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Protocols Version 6 Washoe County Regional EMS Protocols Version 6 – Effective 01/01/2021 THIS PAGE IS INTENTIONALLY LEFT BLANK Title July 30, 2018 THIS PAGE IS INTENTIONALLY LEFT BLANK Page 4 The Washoe County Regional EMS Protocols are intended to establish guidelines and best practices for regional patient care and treatment. Agencies utilizing these protocols may not be able to procure all medications and equipment due to availability, funding, and Medical Director discretion. All appropriately indicated medications and equipment will be utilized if available. In situations where co-responders may have differing medication or equipment complements, providers should work cooperatively and in the best interest of the patient. THIS PAGE IS INTENTIONALLY LEFT BLANK Table of Contents Foreword……………………………………………………………………………………………………………………………………………………………………. 1 References…………………………………………………………………………………………………………………………………………………………………. 3 UNIVERSAL PROTOCOLS……………………………………………………………………………………………………………………………………………… 5 Acute Adrenal Crisis………………………………………………………………………………………………………………………………………………….... 7 Amputation………………………………………………………………………………………………………………………………………………………………... 8 General Patient Assessment………………………………………………………………………………………………………………………………….….... 9 Less than Lethal Munitions Care……………………………………………………………………………………………………………………………….... 10 Resuscitation/Prehospital Death Determination………………………………………………………………………………………………………... 11 Spinal Motion Restriction…………………………………………………………………………………………………………………………………………… 12 Trauma Criteria and Assessment………………………………………………………………………………………………………………………………... 13 ADULT TREATMENT PROTOCOLS………………………………………………………………………………………………………………………………. 15 Acute Coronary Syndrome (Suspected)………………………………………………………………………………………………………………………. 17 Airway Obstruction…………………………………………………………………………………………………………………………………………………….. 18 Allergy/Anaphylaxis/Dystonia…………………………………………………………………………………………………………………………………….. 19 Behavioral Emergency………………………………………………………………………………………………………………………………………………... 20 Burns………………………………………………………………………………………………………………………………………………………………………….. 21 Cardiac ‐ Arrest………………………………………………………………………………………………………………………………………………………….. 23 Cardiac ‐ Bradycardia………………….……………………………………………………………………………………………………………………………... 24 Cardiac ‐ Narrow Complex Tachycardia with Pulses………………………………..…………………………………………………………………. 25 Cardiac ‐ Post Arrest Care…………………………………………………………………………………………………………………………………..…….. 26 Cardiac ‐ Wide Complex Tachycardia with Pulses……………………………………………………………………………..………………………… 27 Childbirth/Labor/Obstetrical Emergency…………………………………………………………………………………………………………………….. 28 Crush Injury………………………………………………………………………………………………………………………………………………………………... 29 Hyperglycemia/Hypoglycemia……………………………………………………………………………………………………………………………………. 30 Hyperkalemia (Suspected)………………………………………………………………………………………………………………………………………….. 31 Hyperthermia/Heat Emergency……………………………………………………………………………………………………………………………….... 32 Hypothermia/Cold Emergency…………………………………………………………………………………………………………………………………... 33 Hypothermia Post ROSC…………………………………………………………………………………………………………………………………………….. 34 Medication Assisted Intubation…………………………………………………………………………………………………………………………………. 35 Nausea & Vomiting……………………………………………………………………………………………………………………………………………………. 36 Overdose/Poisoning………………………………………………………………………………………………………………………………………………….. 37 Pain Management/Sedation……………………………………………………………………………………………………………………………………… 39 Pulmonary Edema…………………………………………………………………………………………………………………………………………………….. 40 Table of Contents ADULT TREATMENT PROTOCOLS (cont.) Respiratory Distress……………………………………………………………………………………………………………………………………………………. 41 Seizure……………………………………………………………………………………………………………………………………………………………………….. 42 Sepsis…………………………………………………………………………………………………………………………………………………………………………. 43 Shock‐Cardiogenic……………………………………………………………………………………………………………………………………………………… 44 Shock‐Hemorrhagic…………………………………………………………………………………………………………………………………………………….. 45 Smoke Inhalation……………………………………………………………………………………………………………………………………………………….. 46 Stroke………………………………………………………………………………………………………………………………………………………………........... 47 PEDIATRIC TREATMENT PROTOCOLS……………………………………………………………………………………………………………………...… 49 Pediatric Airway Obstruction……………………………………………………………………………………………………………………………………… 51 Pediatric Allergy/Anaphylaxis…………………………………………………………………………………………………………………...………………. 52 Pediatric Behavioral Emergency………………………………………………………………………………………………………………………………… 53 Pediatric Burns…………………………………………………………………………………………………………………………………..……………………… 54 Pediatric Cardiac ‐ Arrest…………………………………………………………………….…………………………………………..………………………… 56 Pediatric Cardiac ‐ Bradycardia…………………………………………………………………………………………………………………………………… 57 Pediatric Cardiac ‐ Narrow Complex Tachycardia with Pulses.……………………………………………………………………...…………… 58 Pediatric Cardiac ‐ Wide Complex Tachycardia with Pulses…………………………………………………………………………………...