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Standard Operating Guidelines Alton Memorial Hospital, Anderson Hospital, Belleville Memorial Hospital, HSHS Holy Family Hospital, and OSF Healthcare St. Anthony’s Standard Operating Guidelines VERSION 2017.003.2 (Jan 2018) IDPH Region IV Standard Operating Guidelines 2017 STANDARD OPERATING GUIDELINES Developed and approved through a collaborative process involving the Region IV Resource Hospitals Alton Memorial Hospital, Anderson Hospital, Belleville Memorial Hospital, HSHS Holy Family Hospital, and OSF Healthcare St. Anthony’s System members are authorized to carry out these procedures to the extent necessitated by patient condition. Medical Control contact should be established as soon as practical. Some SOPs, designated by the header notation of Time Sensitive, emphasize early contact with Medical Control, which can benefit the patient by minimizing the time to definitive care. It is recognized that hospice patients, patients with valid DNR/POLST orders, patients who have not responded to ALS procedures, or patients involved in a mass casualty incident (MCI) present unique circumstances that may, in the medical opinion of the Medical Control Physician, justify deviation from these procedures, including bypass of the closest destination. Dr. Andrew Russell EMS Medical Director Anderson Hospital Dr. Delwin Merchant EMS Medical Director Dr. Matt Jackson Belleville Memorial Hospital EMS Medical Director OSF Healthcare St. Anthony’s pg 1 ver 2017.003.2 IDPH Region IV Standard Operating Guidelines Section I: General Medical Care 01.001 General Medical Assessment 7 01.002 Special Considerations 10 01.003 Geriatric Emergencies 11 01.004 Initial Medical Care 12 01.005 ALS Assist Guidelines for BLS/ILS Units (In-Field Service Upgrades) 14 Section II: Circulation Basic Concept and Cardiac Emergencies 02.001 Pulseless Patients 17 02.002 Ventricular Fibrillation/Pulseless Ventricular Tachycardia 21 02.003 PEA/Asystole 23 02.004 Post-Cardiac Arrest Care 24 02.005 Region IV Do-Not-Resuscitate Policy 25 02.006 Termination of Resuscitation for Non-Traumatic Cardiac Arrest 28 02.007 Shock (Undifferentiated) 30 02.008 Cardiogenic Shock 32 02.009 Ventricular Ectopy 34 02.010 Wide Complex Tachycardia With a Pulse 35 02.011 Supraventricular Tachycardia 37 02.012 Atrial Fibrillation or Atrial Flutter 40 02.013 Sinus Bradycardia and Second Degree AV Block, Mobitz Type I 42 02.014 Second Degree Mobitz Type II and Third Degree AV Block 44 02.015 Implanted Cardiac Defibrillators 46 02.016 Hyperkalemia 47 02.017 Pulmonary Edema (Due to Heart Failure) 49 02.018 Hypertensive Emergencies 53 02.019 Acute Coronary Syndrome 54 02.020 Chest Pain (Not Suspected ACS) 57 02.021 Syncope/Near Syncope 58 02.022 Acute Life-Threatening Event (ALTE) 59 Section III: Airway Basic Concept and Emergencies 03.001 Basic Airway Evaluation and Management 61 03.002 Advanced Airway Evaluation and Management 62 03.003 Difficult and Failed Airways 65 03.004 Airway Placement Confirmation 66 03.005 Airway Obstruction 67 03.006 Foreign Body Airway Obstruction 68 03.007 Non-Foreign Body Airway Obstruction 70 Section IV: Breathing Basic Concept and Emergencies 04.001 Respiratory Arrest 73 04.002 Respiratory Distress 74 04.003 Asthma/COPD/RAD 76 04.004 Uncertain or Other Cause 78 04.005 Respiratory Distress or Arrest In a Patient with a Tracheostomy Tube or Stoma 80 pg 2 ver 2017.003.2 IDPH Region IV Standard Operating Guidelines Section V: Disability Basic Concept and Emergencies 05.001 Coma of Unknown Origin 85 05.002 Seizure 86 05.003 Stroke 89 Section VI: Pain Control and Chemical Sedation 06.001 Pain Control 92 06.002 Conscious Sedation 94 Section VII: Medical Emergencies 07.001 Anaphylactic Shock 97 07.002 Septic and Hypovolemic (Non-Hemorrhagic) Shock 100 07.003 General Illness 102 07.004 Acute Abdominal Pain 103 07.005 Diabetic/Glucose Emergencies 104 07.006 Renal Dialysis Patients – Shunts, Fistulas, and Grafts 107 07.007 Sickle Cell Emergencies 108 07.008 Behavioral Emergencies 109 07.009 Guidelines on Inter-facility Transfers 113 07.010 ALS Transfer Medications 116 07.011 Transfer of Blood Products 117 07.012 Complications of Transfusion 119 07.013 Chest Tube Transfers 121 Section VIII: Obstetric Emergencies and Care of the Newly Born 08.001 Pregnancy Complications 122 08.002 Pre-Eclampsia and Eclampsia 123 08.003 Preterm labor 124 08.004 Emergency Childbirth 125 08.005 Delivery Complications 126 08.006 Routine Neonatal Care 132 08.007 Neonatal Resuscitation 133 08.008 Meconium-Stained Amniotic Fluid 134 Section IX: Environmental Emergencies 09.001 Frostbite 135 09.002 Hypothermia 137 09.003 Heat Emergencies 138 09.004 Near Drowning 141 09.005 Firefighter Rehabilitation 143 09.006 Lightning Strikes and Electrocution 145 09.007 Venomous Snake Bites 146 09.008 Other Bites 147 pg 3 ver 2017.003.2 IDPH Region IV Standard Operating Guidelines Section X: Trauma 10.001 Initial Trauma Assessment 148 10.002 Initial Trauma Care 151 10.003 Critical Trauma/Load-and-Go 