EMERGENCY MEDICAL SERVICES PRE-HOSPITAL STATEWIDE TREATMENT PROTOCOLS OFFICIAL VERSION 2018.1 Complete Version January 29, 2018 Commonwealth of Massachusetts Department of Public Health Bureau of Healthcare Safety and Quality Office of Emergency Medical Services Statewide Treatment Protocols – Version 2018.1 Legend Definition FR First Responder (FR)-- Found only in protocols 2.2A, 2.2P, 2.9, and 2.14 E Emergency Medical Technician (EMT) A Advanced Emergency Medical Technician (AEMT) P Paramedic CAUTION – Red Flag topic Medical Control Orders Pediatric-specific protocol Clinical notes boxes show important assessment or treatment considerations. EMT level protocols are designated by colors (see above), and labels, and EMTs are responsible for providing Routine Care to all patients, and for their level of care, and those above on the protocol page. These protocols are developed and approved by the Department of Public Health, based on the recommendations of Emergency Medical Care Advisory Board (EMCAB) and its Medical Services Committee (MSC). For the latest corrections or addenda, see the OEMS website at http://www.mass.gov/dph/oems These are Massachusetts Statewide Treatment Protocols; they are the standard of EMS patient care in Massachusetts. Questions and comments should be directed to: Massachusetts Department of Public Health Office of Emergency Medical Services 99 Chauncy St. 11th Floor Boston, MA 02111 2013 2013 Massachusetts Pre-Hospital Statewide Treatment Protocols 2018.1 TABLE OF CONTENTS (Alphabetical order by section) Protocol ID SECTION 1 – General Patient Care Routine Patient Care……………………………………….……………………..………….1.0 High Quality CPR - Adult………………..………..………………………………………….1.1 SECTION 2 – Medical Protocols Adrenal Insufficiency - Adult/Pediatric………………………………………..……………2.1 Allergic Reaction/Anaphylaxis – Adult……………………………………………..……….2.2A Allergic Reaction/Anaphylaxis – Pediatric……………………………………………...…. 2.2P Altered Mental/Neurological Status/Diabetic Emergencies/Coma – Adult…………..….2.3A Altered Mental/Neurological Status/Diabetic Emergencies/Coma – Pediatric..……..…2.3P Behavioral Emergencies – Adult & Pediatric………………………………………...…….2.4 Behavioral Emergencies – Restraint……………………………………………………..... 2.5 Bronchospasm/Respiratory Distress – Adult………..……………………………………..2.6A Bronchospasm/Respiratory Distress – Pediatric……….………………………………… 2.6P Hyperthermia (Environmental) – Adult & Pediatric………..………………………………2.7 Hypothermia (Environmental) – Adult & Pediatric……………..…………………………. 2.8 Nerve Agent/Organophosphate Poisoning – Adult & Pediatric…....…………………... 2.9 Obstetrical Emergencies…………………………………………………..…………………2.10 Newly Born Care………………………………………………………………..…………….2.11 Resuscitation of the Newly Born…………………………………………………..……….. 2.12 Pain and Nausea Management – Adult & Pediatric…………………………………..…. 2.13 Poisoning/Substance Abuse/Overdose – Adult & Pediatric……..……………………….2.14 Seizures – Adult……………………………………………………………..……………….. 2.15A Seizures – Pediatric……………………………………………………………..……………2.15P Shock – Adult……………………………………………………………………..………….. 2.16A Shock – Pediatric……………………………………………………………………..……… 2.16P Sepsis – Adult …….………..…………………………………………………………..……. 2.17 Stroke – Adult …….………..…………………………………………………………..……. 2.18 Massachusetts Pre-Hospital Statewide Treatment Protocols 2018.1 – Table of Contents (Alphabetical order by section) Protocol ID SECTION 3 – Cardiac Emergencies Acute Coronary Syndrome – Adult………………………………………………………….3.1 Atrial Fibrillation/Flutter………………………………...……………………..………….…..3.2 Bradycardia – Adult………………………………………………………………………….. 3.3A Bradycardia – Pediatric……………………………………………………………………... 3.3P Cardiac Arrest (Adult)- Asystole/Pulseless Electrical Activity…………………...……… 3.4A Cardiac Arrest (Pediatric)- Asystole/Pulseless Electrical Activity………………….…… 3.4P Cardiac Arrest (Adult)-Ventricular Fibrillation/Pulseless Ventricular Tachycardia……..3.5A Cardiac Arrest (Pediatric)-Ventricular Fibrillation/Pulseless Ventricular Tachycardia…3.5P Congestive Heart Failure (Pulmonary Edema)…………………………………..……….. 3.6 Targeted Temperature Management – Adult…………………………………………...... 3.7 Post Resuscitative Care (Adult & Pediatric)………………………………………………. 3.8 Supraventricular Tachycardia - Adult…………………………………………………….…3.9A Supraventricular Tachycardia - Pediatric………………………………………………..… 3.9P Ventricular Tachycardia with Pulses – Adult & Pediatric…..…………………………..…3.10 SECTION 4 – Trauma Protocols Burns/Inhalation/Lightning Strike/Electrocution Injuries – Adult & Pediatric….……..… 4.1 Drowning/Submersion Injuries – Adult & Pediatric………………………………..……... 4.2 Eye Emergencies – Adult & Pediatric……………………………………………....………4.3 Head Trauma/Injuries – Adult & Pediatric………………………………………..……….. 4.4 Multisystem Trauma – Adult & Pediatric.…………………………………………..……… 4.5 Musculoskeletal Injuries – Adult & Pediatric….