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Houston Fire Department Patient Care Guidelines and Standing Orders for BLS and ALS Units

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Houston Fire Department Patient Care Guidelines and Standing Orders for BLS and ALS Units Houston Fire Department Patient Care Guidelines and Standing Orders For BLS and ALS Units GEOGRAPHICAL AREA / DUTY STATUS / NON-EMS CERTIFIED LICENSED MEDICAL PERSONNEL GEOGRAPHICAL AREA The guidelines shall only be utilized under my medical direction within the Houston city limits, mutual aid areas, when operating in regional deployments and when transferring patients. DUTY STATUS Houston Fire Department EMS personnel are authorized to utilize these guidelines under my medical direction only when acting in their official capacity (i.e. on-duty) when representing the Houston Fire Depart- ment as defined in the BLS and ALS Guidelines, Patient Care Guidelines and Standing Orders, HFD Rules and Regulations and other written directives and guidelines. NON EMS-CERTIFIED LICENSED MEDICAL PERSONNEL Includes RN’s and other allied healthcare personnel (other than licensed physicians authorized to function within the City of Houston EMS system). Currently, the Houston Fire Department Physician Director does not recognize nor utilize persons in this category. All personnel performing direct patient care within the City of Houston EMS system possess valid TDSHS EMS certification and function under the appropriate guidelines as EMT’s or paramedics. Effective Date : March 1, 2019 Expiration Date : September 30, 2020 March 1, 2019 David Persse, MD Date EMS Physician Director HOUSTON FIRE DEPARTMENT PATIENT CARE GUIDELINES AND STANDING ORDERS FOR BLS AND ALS UNITS REFERENCE NO. III-01 ©2019 City of Houston, Fire Department HOUSTON FIRE DEPARTMENT SUBJECT : PATIENT CARE GUIDELINES AND STANDING ORDERS FOR BLS AND ALS UNITS VOLUME NO. III COMMAND: EMS REFERENCE NO. III-01 SECTIONS 1.00 - 9.06 Table of Contents 1.00 PURPOSE .....................................................I-7 2.00 OBJECTIVES ..................................................I-7 3.00 DEFINITIONS .................................................I-8 4.00 SCOPE ........................................................I-11 5.00 RESPONSIBILITIES ............................................I-11 6.00 GUIDELINES ..................................................I-12 6.01 Fundamental Principles .....................................................I-12 6.02 Ambulance Diversion ......................................................I-12 6.03 Communication ...........................................................I-13 6.04 Confidential Patient Information ..............................................I-14 6.05 Controlled Substances Accountability .........................................I-14 6.06 Documentation ...........................................................I-14 6.07 Emergency Transfers (One Emergency Dept. to Another) ..........................I-16 6.08 Equipment and Actions on Each Run ..........................................I-16 6.09 Family-Centered Care ......................................................I-17 6.10 Physical Restraints ........................................................I-18 6.11 Helicopter Utilization ......................................................I-18 6.12 Hospital Destination Decisions - Emergency Ambulance Routing ...................I-19 6.13 Identification Badges ......................................................I-24 6.14 Infection Control Precautions ................................................I-24 6.15 Multiple Casualty Management ..............................................I-24 6.16 Non-Transports ..........................................................I-24 6.17 Out-of-Hospital DNR Orders ................................................I-27 6.18 Patient Belongings ........................................................I-30 6.19 Physician Intervener at the Scene .............................................I-30 6.20 Requesting Assistance ......................................................I-30 6.21 Riding in Charge ..........................................................I-32 6.22 Termination of Resuscitation ................................................I-33 6.23 Voluntary Self Reporting of Medical Errors .....................................I-35 7.00 SKILLS .......................................................II-1 7.01 Patient Assessment [BLS/ALS] ..............................................II-3 A. Assess the Situation ........................................................II-3 B. Primary Survey ...........................................................II-3 C. Secondary Survey .........................................................II-5 7.02 Airway Management .......................................................II-8 A. Two Person Bag-Valve-Mask Ventilation [BLS/ALS] .............................II-8 