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Statewide Emergency Medical Services Protocols

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Statewide Emergency Medical Services Protocols Rhode Island Statewide Emergency Medical Services Protocols Version 2021.01 These protocols are established by the Center for Emergency Medical Services (CEMS) Medical Director of the Rhode Island Department of Health and the Rhode Island Ambulance Service Coordinating Advisory Board. These protocols and standing orders shall supersede all protocols and standing orders previously published. Contains all protocols effectiveFebruary 15, 2021. _______________________________________ Kenneth A. Williams, MD, FACEP CEMS Medical Director _____________________________________ John H. Potvin Chairperson, Ambulance Service Coordinating Advisory Board Acknowledgements Rhode Island Ambulance Service Coordinating Advisory Board (RI Gen. Laws §23-4.1-2) John Potvin, NRP, EMS-IC, Chairperson, EMS Director, East Providence Fire Department, RISAFF* Michael DeMello, NRP, EMS-IC, Vice Chairperson, Chief, Bristol Fire Department, Bristol County Raymond Medeiros, AEMT-C, EMS-IC, Secretary, RISAFF Kenneth Williams, MD, Rhode Island Medical Society Joseph Lauro, MD, RI American College of Emergency Physicians, Cumberland Emergency Medical Services Lynne Palmisciano, MD, American Academy of Pediatrics Michael Connolly, MD, American College of Surgeons, Committee on Trauma Scott Partington, AEMT-C, Chief, Narragansett Fire Department, RI Association of Fire Chiefs James Richard, NRP, EMS-IC, Captain, Cumberland Emergency Medical Services, RISAFF Lori Poirier, NRP, EMS-IC, Lieutenant, Oakland-Mapleville Fire Department, RI State Firemen’s League Jason Umbenhauer, AEMT-C, EMS-IC, Assistant Chief, Warwick Fire Department, Kent County Randall Watt, AEMT-C, Captain, Little Compton Fire Department, Newport County Kimberly Perreault, AEMT-C, EMS-IC, Captain, Potterville Fire Department, Providence County, volunteer Gillian Cardarelli, NRP, Lieutenant, Providence Fire Department, Providence County, career department Bethany Gingerella, RN, NRP, EMS-IC, Charlestown Ambulance-Rescue Service, Washington County John Pliakas, MSN, NP, NRP, TP-C, EMS-IC, Chief, Cumberland Emergency Medical Services, RI ENA Dawn Lewis, PhD, RN, EMT, Hospital Association of Rhode Island Adam Reis, RN, Chief, Access Ambulance, private EMS Andrew Pappas, NRP, CEO, Southcoast Emergency Medical Services, Inc., private EMS Joseph M. Polisena, RN, MEd., AEMT-C, EMS-IC, Town of Johnston Mayor, RI Senate President appointee Zachariah Kenyon, AEMT-C, EMS Chief, Providence Fire Department, RI Senate President appointee Paul Casey, AEMT-C, EMS-IC, Deputy Chief, Cranston Fire Department, RI Speaker of the House appointee Keith Calci, AEMT-C, Captain, Johnston Fire Department, RI Speaker of the House appointee Kathleen Barton, Public Member Albert Peterson, AEMT-C, EMS-IC, Public Member *RISAFF is the Rhode Island State Association of Fire Fighters Special thanks to: Division of Preparedness, Response, Infectious Disease & Emergency Medical Services (PRIDEMS), Center for Emergency Medical Services Nicole Alexander-Scott, MD, MPH, Director of Health Utpala Bandy, MD, MPH, PRIDEMS Medical and Division Director, RI State Epidemiologist Christine Goulette, MAT, PRIDEMS Associate Director of Health Jason M. Rhodes, MPA, AEMT-C, EMS-IC, Chief, Center for Emergency Medical Services Kenneth Williams, MD, FACEP, Medical Director, Center for Emergency Medical Services Carolina Roberts-Santana, DHS, MHA, Deputy Chief, Center for Emergency Medical Services Eric Rossmeisl, AEMT-C, EMS-IC, Training Coordinator, Center for Emergency Medical Services Christina Crowley, MPH, EMS Epidemiologist, Center for Emergency Medical Services Todd Manni, Program Planner, Center for Emergency Medical Services Christine Moniz, EMT, Center for Emergency Medical Services Elizabeth Fernandes, Licensing Aide, Center for Emergency Medical Services John Pliakas, MSN, NP, NRP, TP-C, EMS-IC - Primary author These individuals selflessly and enthusiastically provided their expertise and extensive effort to ensure this document is of the highest quality and adheres to contemporary medical standards. The State of Rhode Island is truly grateful for their dedication to the emergency medical services community and to the residents of our state. Rhode Island Department of Health – Center for Emergency Medical Services Statewide Treatment Protocols - 2021.01 Table of Contents Preface: Use of Protocols Section 1: General Patient Care 01.01 Routine Patient Care 01.02 Documentation 01.03 Medical Control 01.04 Biological Death 01.05 Mobile Integrated Health / Community Paramedicine 01.06 Emergency Medical Responder (EMR) Scope of Practice 01.07 Advanced Emergency Medical Technician (AEMT) Scope of Practice Section 2: Medical Protocols 02.01 Acute Neurologic Event