CENTURY AMBULANCE SERVICE, INC. Medical Standard Operating Guidelines (Released May 2016) Authorization These guidelines and treatment guidelines were developed and reviewed under the authorization of the below-signed Medical Director in accordance with Florida Statute 401 and Chapter 64J-1 of the Florida Administrative Code. Changes to these guidelines can only be made with the authorization of the Medical Director and Century Ambulance Service, Inc. Signature on File David Murray, M.D. Medical Director These Medical Standard Operating Guidelines (MSOG) as reviewed and signed above by Century Ambulance Service, Inc.’s Medical Director supersede all previous memos, Emergency Medical Services Standard Operating Guidelines, Medical Standard Operating Guidelines, and Drug Listings. Century Ambulance Service, Inc. Medical Standard Operating Guidelines 1 Table of Contents (200.00) Authorization...................................................................................................................................... 1 Table of Contents (200.00) ................................................................................................................ 2 Introduction (200.02) ......................................................................................................................... 8 Reporting and Treating Patient Abuse / Neglect (205.00) ................................................................. 9 Clinical Quality Assurance Program Purpose and Overview (205.02)............................................ 10 Transport and Destination Determination (204.00) ......................................................................... 12 Medical Attendant Policy (204.01) .................................................................................................. 15 Medical Radio Reports (204.02) ...................................................................................................... 16 Scope of Practice (203.00) ............................................................................................................... 17 Emergency Medical Technician (EMT)....................................................................................... 17 Paramedic (PMD)......................................................................................................................... 18 Consent to Treat and Competency (210.00) .................................................................................... 19 General Treatment Considerations (210.02) .................................................................................... 24 Arrive on Scene Prepared............................................................................................................. 24 Medical Necessity ........................................................................................................................ 24 Vital Signs .................................................................................................................................... 25 Bariatric Patients .......................................................................................................................... 25 Ambulating Patients ..................................................................................................................... 26 Transport the Correct Patient ....................................................................................................... 26 Multiple Patient Transports .......................................................................................................... 26 Patient Transfer Considerations ................................................................................................... 27 Positioning ................................................................................................................................... 28 Transfer of Care ........................................................................................................................... 28 Behavioral Emergencies and Restraints (210.04) ............................................................................ 29 Violent / Combative Patient Management (210.06) ........................................................................ 31 Cooperation With Law Enforcement (210.08)................................................................................. 33 Do Not Resuscitate and Allow Natural Death Orders (210.10) ....................................................... 38 Do Not Resuscitate Orders ........................................................................................................... 38 Florida Administrative Code 64J-2.018 regarding DNRO’s ....................................................... 38 Allow Natural Death Orders ........................................................................................................ 38 Revocation of a DNRO / AND (Century applies the same criteria to DNRO's and AND's) ....... 38 Dead on Scene (210.12) ................................................................................................................... 39 Common Acronyms and Assessment References (210.14) ............................................................. 41 Century Ambulance Service, Inc. Medical Standard Operating Guidelines 2 AVPU ........................................................................................................................................... 41 DCAP-BTLS ................................................................................................................................ 41 D.U.M.B.E.L.S. / D.U.M.B.B.B.E.L.S. ....................................................................................... 41 OPQRST ...................................................................................................................................... 41 SAMPLE ...................................................................................................................................... 41 Adult Glasgow Coma Score ......................................................................................................... 42 Pediatric Glasgow Coma Scale .................................................................................................... 43 Rule of Nines ............................................................................................................................... 44 EMT Assessment / Treatments (210.16) .......................................................................................... 45 Airway Guidelines (215.00) ............................................................................................................. 46 Airway Treatments / Adjuncts ..................................................................................................... 48 Facilitated Intubation (Orotracheal Intubation) ................................................................. 52 EMT Airway Algorithm ............................................................................................................... 54 Paramedic Airway Algorithm ...................................................................................................... 55 Post Intubation Management Algorithm ...................................................................................... 56 Failed Airway Algorithm ............................................................................................................. 57 Ventilator Guidelines ................................................................................................................... 58 BiPAP Guidelines ........................................................................................................................ 64 NG / OG Insertion (215.02) ............................................................................................................. 68 Respiratory Insufficiency (215.04) .................................................................................................. 70 Hyperventilation (215.06) ................................................................................................................ 72 Needle Thoracentesis (215.08)......................................................................................................... 73 Respiratory Arrest / Failure (215.10) ............................................................................................... 74 Drowning / Near-drowning Submersion (215.12) ........................................................................... 76 Vascular Access (220.00)................................................................................................................. 78 Fluid Challenge (220.02) ................................................................................................................. 82 Pain Management (225.00) .............................................................................................................. 85 Nausea / Vomiting (230.00) ............................................................................................................. 88 Abdominal / Flank Pain (230.02) ..................................................................................................... 89 Diabetic Emergencies (230.04) ........................................................................................................ 91 Coma / Altered Consciousness (230.06) .......................................................................................... 92 Seizures