Toxic-Environmental Protocol Section R. nsport. 7

- mouth - quality CPR. quality to - - NO Pulse Exit to to Exit Airway as as tolerated minutes. minutes. mouth as as indicated Protocol TB8 Protocol Cardiac Cardiac Arrest Unresponsive 5 Breaths via BVM BVM Breaths 5/ via Age Age Appropriate

Protocol(s) AR 1AR Protocol(s)

Protocol(s) AC 3 /3AC4 PC Protocol(s) Spinal RestrictionSpinal Motion immersion immersion syndrome - Hypoglycemia Cardiac Dysrhythmia Barotrauma Decompression sickness existing medical existingmedical problem - YES Trauma Pre injury(SCUBAPressure diving) Post

Differential     be rescuers. be - mouth 7

- - to - 7 - hour consider moving to recovery phase instead of rescue. instead phasetomoving recovery of consider hour

TE 3 TE

as as tolerated as tolerated as as indicated as indicated Protocol UP4 Protocol Cardiac Cardiac Monitor if if indicated Age Age Appropriate IV / IO ProcedureIO IV / as as indicated Protocol TB8 Protocol Dry / Patient / Dry Warm Protocol(s) 1 Protocol(s) Removewetclothing Supplemental Supplemental Oxygen Altered Mental Mental Altered Status Awake but with with but Awake AMS Drowning Airway Protocol(s) AR 1 Protocol(s) 1 AR Airway Age Airway Age Appropriate NotifyDestination or ContactMedical Control Unresponsive status Mental changes signs absent or Decreased vital / FoamingVomiting Rales, Wheezing, Coughing, Rhonchi, Stridor Apnea 5 Breaths 5BVMBreaths mouth via /

Spinal Motion Restriction Procedure Procedure RestrictionSpinal / Motion       Signs andSymptoms P A resuscitate all patients with known submersion time submersion patients known of time resuscitate with all timeIf submersion mL/kg of water in lungs (does not require suction) Primary treatment is hypoxia. of reversalis Primary treatment require notsuction) water in (does of lungs mL/kg

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– <1 Any local EMS System changes to this document must follow the NC OEMS mustbe Policy the documentProtocolNC this EMS local by followchanges OEMS Any Changeapproved System OEMS and to 6 hours hours 6 if if indicated if if indicated as as tolerated as as indicated Cardiac Cardiac Monitor IV IOProcedureIV / evaluation even if evaluation even Dry / Patient / Dry Warm minimal minimal symptoms Remove wet clothingwetRemove Awake andAlert Awake Supplemental Supplemental Oxygen Monitor and and Monitor Reassess asymptomatic or with with or asymptomatic Asymptomatic drowning Asymptomatic drowning Procedure / Protocol 8 Procedure / TB Spinal Spinal RestrictionMotions Encourage transport andtransport Encourage patients (refusing transport)(refusing patients medical care/call 911 if they if medical 911 care/call Spinal motion restriction is usually unnecessary. When indicated it should not interrupt ventilation, oxygenation and /CPorindicatedventilation, and oxygenationshouldusuallyis interrupt notunnecessary. it restriction When Spinal motion potential worsening over the next 6 the worsening potential hours. 6 next over death,tra status. obvious Unless with difficult isand correlatemental not does setting in prehospital Predicting prognosis withwarm conditions. ambient even submersion associated injuries with and oftenisdrowning Hypothermia hastypically patient Drowning through foam (suction water and vomit only when present.)whenonlyand vomit through water (suction foam important are andto by ventilation is high arrestequally drowning inairway hypoxia, Cardiac caused to dyspnea, (cough,hypoxia) lung of transportfoam, due patients sounds, abnormal all Encourage symptomatic When feasible, only appropriately trained and certified rescuers should remove patients from areas of danger. areas from should of appropriately only patients and remove rescuers feasible, Whencertified trained temperature of Regardless water temperature of Regardless water with attemptingtime Ventilate to may NOT BVM presentcopious, suction. is airway inwaste DO be Foam and usually Drowning is the process of experiencing respiratory impairment (any respiratory symptom) from submersion submersion from / symptom) respiratory (any experiencing impairment process respiratory the of Drowning is liquid. ainimmersion supplemental mode apply oxygen. ifappropriate tolerate notof patient ventilations, BVMthen Begin does with amongof is would safety. death cause scene Ensureleading a Drowning Recommended Exam: Respiratory, Mental status, Trauma Survey, Mental Neuro Skin, Exam: Respiratory, Trauma Recommended status, of hypothermia of Possible history of of trauma Possible history / immersion submersion Duration of water possibility or of Temperature Submersion in water in of water Submersion regardless depth Revised should be instructed to seek instructed seek to should be Slammed into shore wave break wave into Slammedshore develop anywithinsymptoms develop 01/01/2017

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