……………………………………...…… 4.6 Soft Tissue/Crush Injuries – Adult & Pediatric..…………………………………...……… 4.7 Spinal Column/Cord Injuries – Adult & Pediatric..………………………………...……… 4.8 Thoracic Injuries – Adult & Pediatric..……………………………………………………… 4.9 Traumatic Amputations – Adult & Pediatric..……………………………………………… 4.10 Traumatic Cardiopulmonary Arrest – Adult & Pediatric……………………..…………… 4.11 SECTION 5 – Airway Protocols & Procedures Upper Airway Obstruction – Adult………….………………………….…………………… 5.1A Upper Airway Obstruction – Pediatric …………...………………..………………………. 5.1P Difficult Airway……………………………..……………………………………..………….. 5.2 Tracheostomy Tube Obstruction Management…………………………….…………….. 5.3 Massachusetts Pre-Hospital Statewide Treatment Protocols 2018.1 - Table of Contents (Alphabetical order by section) Protocol ID SECTION 6 – Medical Director Options Requirements for Medical Director Options..………….………………………………..… 6.0 BLS Albuterol…..…………………..………………………………………………………… 6.1 Needle Cricothyrotomy…………………..………………………………………………….. 6.2 Selective Spinal Assessment….…………….…………………...………..…………….…. 6.3 Urban Search and Rescue (USAR) Medical Specialist..……………..…………………..6.4 Tranexamic Acid………………………………………………....……………..…………….6.5 Check and Inject Epinephrine By BLS Providers……...……………..…………………...6.6 Acetaminophen IV…………………………………………………………………………….6.7 SECTION 7 – Medical Policies & Procedures Air Medical Transport…………………………….………………………………………….. 7.1 Electrical Control Weapons…..…………………….………………………………………. 7.2 Medical Orders for Life Sustaining Treatment (MOLST) and Comfort Care/DNR….… 7.3 Pediatric Transportation………………………………….………..……………………….. 7.4 Refusal of Medical Care and Transportation..……………..………………………………7.5 Sedation and Analgesia for Electrical Therapy……………………………………….… 7.6 Withholding and Cessation of Resuscitation……………………….……………………...7.7 Ventricular Assist Devices (VADs)……………………………………….……………….. 7.8 Process for Changes to the Statewide Treatment Protocols……………..………...……7.9 SECTION 8 – Special Operations Principles Fire and Tactical EMS Rehabilitation………….………………………………...………....8.1 Mass/Multiple Casualty Triage………………………………………………………..……. 8.2 Appendices Adult Medication Reference………………………………………….…………………….. A1 Pediatric Color Coded Medication Reference…………………………..………………… A2 Interfacility Transfer Guidelines and Protocols……………………………..…………….. A3 Scope of Practice…………………………..……………………………...………..……….. A4 Department-Approved Statewide Point of Entry (POE) Plans………………………….. A5 This page intentionally left blank SECTION 1: GENERAL PATIENT CARE Statewide Treatment Protocols Version 2018.1 1.0 Routine Patient Care 1.0 NOTE: This protocol applies to all EMS calls. RESPOND TO SCENE IN A SAFE MANNER: Review dispatch information. Use lights and sirens and/or pre-emptive devices when responding as appropriate per emergency medical dispatch information and local guidelines. SCENE ARRIVAL AND SIZE-UP: Utilize Body Substance Isolation, as appropriate. Scene safety, bystander safety. Environmental hazards assessment. Number of patients. Determine need for additional resources. Utilize Mass Casualty Incident (MCI) and/or Incident Command System (ICS) procedures as necessary. Determine mechanism of injury/illness. PATIENT APPROACH: Routine Patient Care RoutinePatient The presumption is that patients requesting EMS services should not walk to the stretcher or ambulance, but should be moved using safe and proper lifts and devices. Specifically the condition of patients with cardiac, respiratory, or neurological conditions, and of patients with unstable vital signs, can be worsened by exertion, so patient effort in moving to the stretcher and ambulance should be minimized. Unique circumstances and deviations from these principles must be clearly described in the Patient Care Report (PCR) and the service must have an internal performance improvement (PI) mechanism to review each case. DO NOT allow sick or injured patients to walk or otherwise exert themselves. Use safe and proper lifts and carries and appropriate devices to extricate patients to the ambulance stretcher. Begin assessment and care at the side of the patient; avoid delay. Bring all necessary equipment to the patient in order to function at your level of certification and 1 up to the level of the ambulance service license. 0 Request and use available advanced life support (ALS) – paramedic resources in accordance with these protocols, initiate transport as soon as possible, with or without ALS. Activate air-medical transport early and if applicable to do so. Determine if a valid MOLST order or Comfort Care/DNR Verification form is in place, and act accordingly. ASSESSMENT AND TREATMENT PRIORITIES Determine unresponsiveness, absence of breathing and pulselessness; Initiate high quality CPR with minimal interruptions