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State of New Hampshire Patient Care Protocols Version EMR EMT AEMT PARAMEDIC EXTENDED State of New Hampshire Patient Care Protocols Version 7.1 Effective April 2018 Approved by the NH Medical Control Board New Hampshire Department of Safety Division of Fire Standards and Training and Emergency Medical Services Patient Care Protocols – Version 7.1 Legend Definition EMR Emergency Medical Responder (EMR) E Emergency Medical Technician (EMT) A Advanced Emergency Medical Technician (AEMT) P Paramedic X Extended Care Protocol CAUTION – Red Flag topic Telephone Medical Control Pediatric Blue underline – text formatted as a hyperlink This document is the Patient Care Protocols for New Hampshire Prehospital Medical Providers – Version 7.1. These protocols are a “living document” developed and drafted by the Protocol Committee of the New Hampshire Emergency Medical Services Medical Control Board. At the option of the Bureau of EMS and the Medical Control Board, they can be edited and updated at any time. However, they are formally reviewed, edited, and released every two years. These NH EMS Patient Care Protocols, Version 7.1 were reviewed, edited, and unanimously approved of by the NH EMS Medical Control Board. These are New Hampshire State Patient Care Protocols; they have been written and approved of by the NH EMS Medical Control Board to establish the standard of EMS patient care. Any deviation from these protocols must be approved in writing by the NH EMS Medical Control Board and the NH Bureau of EMS. Please Note: For visual clarity, trademark and registered symbols have not been included with drug, product, or equipment names. Questions and comments should be directed to: Bureau of Emergency Medical Services 33 Hazen Drive Concord, NH 03305 603-223-4200 Copyright 2005, renewed 2007, 2009, 2011, 2013, 2015, 2018 New Hampshire Bureau of Emergency Medical Services. This document may not be amended or altered; however, it may be reproduced and distributed for free to NH EMS Providers without permission. DISCLAIMER: Although the authors of this document have made great efforts to ensure that all the information is accurate, there may be errors. The authors cannot be held responsible for any such errors. For the latest corrections to theses protocols, see the New Hampshire EMS website at: https://www.nh.gov/safety/divisions/fstems/ems/advlifesup/patientcare.html. 20132013 2013 State of New Hampshire Department of Safety Division of Fire Standards and Training and Emergency Medical Services Richard M. Flynn Fire Academy 98 Smokey Bear Blvd, Concord, New Hampshire Mailing Address: 33 Hazen Drive, Concord, New Hampshire 03305-0002 John J. Barthelmes Deborah A. Pendergast Commissioner Director NH Patient Care Protocol 7.1 Updates and Corrections _________________________________________________________________ April 2018: Anaphylaxis/Allergic Reaction – Adult in the EMT section: Epinephrine 1mg/mL: Administer 0.3 mg (0.3 mL) IM*. Anaphylaxis/Allergic Reaction – Pediatric was updated in the EMT section with: If < 25 kg, epinephrine (1 mg/mL) 0.15 mg (0.15 mL) IM*, If > 25 kg, epinephrine (1 mg/mL) 0.3 mg (0.3 mL)IM*. o For additional dosing, contact Medical Control *EMTs must have completed the Ready, Check & Inject training, click here. The EMTs will need to complete the online training and then practice with their Medical Director or designee. Nitronox In the Pain Protocol Adult & Pediatric, Nitronox may only be used if patient has not received an opiate. Ketamine was added to the opiates so the bullet now reads: Note: Nitronox may only be used if patient has not received an opiate or ketamine. Obstetrical Emergencies After the release of the protocols, it was recognized that in the presence of a prolapsed cord it did not matter if a pulse was present or not, the provider should place a gloved hand in the vagina and decompress the cord by elevating the presenting fetal part off of the cord. The protocol was changed to strike the words, “If umbilical cord pulse is absent”. TXA Change the TXA dosing to, “Mix 1 gram of TXA in 50 – 100 mL of 0.9% NaCl”. Emergency Medical Services – Fire Training and Certification – Fire Academy Business: (603) 223-4200 Fax: (603) 271-4567 Toll Free: 1-800-371-4503 TDD Access: 1-800-735-2964 http://www.nh.gov/safety/divisions/fstems/index.html New Hampshire Patient Care Protocols 2017 – Table of Contents (Alphabetical order by section) Page Dedication………………………………………………………………………………….vi Preface……………………………………………………………………………………..vii SECTION 1 – General Patient Care Routine Patient Care…………………………………………………………………….. 1.0 Exception Protocol……………………………………………………………………….. 1.1 Extended Care Guidelines………………………………………………………………. 1.2 SECTION 2 – Medical Protocols Abdominal Pain – Adult/Pediatric………………………………………………………..2.0A Adrenal Insufficiency - Adult/Pediatric………………………………………………… 2.1 Allergic Reaction/Anaphylaxis – Adult…………………………………………………. 