B. One Person Bag-Valve-Mask Ventilation [BLS/ALS] .............................II-8 C. Orotracheal Intubation [ALS] ................................................II-8 D. Nasotracheal Intubation [ALS] ...............................................II-9 E. Supraglottic Airway [BLS/ALS]. .II-10 SUBJECT : PATIENT CARE GUIDELINES AND STANDING ORDERS FOR BLS AND ALS UNITS I-2 REFERENCE NO. III-01 PUBLICATION : 9/17/19 F. One-Person Bag-Valve-ET Tube/Supraglottic Airway Ventilation [BLS/ALS] ..........II-11 G. Airway Foreign Body Removal (Adult/Adolescent) [BLS/ALS] ....................II-11 H. Airway Foreign Body Removal (Child/Infant) [BLS/ALS] .........................II-12 I. CPAP - Continuous Positive Airway Pressure [ALS] ..............................II-13 J. Needle Thoracostomy [ALS] ................................................II-14 K. Waveform Capnography - End Tidal CO2 Monitoring [ALS] .......................II-15 L. Neonatal / “Newly Born” [BLS/ALS] .........................................II-16 M. Oxygen Therapy Guideline [BLS/ALS] ........................................II-16 N. Tracheostomy Care [BLS/ALS] ..............................................II-17 7.03 Medication Administration ..................................................II-18 A. Airway Administration – Aerosol [BLS/ALS] ...................................II-18 B. Intraosseous – EZ-IO® [ALS] ...............................................II-18 C. Intranasal (IN) - Mucosal Atomization Device ...................................II-20 D. Intranasal Spray – Single Dose Pre-Packaged by Manufacturer .....................II-21 7.04 Cardiac Electrical Therapy ..................................................II-21 A. Automated External Defibrillator [BLS/ALS] ...................................II-21 B. Synchronized Cardioversion [ALS] ...........................................II-22 C. Defibrillation [ALS] .......................................................II-22 D. Cardiac Pacing – Transthoracic [ALS] .........................................II-22 7.05 Cardiopulmonary Resuscitation [BLS/ALS] ....................................II-23 A. Neonatal / “Newly Born” CPR (Less than 1 hour of age) ..........................II-23 B. Infant CPR (1 hour to < 1 year of age) .........................................II-24 C. Child CPR (1 year to < 8 years of age) .........................................II-24 D. Adolescent (8 years of age to <16 years) / Adult CPR (16 years of age or greater) .......II-25 7.06 Hemorrhage Control [BLS/ALS] .............................................II-25 A. Direct Wound Care ........................................................II-25 B. Tourniquet Use ...........................................................II-26 C. Wound Packing ...........................................................II-26 7.07 Extremity Splinting Skills [BLS/ALS] .........................................II-26 A. Repositioning Injured Extremities ............................................II-26 B. Use of Splints ............................................................II-27 C. Use of Traction Splints .....................................................II-27 7.08 Eye Irrigation [BLS/ALS] ...................................................II-27 7.09 Patient Movement [BLS/ALS] ...............................................II-28 7.10 Radio Report [BLS/ALS] ...................................................II-28 8.00 GUIDELINES / STANDING ORDERS ............................ III-1 8.01 General Principles for Guidelines / Standing Orders ..............................III-2 8.02 Cardiac Arrest Emergencies .................................................III-3 A. General Principles for Cardiac Arrest Emergencies ...............................III-4 B. Unresponsive Patient .......................................................III-7 C. Pulseless Patient - BLS First on Scene .........................................III-8 D. Pulseless Patient - ALS First On Scene ........................................III-10 E. Cardiac Arrest Resuscitation .................................................III-12 F. Post-Cardiac Arrest Care ....................................................III-15 8.03 Medical Emergencies ......................................................III-17 A. General Principles for Medical Emergencies ....................................III-18 B. Abdominal Pain / Acute Abdomen ............................................III-19 C. Airway Obstruction (Foreign Body) ...........................................III-20 SUBJECT : PATIENT CARE GUIDELINES AND STANDING ORDERS FOR BLS AND ALS UNITS REFERENCE NO. III-01 PUBLICATION : 9/17/19 I-3 D. Allergic Reaction / Anaphylaxis ..............................................III-21 E. Altered Mental Status (AMS) ................................................III-22 F. Aortic Aneurysm / Dissection,
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