SCHERTZ EMERGENCY MEDICAL SERVICES STANDARD MEDICAL OPERATING PROTOCOLS Version 2020 Schertz EMS System SMOPs Table of Contents Cover Pages Page Cover / Signature Page 1 Supplies List 2 - 3 Equipment List 4 Medication List 5 Update Log 6 General Guidelines Page Authority of Medical Director G 1 – 2 Credentialing G 3 Credentialing – Scope of Practice G 4 – 7 EMS Personnel Guidelines G 8 – 9 Active Threats G10 - 13 Cancellation of Responding Units G 14 Family Violence G 15 Fire Rehab G 16 - 18 Hospital Selection Criteria G 19 - 20 Hospital Selection Criteria - Emerus G 21 Infection Control / Exposure Information G 22 - 23 Mass Casualty / Disaster Guidelines G 24 - 25 Medical Control – Mandatory Notification G 26 Medical Control – Online G 27 Medical Device / Medication Storage Policy G 28 Obese Patient Guidelines G 29 - 30 Patient (with lift assist) G 31 Patient Classification G 32 Patient Consent G 33 Refusals G 34 Transports – Ambulance G 35 Transports – Helicopter Transports G 36 Transports – Interfacility Transports G 37 Transports – Non Paramedic Attendant G 38 Trauma Alert Criteria G 39 Regional Trauma Alert Criteria (Red/Blue/Grey) G 40 Cardiac Page Arrest Management C1 – 5 - Asystole / PEA C6 – 7 - V-Fib / V-Tach C8 – 9 - Post Resuscitation C10 - 11 Atrial Fibrillation / Atrial Flutter C12 – 13 Bradycardia C14 Chest Pain / ACS C15 - 16 - Heart Alert Criteria C17 - 18 Congestive Heart Failure (CHF) C19 - 20 Supraventricular Tachycardia (SVT) C21 - 22 Wide Complex Tachycardia (with a pulse) C23 - 24 Medical SMOPs Page Abdominal Pain M1 Allergic Reactions / Anaphylaxis M2 Altered Mental Status M3 Behavioral Emergencies M4 – M5 Diabetic Emergencies M6 – M7 Diving Illness M8 Drownings / Near Drownings M9 Heat Related Emergencies M10 – M11 Hypertension M12 Hypotension (Non-Trauma) M13 Hypotension (Suspected Sepsis) M14 – M15 Hypothermia M16 – M17 Nausea / Vomiting M18 Nosebleed M19 Overdose / Poisoning M20 – M21 Reactive Airway Disease (Asthma / COPD) M22 – M23 Seizures M24 – M25 Snakebites M26 – M27 Stroke / CVA (Stroke Alert Criteria) M28 – M29 Syncope M30 OB Emergencies SMOPs Obstetric Emergencies - General OB 1 - 2 Obstetrics – Normal Delivery OB 3 Obstetric Emergencies - Complications - Abruptio Placenta OB 4 - Breech Birth OB 4 - Eclampsia OB 4 - Multiple Births OB 4 - Placenta Previa OB 5 - Prolapsed Umbilical Cord / Limb Presentation OB 5 - Ruptured Ectopic Pregnancy OB 5 - Shoulder Dystocia OB 5 - Spontaneous Abortion OB 6 - Uterine Inversion OB 6 - Uterine Rupture OB 6 Trauma SMOPs General Trauma Management T 1 - 2 Amputations T 3 Bleeding Control T 4 Burns (Chemical, Electrical & Thermal) T 5 - 6 Closed Head Injuries T 7 - 8 Crush Injuries T 9 Extremity / Musculoskeletal Trauma T 10 - 11 Physical / Sexual Assault T 12 Spinal Trauma T 13 Trauma Arrest T 14 - 15 Pediatric Emergencies SMOPs Allergic Reactions / Anaphylaxis P 1 Altered Mental Status P 2 Asthma P 3 - 4 Bradycardia P 5 Cardiac Arrest – Asystole / PEA P 6 Cardiac Arrest – V-Fib / Pulseless V-Tach P 7 Diabetic Emergencies P 8 - 9 Drowning / Near Drowning P 10 - 11 Heat Related Emergencies P 12 - 13 Hypotension (Non-Trauma) P 14 Nausea / Vomiting P 15 Newborn Resuscitation P 16 - 17 - APGAR P 18 Overdose / Toxic Exposure P 19 Seizures P 20 - 21 Tachycardia (poor perfusion) P 22 - 23 Pediatric Trauma SMOPs General Pediatric Trauma Management P 24 - 25 Amputations P 26 Burn (Chemical, Electrical & Thermal) P 27 - 28 Closed Head Injuries P 29 - 30 Procedures Airway Classification / Comparison Proc 1 Automatic External Defibrillator (AED) Proc 2 Apparent Death / DOS / Termination of Efforts Proc 3 - 5 Blood Draw for Texas JP Proc 6 Chest Compression System (LUCAS) Proc 7 Chest Decompression Proc 8 Continuous Positive Airway Pressure (CPAP) Proc 9 - 10 Crime Scenes Proc 11 Delayed Sequence Intubation Proc 12 - 14 Endotracheal Intubation Proc 15 Endotracheal Tube Introducer (Bougie) Proc 16 Epi Administration (Anaphylaxis) Proc 17 ETCO2 Monitoring Proc 18 Gastric Tube Placement Proc 19 Glucometer Usage Proc 20 Impendence Threshold Device (ITD) Proc 21 Intranasal Drug Administration Proc 22 Intraosseous Infusion (EZ-IO) Proc 23 - 26 Intravenous Fluid Therapy Proc 27 IV Saline Locks Proc 28 Medication Administration Routes Proc 29 - 31 Medication Infusion – Amiodarone Proc 32 Medication Infusion - Norepinephrine Proc 33 Out of Hospital – Do Not Resuscitate (DNR) Proc 34 - Out of Hospital DNR Form Proc 35 Pain Management Proc 36 - 37 Patient Restraint Proc 38 Push Dose Pressors - Epi Proc 39 SAM® Pelvic Sling Proc 40 Spinal Motion Restriction (SMR) Proc 41 - 43 Standby / Special Event Proc 44 - 45 Supraglottic Airway Proc 46 - 47 Synchronized Cardioversion Proc 48 Taser Information / Treatment Proc 49 Thermometer Proc 50 Traction Splint (Sager) Proc 51 