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Emergency Medical Responder (EMR) Emergency Medical Technician (EMT) Medical First Response Program Medical Control Protocols Standard First Aid (SFA) First Medical Responder (FMR) Emergency Medical Responder (EMR) Emergency Medical Technician (EMT) January 2017 Medical First Response Protocols January 2017 Document Authors Dr. Kevin Hanrahan, Medical Director, MFR Program, Alberta Health Services John Hein, Strategist, MFR Program, Alberta Health Services Emily Barclay, Administrator, MFR Program, Alberta Health Services Contributing Authors Barody, Blaine – MFR Program Manager, AHS Moore, Chad – MFR Strategist, AHS Campbell, Jamie – Black Diamond Fire Department Munn, Susan – Lake Louise Fire Evans, Jennifer – Redwood Meadows Emergency Services Paksi, Tyler – Redwood Meadows Emergency Services Evans, Rob – Redwood Meadows Emergency Services Pirie, Mike – Airdrie Fire Department Manz-Henezi, Jodi – Alberta Health Services Rabel, Garth – Airdrie Fire Department Martens, Keri – Lake Louise Fire Roe, David – High River Fire Department Meikle, Dave – Black Diamond Fire Department Schaaye, Gregg – M.D. of Foothills Fire Department Mikkelsen, Lisa – Black Diamond Fire Department Provincial MFR MCPs Working Group Caralho, Pierre – Alberta Health Services Martens, Keri – Lake Louise Fire Cohoe, Shauna – Alberta Health Services Pedersen, Steen – Alberta Health Services Donelon, Becky – Alberta College of Paramedics Pirie, Mike – Airdrie Fire Department Garofalo, Sergio – Alberta Health Services Read, Chris – Alberta Health Services Kugelstadt, Duane – Alberta Government Roe, Dave – High River Fire Department Landaker, Kelly – Alberta Health Services Wright, Alissa – Alberta Health Services Contributing Document Calgary Fire Department – Medical Protocols – (November 23, 2010*) *Used with Permission Dr. Kevin Hanrahan – Medical Director, Calgary Fire Department Stephen Nicholl, Calgary Fire Department Debbie Bateman, Calgary Fire Department Contact: Medical First Response Alberta Health Services Grande Prairie EMS Station 10710-97 Street Grande Prairie, AB T8V 7G6 Email: [email protected] Toll Free: 1-866-786-1440 2 | P a g e AlbertaMFR.ca Medical First Response Protocols January 2017 Disclaimer and Copyright Alberta Health Services (AHS) Emergency Medical Services (EMS) is committed to providing high quality and safe patient care. AHS EMS has developed this set of Medical First Response (MFR), Medical Control Protocols (MCPs). The MCPs contain best standard practice taken from evidence and expert informed care and treatment information that is specifically intended for the use of medical first responders in Alberta and the physicians who provide medical oversight for these agencies. EMS reserves the right at its own discretion to make changes, including the correction of errors and complete revisions to the MCPs. At the same time, the information is presented “as is” and its use by external organizations or individuals is solely at their own risk. AHS EMS, its employees and physicians accepts no responsibility for any modification or redistribution or use of the MCPs and is not liable for any actions taken by individuals based on the information provided, or for any inaccuracies, errors or omissions in these MCPs. 2015 Alberta Health Services – All rights reserved in relation to these MCPs. Without limiting the reservation of copyright, no person shall reproduce, store in a retrieval system or transmit in any form or by any means (electronic, mechanical, photocopying, recording or otherwise) part or the whole of these MCPs without the prior written permission of Alberta Health Services. Please note that AHS does not retain any liability for the external use of these MCPs or their maintenance outside of the MFR Program. The written protocols have been made available for viewing by the public. It is assumed that your use will be to enhance the care you provide and is not for resale or redistribution purposes. Be advised that these MCP’s will continue to be reviewed and updated at regular intervals to ensure that they meet the above standards. __________________________ Dr. Ian Phelps Senior Medical Director Alberta Health Services Emergency Medical Services 3 | P a g e AlbertaMFR.ca Medical First Response Protocols January 2017 Table of Contents Algorithm 1 Standard Approach and Ongoing Assessment .............................. 5 Algorithm 2 Airway Control – Conscious Patients .............................................. 6 Algorithm 3 Airway Control – Unconscious Patients .......................................... 7 Algorithm 4 Altered Level of Consciousness ...................................................... 8 Algorithm 5 Burns .................................................................................................. 