152 10.004 Traumatic Arrest 154 10.005 Hemorrhagic Shock 156 10.006 Head and Spinal Cord Trauma 158 10.007 Suspension Trauma 160 10.008 Ophthalmologic Injuries 162 10.009 Ear, Nose, and Throat Injuries 163 10.010 Neck, Chest, Abdominal, and Pelvic Injuries 164 10.011 Musculoskeletal Injuries 166 10.012 Burns 169 10.013 Rape/Sexual Assault 171 10.014 Trauma in Pregnancy 173 10.015 Field Triage 174 10.016 School Bus Incident Log of Uninjured Patients 177 10.017 Uninjured Patient Refusal Log 178 Section XI: Overdose/Poisoning, HAZMAT, and CBRNE 11.001 Overdose/Poisoning 179 11.002 Hazardous Materials Exposure 183 11.003 Blood Agents: Carbon Monoxide 185 11.004 Blood Agents: Cyanide 186 11.005 Blood Agents: Hydrogen Sulfide 188 11.006 Choking Agents/Pulmonary Irritants 190 11.007 Hydrofluoric Acid 191 11.008 Organophosphates/Nerve Agents 192 11.009 Methemoglobinemia-Inducing Agents 198 11.010 Hydrazines 198 11.011 Vesicants 198 11.012 Biological WMD and Pandemic Illnesses 201 11.013 Radiation Injuries 205 Section XII: Patient Assessment Tools 12.001 CPR For Adults, Children, and Infants (Excluding Newly Born) 207 12.002 Pediatric Vital Signs 208 12.003 Pediatric Resuscitation 210 12.004 Thrombolytic Checklist for STEMI 211 12.005 Glasgow Coma Scale 212 12.006 Wong Baker Faces 213 12.007 APGAR Scoring For the Newly Born 213 12.008 Adult Revised Trauma Score 213 12.009 Pediatric Trauma Score 215 12.010 The Rule of Nines 216 pg 4 ver 2017.003.2 IDPH Region IV Standard Operating Guidelines Section XIII: Procedures 13.001 Capnography 217 13.002 Suctioning 219 13.003 Cricoid Pressure 221 13.004 Direct Laryngoscopy for Removal of a FBAO 222 13.005 BVM Ventilation 223 13.006 Orotracheal Intubation 225 13.007 Gum-Elastic Bougie Assisted Intubation 227 13.008 Nasotracheal Intubation 229 13.009 Sedative-Assisted Intubation and Rapid Sequence Intubation 231 13.010 Confirmation of Endotracheal Tube Placement 232 13.011 Transtracheal Catheter Ventilation 233 13.012 Surgical Cricothyroidotomy 235 13.013 Use of Mechanical Ventilation 237 13.014 CPAP 238 13.015 Automated External Defibrillators 241 13.016 Manual Defibrillation 244 13.017 Electrical Cardioversion 246 13.018 Non-Invasive External Cardiac Pacing 248 13.019 12 Lead Electrocardiogram 251 13.020 Blood Samples 253 13.021 External Jugular Vein Cannulation 254 13.022 Guidelines for the Use of Vascular Access Devices 255 13.023 Jamshidi-Style Intra-Osseous Access 257 13.024 EZ-IO Intra-Osseous Access 258 13.025 Nasal Atomizer 261 13.026 Aerosol Updraft Treatment 262 13.027 Assisted Administration of Albuterol For Patients with Prescribed Albuterol 263 13.028 Rectal Diazepam Administration 264 13.029 Oral Glucose 265 13.030 Assisted Administration of NTG for Patients with Prescribed NTG 266 13.031 State of Illinois Nerve Gas Autoinjector Guidelines 267 13.032 Epi-Pen Administration 271 13.033 Spinal Motion Restriction Decision Algorithm 272 13.034 Turkel Chest Decompression System 274 13.035 Tourniquets 276 13.036 Taser Removal 278 13.037 Section XIV: Pharmacology 279 13.038 General Principals 279 Medications References 280 Appendix A: System Differences 308 Appendix B: Regional Approved Devices 309 Appendix C: Pediatric Protocols: Region IV Specific 321 Appendix D: Pediatric Protocols: Region IV approved EMSC Protocols 324 pg 5 ver 2017.003.2 IDPH Region IV Standard Operating Guidelines Introduction These Standard Operating Guidelines (SOGs) have been designed as patient care directives for Region IV prehospital care providers. Providers should rely on these guidelines to guide a patient’s treatment prior to arrival in the emergency department. At all times, providers should evaluate each patient, make an assessment, and treat as directed by the appropriate SOG(s). A patient may require utilization of more than one SOG. The prehospital care provider should always keep the best interests of the patient in mind. The medical directors of Region IV understand that varying and exceptional circumstances do occur. Indeed, it may be necessary, at times, to make reasonable deviations from these SOGs. However, it should be noted that the SOGs do NOT replace contact with Medical Control, particularly when deviation from the SOGs is deemed necessary by the prehospital care provider. The Region IV SOGs are divided by category. Each patient shall undergo a general medical or trauma exam, the breadth of which shall be dictated by the time allowed and the nature of the patient’s illness or injury. Next, the Circulation, Airway, and Breathing of each patient shall be assessed without exception. While evaluation of each is often conducted simultaneously, these “Basic Concepts” are delineated in separate chapters, along with specific emergencies pertinent to each. Following evaluation of a patient’s Circulation, Airway, and Breathing, each patient shall be assessed for Disability. Next, the Region IV SOGs include separate chapters for pain control, medical emergencies, obstetric emergencies, etc.
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