vital Signs. 6) Initiate Pulse Oximetry monitoring as indicated. 7) Initiate Cardiac Monitoring as indicated. 8) Initiate Capnography as indicated. 9) Establish Intravenous Access as indicated. 10) Initiate specific treatment per protocol / guideline based upon patient presentation. 11) Obtain and record Serial Vital Signs (pre- and post-intervention or as indicated by patient condition [q5min for unstable patients and q15min for stable patients]) 12) Destination hospital choice is based upon Patient Condition, Patient Request, Trauma Regulation, or Online Medical Oversight. 13) Contact destination hospital for patient notification and pending arrival as required by the receiving facility, and/or specific protocol, giving as much notification as possible for in hospital activation of special services as required by the patient’s condition. For example, hen transporting patients with signs and symptoms of a stroke such as: a) Unilateral weakness or numbness of an extremity b) Unilateral weakness or numbness of the face or body c) Unilateral vision loss or deficit (not trauma related) d) Difficulty walking e) Cannot understand what someone is saying f) Feeling dizzy or losing their balance g) Difficulty speaking Request that C-MED announce a Stroke Alert when setting up your patch. 7 15 NOV 2008 Revision V Patient Assessment Each patient is to have an initial assessment as outlined in this section. Depending upon the results of this patient assessment, the provider will advance to provide appropriate treatment. This constitutes the minimal acceptable assessment. More detailed assessments may be required dependant on patient complaint and condition. 1) General Appearance a) Age and gender b) General state of health c) Amount of distress (mild, moderate, severe) 2) Objective Signs a) Level of consciousness b) Respiratory assessment c) Skin: Temperature, color, moisture d) Pupil status e) Glasgow Coma Scale / Trauma Score if indicated 3) Vital Signs a) Pulse: rate, quality, and rhythm b) Respiratory rate, character of breath sounds c) Blood pressure d) Pulse oximetry 4) History of Episode (obtained from patient, family, or observer) a) Chief complaint b) Time of incident or onset of symptoms c) Prior treatment if related to present illness or injury d) Mechanism of injury if trauma 5) Pertinent Medical History a) Previous medical problems or conditions b) Routine medications c) Allergies 6) Other Pertinent History a) Social (substance abuse, smoking, violence, etc.) b) Family (cardiac, diabetic, asthma) c) Obstetrical / Gynecological (GxPx, LMP) d) Systems review focused to presentation Written Documentation shall be left with every patient in the form of service specific Patient Care Reports (see Patient Care Report Protocol). 8 15 NOV 2008 Revision V Patient Care Reports Procedure: Emergency Medical Service Patient Care Report (PCR) or a state authorized equivalent

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