with Evidence of Increased ICP 02.02 Abdominal Pain 02.03 Adrenal Insufficiency 02.04A Allergic Reaction / Anaphylaxis - Adult 02.04P Allergic Reaction / Anaphylaxis - Pediatric 02.05A Altered Mental Status - Adult 02.05P Altered Mental Status - Pediatric 02.06P Brief Resolved Unexplained Event 02.07A Patient Comfort - Adult 02.07P Patient Comfort - Pediatric 02.08A Respiratory Distress (Asthma/COPD/RAD) - Adult 02.08P Respiratory Distress (Asthma/RAD/Croup) - Pediatric 02.09 Behavioral Emergencies 02.10A Diabetic Emergencies - Adult 02.10P Diabetic Emergencies - Pediatric 02.11 Dialysis Emergencies and Renal Failure 02.12 Ischemic Stroke 02.13 IV tPA for Acute Ischemic Stroke 02.14 Epistaxis 02.15A Fever - Adult 02.15P Fever - Pediatric 02.16 Neonatal Resuscitation 02.17 Obstetrical Delivery - Labor 02.18 Obstetrical Complications 02.19A Seizures - Adult 02.19P Seizures - Pediatric 02.20A General Shock and Hypotension - Adult 02.20P General Shock and Hypotension - Pediatric 02.21A Hemorrhagic Shock - Adult 02.21P Hemorrhagic Shock - Pediatric 02.22A Septic Shock - Adult 02.22P Septic Shock - Pediatric 02.23 Sickle Cell Crisis 02.24 Syncope 02.25 Excited Delirium Rhode Island Department of Health – Center for Emergency Medical Services Statewide Treatment Protocols - 2021.01 Table of Contents Section 3: Cardiac Protocols 03.01 Acute Decompensated Heart Failure/Pulmonary Edema 03.02 Chest Pain - Acute Coronary Syndrome - STEMI 03.03A Cardiac Arrest - Adult 03.03P Cardiac Arrest - Pediatric 03.04A Post Cardiac Arrest Care - Adult 03.04P Post Cardiac Arrest Care - Pediatric 03.05A Cardiac Dysrhythmia - Bradycardia - Adult 03.05P Cardiac Dysrhythmia - Bradycardia - Pediatric 03.06A Cardiac Dysrhythmia - Narrow Complex Tachycardia - Adult 03.06P Cardiac Dysrhythmia - Narrow Complex Tachycardia - Pediatric 03.07A Cardiac Dysrhythmia - Wide Complex Tachycardia - Adult 03.07P Cardiac Dysrhythmia - Wide Complex Tachycardia - Pediatric 03.08 Care of the Patient with a Ventricular Assist Device (VAD) Section 4: Trauma - Environmental - Toxicological Protocols 04.01A Multiple Trauma - Adult 04.01P Multiple Trauma - Pediatric 04.02 Head Trauma - Traumatic Brain Injury 04.03 Spinal Motion Restriction Precautions 04.04 External Hemorrhage Control 04.05 Extremity and Musculoskeletal Injuries 04.06 Traumatic Cardiac Arrest 04.07A Thermal Burn Injury - Adult 04.07P Thermal Burn Injury - Pediatric 04.08 Chemical and Electrical Burn Injury 04.09 Crush Injury 04.10 Dental Trauma and Emergencies 04.11 Ocular Trauma and Emergencies 04.12 Heat Related Illness 04.13A Hypothermia and Localized Cold Injury - Adult 04.13P Hypothermia and Localized Cold Injury - Pediatric 04.14 Submersion - Near Drowning 04.15 Diving Emergencies 04.16 Marine Envenomation 04.17 Bites - Stings- Envenomation 04.18A Toxicological Emergencies - General - Adult 04.18P Toxicological Emergencies - General - Pediatric 04.19 Toxicological Emergencies- Nerve Agent or Organophosphate Toxicity 04.20 Carbon Monoxide Exposure 04.21 Blast Injury Incident 04.22 Radiation Incident Rhode Island Department of Health – Center for Emergency Medical Services Statewide Treatment Protocols - 2021.01 Table of Contents Section 5: Airway Protocols 05.01A Airway Management - Adult 05.01P Airway Management - Pediatric 05.02A Failed Airway - Adult 05.02P Failed Airway - Pediatric 05.03 Respiratory distress in a patient with a Tracheostomy Tube 05.04 Medication Assisted Intubation Section 6: Special Situations 06.01 Multiple Patient Incident (Mass Casualty Incident) 06.02 Helicopter Emergency Medical Services (HEMS) 06.03 Medical Orders for Life Sustaining Treatment / Comfort One 06.04 Refusal of Patient Care or Transport 06.05 Interfacility Transport 06.06 Patient in Police Custody 06.07 Specialized Patient Care 06.08 Termination of Resuscitation Efforts 06.09 Deceased Persons 06.10 Immunizations (prerequisite restricted protocol) Section 7: Procedure Protocols 07.01 Airway - Continuous Positive Airway Pressure (CPAP) 07.02 Airway - Foreign Body Airway Obstruction 07.03 Airway - Endotracheal Intubation – Oral 07.04 Airway - Endotracheal Intubation – Nasotracheal 07.05 Airway - Use of an Endotracheal Tube Introducer 07.06 Airway - Blindly Inserted Airway Devices (BIAD) 07.07 Airway - Cricothyrotomy 07.08 Airway - Peak Expiratory Flow Rate Measurement 07.09 Airway - Use of Colorimetric EtCO2 Detector 07.10 Airway - Waveform Capnography 07.11 Airway - Suctioning (basic) 07.12 Airway - Suctioning (advanced) 07.13 Airway - Tracheostomy Tube Change 07.14 Airway/Breathing - Nebulized Medication Administration 07.15 Airway - Metered Dose Inhaler Medication Administration 07.16 Airway/Breathing - Pulse Oximetry 07.17 Airway/Breathing - Mechanical Ventilation 07.21 Cardiac - Multi-lead ECG Acquisition 07.22 Cardiac - Carotid Sinus Massage 07.23 Cardiac - Defibrillation–
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