Universal Protocol Section 1 if indicated if indicated Cardiac Monitor BARS scoring: 7 BARS scoring: IV / IO Protocol UP 6 UP Protocol / IO IV Hyperthermia Protocol Hyperthermia Preferably 2 large bore Notify Destination Notify or Monitor per restraint procedure per restraint Monitor Contact Medical Control Medical Contact Restraint Physical Procedure USP 5 Physical Procedure Restraint Behavioral Activity Rating Scale Rating Activity Behavioral Behavioral Activity Rating Scale (BARS) Rating Scale Activity Behavioral Restraint Therapeutic Take Down Procedure USP 6 Down Procedure Take Therapeutic Restraint P P A UP 19 UP Behavioral Behavioral or Call for help for Call General Guidance General Any local EMS System changes to this document must follow the NC OEMS Protocol Change Policy and be approved by OEMS and be approved Policy follow the to document System by OEMS Change changes Any must NC Protocol this local EMS ExcitedSyndromeDelirium Violent / Stage prior toStage prior arrival medical requestsorpersonnel - Call for additional resources Call for additional Wthdraw from scene until safe from scene Wthdraw Non factornotbe a should asused opinions implementing when protocol. this physical restraint and chemical restraint in in physical restraint and chemical restraint injuryaprevent totoimminent order providers. patient and/or medicalrequires protocol this Use of medical judgement with and consultation indicated. where control Use of protocol is indicated when a when indicated medical is protocol Use of of both a requires combination emergency

Revised • • • 01/01/2021 Universal Protocol Section 2 6: - UP 19 UP Behavioral Behavioral threatening and associated with use of physical control measures, including physical restraints.threatening and associated with use of physical control measures, including physical - medication. medication. particularly stimulant drugs such as cocaine, crack cocaine, methamphetamine, amphetamines or similar similar or amphetamines methamphetamine, cocaine, crack cocaine, as such drugs stimulant particularly agents. with DIRECT ONLINE MEDICAL ORDER, by the system MEDICAL DIRECTOR or ASSISTANT MEDICAL DIRECTOR. disorientation, violent / bizarre behavior, insensitivity to pain, hyperthermia and increased strength. Any local EMS System changes to this document must follow the NC OEMS Protocol Change Policy and be approved by OEMS and be approved Policy follow the to document System by OEMS Change changes Any must NC Protocol this local EMS ExcitedSyndromeDelirium Violent / Prevent patient from assuming position for a prone prolonged period, move to supine position as quickly as possible. USP Procedure Take Down Therapeutic Restraint and for sedation Team approach administer to Provider 1 head. control and airway maintain restraint, lead to provider 1 limb. each for 1 provider ventilation and respiration impede this can as with restraints prone position Do not Most commonly seen in male subjects with a history of serious mental illness and/or acute or chronic drug abuse, abuse, drug or chronic acute and/or illness mental of serious history with a male subjects in seen Most commonly Alcohol or substance withdrawal as well as head trauma may also contribute to the condition. Physical restraints are not contraindicated in agitated or excited delirium, but you must use caution. condition. Once sedated, prevent patient from continued struggle which can worsen metabolic Ketamine may be used in patients who fit within a Pediatric Medication/Skill Resuscitation System product only only product System Resuscitation Medication/Skill a Pediatric fit within who used in patients may be Ketamine disturbances, speech hallucinations, anxiety, agitation, psychomotor delirium, of Combination emergency: Medical Potentially life Ketamine may be used in patients who are outside a Pediatric Medication/Skill Resuscitation System product. System Resuscitation Medication/Skill a Pediatric are outside who used in patients may be Ketamine Hyperthermia: Assess for and treat hyperthermia. hyperthermia. treat and for Assess Hyperthermia: Restraint use: Restraint Excited Delirium Syndrome and Violent: Ketamine: Revised

01/01/2021 • • • • Pearls