9 Algorithm 6 Cervical-Spine Assessment ........................................................... 10 Algorithm 7 Chest Pain ........................................................................................ 11 Algorithm 9 CPR Adults ....................................................................................... 13 Algorithm 10 CPR Children (1 to 8 years) ............................................................ 13 Algorithm 11 CPR Infants (Less than 1 Year) ...................................................... 15 Algorithm 12 Death On-Scene ................................................................................ 16 Algorithm 13 Drowning / Near Drowning .............................................................. 17 Algorithm 14a Dyspnea (shortness of breath) - Pulmonary Edema / Unknown .. 18 Algorithm 14b Adult Anaphylaxis ............................................................................ 19 Algorithm 14c Pediatric Anaphylaxis ...................................................................... 20 Algorithm 14d Adult Bronchospasm ....................................................................... 21 Algorithm 14e Pediatric Bronchospasm ................................................................. 22 Algorithm 15 Environmental Emergencies – Cold Related ................................. 23 Algorithm 16 Environmental Emergencies – Heat Related .................................. 24 Algorithm 17a Adult Hypoglycemia ......................................................................... 25 Algorithm 17b Pediatric Hypoglycemia ................................................................... 26 Algorithm 18 Obstetrics and Gynecological – Vaginal Bleeding ........................ 27 Algorithm 19 Obstetrics and Gynecology – Childbirth ........................................ 28 Algorithm 20 Obstetrics and Gynecology – Neonatal Resuscitation ................. 29 Algorithm 21 Obstructed Airway – Adults/Children ............................................. 30 Algorithm 22 Obstructed Airway – Infants (Birth – 1 Year) ................................. 31 Algorithm 23 Poisoning .......................................................................................... 32 Algorithm 24 Seizure ............................................................................................... 33 Algorithm 25 Shock ................................................................................................. 34 Algorithm 26 Stroke ................................................................................................ 35 Algorithm 27 Trauma Assessment ........................................................................ 36 Algorithm 28 Overdose – Opioid ............................................................................ 37 4 | P a g e AlbertaMFR.ca Medical First Response Protocols January 2017 Algorithm 1 Standard Approach and Ongoing Assessment Init ial Scene Assessment SFA · Scene Safety FMR · Additional Resources EMR EMT · Crime Scene? · Note Mechanism of Injury and Number of Patients SFA Follow Infection Prevention FMR Perform Hand Hygiene EMR Don Appropriate PPE EMT Perform Primary Patient Assessment · Assess mental status SFA* · Assess A,B,C,Ds *SFA FMR · Consider Spinal Motion Restriction If trained and equipped EMR EMT · Expose and examine priority areas · Identify priority patients · Record Vital Signs Perform Primary Set of Vital Signs on all Patients *50th Percentile Values Blood Pressure Pulse Respirations SPO2 GCS Temperature (Systolic) Newborn 110 – 160 b/min 35 – 60 / min 60 – 76 mm Hg 94% – 100% n/a 35.5 – 37.5 C 1 Yr Old 100 – 130 b/min 30 – 50 / min 86 mm Hg* 94% – 100% 15 35.5 – 37.5 C 6 Yr Old 70 – 100 b/min 18 - 30 / min 95 mm Hg* 94% – 100% 15 35.5 – 37.5 C 10 Yr Old 65 – 100 b/min 12 – 25 / min 103 mm Hg* 94% – 100% 15 35.5 – 37.5 C Adult 60 – 100 b/min 12 – 20 / min (90 – 140 mm Hg) 94% – 100% 15 35.5 – 37.5 C No Go to Appropriate algorithm 5 | P a g e AlbertaMFR.ca Medical First Response Protocols January 2017 Algorithm 2 Airway Control – Conscious Patients SFA FMR Standard Approach and EMR Ongoing Assessment EMT Go to Unconscious Is patient No Patients conscious? algorithm Yes Go to Obstructed Is the *SFA No Airway airway clear? If trained and equipped algorithm Yes Rate, rhythm and quality of Adequate respirations? Inadequate SFA* SFA Consider spinal motion restriction FMR FMR Consider spinal motion restriction Administer O2 if SpO2 < 94% on EMR EMR Ensure open airway room air (RA) EMT EMT SFA* SFA* Treat for Shock Suction airway as needed FMR FMR Provide comfort/reassurance BVM ventilation EMR EMR Monitor patient’s LOC and ABC Administer O2 if SpO2 < 94% on RA EMT EMT SFA* Secondary survey FMR EMR Consider: Nasopharyngeal Airway History-SAMPLE EMR EMT (NPA) Record Vital Signs
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