Transcutaneous Pacing Proc 52 Whole Blood (LTOWB) Administration Proc 53 - 54 12 Lead EKG Monitoring Proc 55 - 56 Medications Page Acetaminophen D 1 Activated Charcoal D 2 Adenosine D 3 Albuterol Sulfate D 4 Amiodarone Hydrochloride D 5 - 6 Aspirin (ASA) D 7 Atropine Sulfate D 8 Calcium D 9 Dexamethasone D10 Dextrose D 11 Diazepam D 12 Diltiazem D 13 Diphenhydramine Hydrochloride D 14 Epinephrine D 15 Fentanyl D 16 Glucagon D 17 Ketamine D 18 Ketorolac D 19 Levabuterol D 20 Lidocaine Hydrochloride D 21 Magnesium Sulfate D 22 Midazolam D 23 Naloxone D 24 Nitroglycerine D 25 Norepinephrine D 26 Ondansetron D 27 Promethazine D 28 Rocuronium D 29 Sodium Bicarbonate D 30 Terbutaline D 31 Tranexamic Acid (TXA) D 32 Pregnancy Classification D 33 IV Pump Medication Reference D 34 Schertz EMS Protocol Update Log This page will be utilized to update future changes/additions to the protocols Date Protocol Changed Comment 6/1/20 Added TXA IN for refractory nosebleed 6/1/20 Changed Epi dose 1mg every 10min 6/1/20 Changed Ketamine dose for pain mgmt 7/1/20 Added definition of Adult / Pedi patient Added EMT Administration of NTG with 7/1/20 paramedic on scene 11/1/20 Added Ketorolac to pain management 12/29/20 Added Norepinephrine for shock 04/10/21 Changed Epi dose for cardiac arrest 6 GENERAL GUIDELINES GUIDELINES AUTHORITY OF THE MEDICAL DIRECTOR AUTHORITY OF THE MEDICAL DIRECTOR The Medical Practice Act, Regulations of the Texas Medical Board, and the Texas Health and Safety Code 773. RESPONSIBILITIES OF THE MEDICAL DIRECTOR The regulations of the Texas Medical Board delegates the following responsibilities of the Medical Director: . Satisfy him/herself as to the ability and competence of the emergency medical technician . Authorize the emergency medical technician to perform such duties, which do not require the exercise of independent judgment . Retain telephonic, radio, or direct control and supervision of the emergency medical technician . Be responsible for appropriate medical records being maintained, including but not limited to information on transport forms, procedures performed, and medications administered by the emergency medical technician • The Medical Director may at his discretion delegate some or all these duties. AUTHORIZATION The Medical Director herby authorizes emergency medical technicians of all levels in the Schertz EMS System (the System) including Schertz EMS and their corresponding First Responder Organizations (FRO) to practice according to the standards established in this document and other accepted standards, provided: . Authorization has not been specifically withdrawn . Prior notification is given to the Medical Director of the technician’s acceptance into one of the System’s agencies . The technician retains a copy of these SMOP’S in their on-duty unit . Technician is wearing the uniform of one of the System’s agencies that clearly identifies the person’s name, certification level and agency affiliation. The only exception to this is an unplanned response to an emergency within the System’s service area. The technician must periodically pass a written test over the contents of these pages and show competence in the skills prescribed herein. The technician shall only practice those skills in which he/she is proficient. Clinical Services will determine proficiency. The technician may not practice those skills that proficiency has not been documented. Retesting of skills and documentation of proficiency shall be required periodically . The technician shall maintain attendance and satisfactory performance in the continuing education program . The technician must be certified or licensed by the Texas Department of State Health Services at all times. REMOVAL OF AUTHORIZATION • The Medical Director reserves the right to remove authorizations to practice. Disciplinary action against an individual to practice is at the discretion of field operations, Clinical Services, the agencies Director or designee and/or the Medical Director • Removal of an individual’s authorization to practice may be appealed according to each agency’s in-house appeals process. • Deviations from these SMOP’S will be dealt with on a case-by-case basis by Clinical Services and the Medical Director G - 1 GUIDELINES AUTHORITY OF THE MEDICAL DIRECTOR STANDARD OF CARE • The SMOP’S will act as a guideline for all normal situations. • For all other situations or items not covered by the SMOP’S, technicians are expected to follow established standards of emergency care and/or contact On-Line Medical Control (OLMC). GEOGRAPHICAL AREA • These protocols shall only be utilized under the Medical Director’s direction in the Schertz EMS primary service area or outside of our service area while functioning in an official capacity. This includes