Final Draft – For Training Purposes Only.

The following document ⎯ the January 2008 Pierce County Patient

Care Protocols ⎯ is being made available for general viewing and is not to be considered the MPD approved Patient Care Protocols for

Pierce County. It may be printed out but is not intended to be altered in any way. If a copy is found with text other than what is found in the version on file in the Pierce County Emergency Medical Services office, it will not be recognized as valid. Pierce County EMS personnel will be held accountable to the printed pocket-sized version which was issued/ purchased for individual use/certification. Final Draft – For Training Purposes

PATIENT CARE PROTOCOLS

and the Emergency Medical Program Director January 2008 Pierce County EMERGENCY MEDICAL SERVICES

PATIENT CARE PROTOCOLS

February 1984 Revised August 1985 Revised February 1988 Revised March 1989 Revised December 1992 Revised August 1994 Revised August 1997 Revised July 1999 Revised August 2001 Revised January 2005 Revised January 2008

No part of this manual may be reproduced in any form or by any means, including photocopying, or utilized by any information storage and retrieval system without permission from Pierce County Emergency Medical Services, 2501 South 35th Street, Tacoma WA 98409-7405. Telephone (253) 798-7722.

(a) Preface

Requests for changes should be in writing using the Patient Care Protocol Request for Change form and directed to:

Medical Program Director Pierce County Emergency Medical Services Department of Emergency Management 2501 South 35th Street Tacoma WA 98409-7405

(253) 798-7722

A sincere thank you to all those individuals who attended the monthly meetings to write, revise and review draft after draft of this document. Without the help and dedication of all involved, this monumental task could not have been accomplished.

(b)

Table of Contents

Section Name Page Administrative Policy (White) ...... 1 Communication Policy (White) ...... 8 Transport Policy (White) ...... 9 General Principles/Routine Care (Lt. Pink) ...... 11 Traumatic Emergencies (Red) ...... 17 Cardiac Emergencies (Goldenrod) ...... 23 Shock Emergencies (Yellow) ...... 26 Respiratory Emergencies (Blue) ...... 28 Medical Emergencies (Lt. Green) ...... 30 Environmental Emergencies (Dk. Green) ...... 34 Behavioral Emergencies (Orange) ...... 37 OB/GYN Emergencies (Hot Pink) ...... 40 Pediatric Emergencies (Lilac) ...... 43

Appendices (Gray) Standard Reporting Format ...... A Pierce County Prehospital Trauma Triage Procedures ...... B ALS/BLS Transport Guidelines ...... C Rapid Sequence Intubation ...... D Glasgow Coma Scale (GCS) ...... E Pneumatic Anti-Shock Garment (PASG) ...... F APGAR Score ...... G Blood Draw ...... H Pediatric Cardiac Arrest Guide ...... I Hospital/Facility Telephone Numbers ...... J Simple Triage and Rapid Transport (START) Guideline ...... K Medication/IV Guide ...... L

(c)

ADMINISTRATIVE POLICY

All ALS procedures are in italics. All treatments needing an order from a Base Station are asterisked (*). Pediatric patient care is Bold. All references to “AHA Handbook” refer to the current AHA Handbook of Emergency Cardiovascular Care for Healthcare Providers.

I. Scope of Practice. A. First Responder. 1. Airway management.

a. O2 administration, BVM, NC, NRB, adjuncts, suction. b. CPR/obstructed airway (all ages). 2. Splinting. a. Traction. b. Rigid. c. Non-rigid. 3. Spine management. a. Long backboard, immobilization, KED, standing board, helmet removal, rapid extrication, log roll, strapping. 4. Semi-Automated External Defibrillation (SAED). 5. Normal delivery/newborn care. B. EMT-B. In addition to First Responder scope of practice, an EMT-B in Pierce County may perform the following: 1. Medication administration. a. May administer: 1. Oxygen. 2. Oral glucose. 3. Syrup of Ipecac. 4. Activated Charcoal. 5. Ep