2.2A Allergic Reaction/Anaphylaxis – Pediatric…………………………………………….. 2.2P Asthma/COPD/RAD – Adult…………………………………………………………….. 2.3A Asthma/Bronchiolitis/Croup – Pediatric Respiratory Distress………………………..2.3P Behavioral Emergencies – Adult/Pediatric…………………………………………......2.4 BRUE (Brief Resolved Unexplained Event……………………………………………..2.5 Childbirth…………………………………………………………………………………...2.6 Hyperglycemia – Adult & Pediatric...…………………………..………………………..2.7 Hyperthermia (Environmental) – Adult & Pediatric…………………………………… 2.8 Hypoglycemia – Adult……………...……………………………………………………..2.9A Hypoglycemia – Pediatric………………………………………………………………...2.9P Hypothermia (Environmental) – Adult & Pediatric……………………………………. 2.10 Nausea/Vomiting – Adult & Pediatric…………………………………………………... 2.11 Nerve Agent/Organophosphate Poisoning – Adult…………………………………… 2.12A Nerve Agent/Organophosphate Poisoning – Pediatric………………………………. 2.12P Newborn Resuscitation…………………………………………………………………. 2.13 Obstetrical Emergencies…………………..……………………………………………. 2.14 Pain Management – Adult………………………………………………………………. 2.15A Pain Management – Pediatric…………………………………………………………... 2.15P Poisoning/Substance Abuse/Overdose – Adult………………………………………. 2.16A Poisoning/Substance Abuse/Overdose – Pediatric………………………………….. 2.16P Seizures – Adult…………………………………………………………………………...2.17A Seizures – Pediatric……………………………………………………………………… 2.17P Sepsis – Adult…………………………………………………………………………….. 2.18A Sepsis – Pediatric…………………………………………………………………………2.18P Shock – Non-traumatic – Adult/Pediatric……………………………………………….2.19 Smoke Inhalation – Adult……………………………………………………………….. 2.20A Smoke Inhalation – Pediatric…………………………………………………………….2.20P Stroke – Adult & Pediatric……………………………………………………………….. 2.21 Syncope………………………………………………………………………………........2.22 New Hampshire Patient Care Protocols 2017 – Table of Contents (Alphabetical order by section) Page Section 3 – Cardiac Emergencies Acute Coronary Syndrome – Adult……………………………………………………...3.0 Bradycardia – Adult ………………………………………………………………........3.1A Bradycardia – Pediatric…………………………………………………………………...3.1P Cardiac Arrest – Adult…………………………………………………………………… 3.2A Cardiac Arrest – Pediatric………………………………………………………………. 3.2P Congestive Heart Failure (Pulmonary Edema)……………………………………….. 3.3 Post Resuscitative Care………………………………………………………………… 3.4 Tachycardia – Adult …………………………………………………………………… 3.5A Tachycardia – Pediatric…………………………………………………………………..3.5P Team Focused CPR……………………………………………………….……………..3.6 Section 4 – Traumatic Emergencies Burns/Electrocution/Lightening – Adult & Pediatric………...………………………….4.0 Drowning/Submersion Injuries – Adult & Pediatric…………………………………….4.1 Eye & Dental Injuries – Adult & Pediatric……………………………………………… 4.2 Musculoskeletal Injuries – Adult & Pediatric……………………………………...…… 4.3 Shock – Traumatic Adult & Pediatric……………………………………………………4.4 Spinal Injury – Adult & Pediatric..…………………………………………………..……4.5 Thoracic Injuries – Adult & Pediatric………………………………………………........4.6 Traumatic Brain Injury – Adult & Pediatric……………………………………………...4.7 Tranexamic Acid (TXA)………………………………………………...…………………4.8 Section 5 – Airway Protocols & Procedures Airway Management Procedure………………………………………………………... 5.0 Airway Management Protocol – Adult…………………………………………………. 5.1A Airway Management Protocol – Pediatric……………………………………………...5.1P Cricothyrotomy – Percutaneous…………………………………………………………5.2 Bi-Level Positive Airway Pressure (BiPAP)…………………………………………....5.3 Continuous Positive Airway Pressure (CPAP)……………………………………….. 5.4 Endotracheal Tube Introducer…………………………………………………………. 5.5 Nasotracheal Intubation…………………………………………………………………. 5.6 Orotracheal Intubation…………………………………………………………………… 5.7 Suction (Advanced)……………………………………………………………………… 5.8 Supraglottic Airways……………………………………………………………………...5.9 Tracheostomy Care……………………………………………………………………… 5.10 Ventilators………………………………………………………………………………… 5.11 New Hampshire Patient Care Protocols 2017 – Table of Contents (Alphabetical order by section) Page Section 6 – Other Medical Procedures 12 Lead Acquisition……………………………………………………………………… 6.0 Capnography……………………..………………………………………………………..6.1 Double Sequential Defibrillation………………………………………………………....6.2 Gastric Tube Insertion……………………………………………………………............6.3 Intraosseous Access…………………………………………………………………….. 6.4 Restraints…………………………………………………………………………………. 6.5 Tasers…………………………………………………………………………………….. 6.6 Tourniquets………………………………………………………………………………. .6.7 Vascular Access via Central Catheter – Adult & Pediatric………………………….. 6.8 Section 7 – Prerequisite Protocols Advanced Sepsis………………………………………………………………………….7.0 Immunizations……………………………………………..………………………….….. 7.1 Interfacility Transfer……………………………………………………………………… 7.2 Mobile Integrated Healthcare……………………………………………………............7.3 Rapid Sequence Intubations…………………………………………………………….
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