….. 59 Pediatric Fever…………………………………………………………………………………………………………………………………………………………… 60 Pediatric Hyperglycemia/Hypoglycemia……………………………………………………………………………………………………………………… 61 Pediatric Hyperthermia/ Heat Emergency………………………………………………………………………………………………………………….. 62 Pediatric Hypothermia/Cold Emergency……………………………………………………………………………………………………………………. 63 Pediatric Medication Assisted Intubation……………………………………………………………………………………………………………………. 64 Pediatric Nausea & Vomiting…………………………………………………………………………………...………………………………………........... 65 Pediatric Neonatal Resuscitation………………………………………………………………………………………………………………………………. 66 Pediatric Overdose/Poisoning……………………………………………………………………………………………………………………………………. 68 Pediatric Pain Management/Sedation……………………………………………………………………………………………………………………….. 70 Pediatric Respiratory Distress……………………………………………………………………………………………………………………………………. 71 Pediatric Seizure……………………………………………………………………………………………………………………………………………………….. 72 Pediatric Smoke Inhalation……………………………………………………………………………………………………………………………………….. 73 OPERATIONAL PROTOCOLS…………………………………………………………………………………………………………………………………….... 75 AMA Decision Tree…………………………………………………………………………………………………………………………………………………….. 77 Civil Protective Custody……………………………………………………………………………………………………………………………………………… 78 Contacting Medical Control/Communications………………………………………………………………………………………………………….... 79 Destination………………………………………………………………………………………………………………………………………………………………… 80 Table of Contents OPERATIONAL PROTOCOLS (cont.) Do Not Resuscitate (DNR/POLST)……………………………………………………………………………………………………………………………. 84 Documentation………………………………………………………………………………………………………………………………………………………. 85 Endangerment………………………………………………………………………………………………………………………………………………………… 86 Inter‐facility Transfers…………………………………………………………………………………………………………………………………………….. 87 Minors ……………………………………...…………………………………………………………………………………………………………………………… 88 Unsolicited Medical Intervention……………………………………………………………………………………………………………………………. 89 APPENDIX A: MEDICATIONS…………………………………………………………………………………………………………………………………… 91 Adult Medications……………...…………………………………………………………………………………………………………………………………… 93 Pediatric Medications……………………………………………………………………………………………………………………………………………… 97 Formulary………………………..……………………………………………………………………………………………………………………………………… 101 APPENDIX B: COMMUNITY RESOURCES…………………………………………………………………………………………………………………… 129 Community Resources……..……………………………………………………………………………………………………………………………………… 131 APPENDIX C: OPERATIONAL……………….…………………………………………………………………………………………………………………… 147 Radiological Response Aid..……………………………………………………………………………………………………………………………………… 149 THIS PAGE IS INTENTIONALLY LEFT BLANK Foreword This patient care document has been specifically developed for Washoe County EMS responders. The purpose of this manual is to provide guidance for ALL prehospital care providers. In any such protocol, certain assumptions are made regarding the condition of the patient, expected responses to treatment, and the availability of resources. Since these assumptions will not always be true, the emergency medical technician must use these protocols as a guide, as well as, agency specific Medical Director endorsed medications and procedures. NOTHING contained within these protocols is meant to delay rapid patient transport to a receiving facility. Patient care should be rendered while en-route to the hospital when transport is available. The majority of these protocols generally reflect a conservative and accepted standard for treatment. The technician in charge at an emergency medical incident is encouraged to use judgment in the application of these protocols. If a treatment plan appears to be insufficient for any reason, medical control consultation is encouraged. The medical control physician directing care in the field retains discretion in ordering specific forms of treatment, even if that treatment is in conflict with these guidelines. Obviously, to proceed with an order directed by medical control requires that both the physician and the provider acknowledge and agree that the patient's condition and extraordinary care are not addressed elsewhere within these medical protocols, and that the order is in the best interest in the care of the patient. Additionally, the provider must feel capable, based on the instructions given by the medical control physician, of correctly performing the directed care. Whenever such care is provided, it is necessary for the patient care report (PCR) documentation to describe the circumstances which necessitated the deviation, as well as document the physician s name who gave the order(s), the treatment change and the time of the order. Occasionally, a situation may arise in which a physician's order cannot be carried out due to the provider s sense that the administration
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