EMERGENCY MEDICAL PROTOCOLS TABLE OF CONTENTS MEDICAL DIRECTOR APPROVAL ........................................................................................................................................... 5 24.1 – STANDARDS OF CARE PROTOCOL .............................................................................................................................. 6 24.1.1 - STANDARD OF CARE ......................................................................................................................................................... 7 24.1.2 - RADIO REPORT ................................................................................................................................................................ 8 24.1.3 - INITIATION OF CPR / TERMINATION OF RESUSCITATION .......................................................................................................... 9 24.1.4 - DETERMINATION OF DEATH ............................................................................................................................................. 11 24.1.5 - SUSPECTED CHILD / ELDER ABUSE ..................................................................................................................................... 12 24.1.6 - DETERMINATION OF HOSPITAL DESTINATION ...................................................................................................................... 13 24.1.7 - HOSPITAL EMERGENCY DEPARTMENT EMS BYPASS GUIDELINES............................................................................................. 15 24.1.8 - REFUSAL OF SERVICE ...................................................................................................................................................... 16 24.1.9 - PHYSICIAN ON SCENE ..................................................................................................................................................... 21 24.1.10 - UNIVERSAL PRECAUTIONS ............................................................................................................................................. 22 24.1.11 - QUALITY ASSURANCE PROGRAM..................................................................................................................................... 23 24.1.12 - BAKER / MARCHMAN ACT ............................................................................................................................................. 30 24.1.13 - RAPID EXTRICATION ..................................................................................................................................................... 32 24.1.14 - BARIATRIC PATIENT TRANSPORT ..................................................................................................................................... 33 24.2 – BASIC MEDICAL CARE PROTOCOLS .......................................................................................................................... 34 24.2.1 - BASIC MEDICAL CARE ..................................................................................................................................................... 35 24.2.2 - AIRWAY MANAGEMENT .................................................................................................................................................. 36 24.2.3 - OXYGEN THERAPY (ADULTS) ............................................................................................................................................ 37 24.2.4 - CONTROL OF EXTERNAL BLEEDING .................................................................................................................................... 38 24.2.5 - MCI AND TRIAGE SYSTEM ............................................................................................................................................... 39 24.3 – CARDIOVASCULAR PROTOCOLS............................................................................................................................... 44 24.3.1 - CHEST PAIN – SUSPECTED CARDIAC ................................................................................................................................... 45 24.3.2 - CHEST PAIN – NON-CARDIAC ........................................................................................................................................... 47 24.3.3 - CONGESTIVE HEART FAILURE / PULMONARY EDEMA ............................................................................................................ 48 24.3.4 - CARDIAC ARREST MANAGEMENT ...................................................................................................................................... 49 24.3.5 - POST CARDIAC ARREST MANAGEMENT .............................................................................................................................. 53 24.3.6 - DYSRHYTHMIA – ASYSTOLE / PULSELESS ELECTRICAL ACTIVITY (PEA) ...................................................................................... 54 24.3.7 - DYSRHYTHMIA - BRADYCARDIA ......................................................................................................................................... 56 24.3.8 - DYSRHYTHMIA – TACHYCARDIA WITH A PULSE ..................................................................................................................... 57 24.3.9 - DYSRHYTHMIA – VENTRICULAR FIBRILLATION / PULSELESS VENTRICULAR TACHYCARDIA .............................................................. 60 24.3.10 - CEREBROVASCULAR ACCIDENT (CVA / STROKE) ................................................................................................................ 63 24.3.11 - LVAD ....................................................................................................................................................................... 65 24.3.12 - SYNCARDIA DEVICES .................................................................................................................................................... 66 24.4 – EMERGENCY MEDICAL PROTOCOLS ......................................................................................................................... 67 24.4.1 – ABDOMINAL PAIN ......................................................................................................................................................... 68 24.4.2 – ALLERGIC REACTIONS / ANAPHYLAXIS ............................................................................................................................... 69 24.4.3 – ALTERED MENTAL STATUS .............................................................................................................................................. 70 24.4.4 – CARBON MONOXIDE INTOXICATION ................................................................................................................................. 71 24.4.5 – DIABETIC EMERGENCIES ................................................................................................................................................. 72 24.4.6 – DYSBARISM / DIVING ACCIDENTS ..................................................................................................................................... 73 24.4.7 – GASTROINTESTINAL BLEEDING ......................................................................................................................................... 74 24.4.8 – HYPERTHERMIA ............................................................................................................................................................ 75 24.4.9 – HYPERTENSION ............................................................................................................................................................. 76 24.4.10 – HYPOTENSION / SHOCK ................................................................................................................................................ 78 24.4.11 – HYPOTHERMIA ........................................................................................................................................................... 81 24.4.11 – NAUSEA AND VOMITING .............................................................................................................................................. 82 24.4.12 – OVERDOSE AND POISON INGESTION ............................................................................................................................... 83 24.4.13 – PAIN MANAGEMENT ................................................................................................................................................... 89 24.4.14 – PSYCHIATRIC DISTURBANCES / EXCITED DELIRIUM ............................................................................................................. 91 24.4.15 – RESPIRATORY DISTRESS ................................................................................................................................................ 92 24.4.16 – SEIZURES ................................................................................................................................................................... 94 24.4.17 – SEPSIS ..................................................................................................................................................................... 95 24.4.18 – SNAKE BITE ...............................................................................................................................................................