Houston Fire Department Patient Care Guidelines and Standing Orders For BLS and ALS Units GEOGRAPHICAL AREA / DUTY STATUS / NON-EMS CERTIFIED LICENSED MEDICAL PERSONNEL GEOGRAPHICAL AREA The guidelines shall only be utilized under my medical direction within the Houston city limits, mutual aid areas, when operating in regional deployments and when transferring patients. DUTY STATUS Houston Fire Department EMS personnel are authorized to utilize these protocols under my medical direction only when acting in their official capacity (i.e. on-duty) when representing the Houston Fire Department as defined in theBLS and ALS Guidelines, Patient Care Guidelines and Standing Orders, HFD Rules and Regulations and other written directives and guidelines. NON EMS-CERTIFIED LICENSED MEDICAL PERSONNEL Includes RN’s and other allied healthcare personnel (other than licensed physicians authorized to function within the City of Houston EMS system). Currently, the Houston Fire Department Physician Director does not recognize nor utilize persons in this category. All personnel performing direct patient care within the City of Houston EMS system possess valid TDSHS EMS certification and function under the appropriate protocols as EMT’s or paramedics. Effective Date : November 1, 2014 Expiration Date : September 30, 2016 November 1, 2014 David Persse, MD Date EMS Physician Director HOUSTON FIRE DEPARTMENT PATIENT CARE GUIDELINES AND STANDING ORDERS FOR BLS AND ALS UNITS REFERENCE NO. III-01 ©2014 City of Houston, Fire Department HOUSTON FIRE DEPARTMENT SUBJECT : PATIENT CARE GUIDELINES AND STANDING ORDERS FOR BLS AND ALS UNITS VOLUME NO. III COMMAND: EMS REFERENCE NO. III-01 SECTIONS 1.00 - 9.06 Table of Contents 1.00 Purpose ....................................................................................................................................... I-4 2.00 Objectives .................................................................................................................................. I-4 3.00 Definitions .................................................................................................................................. I-5 4.00 Scope .......................................................................................................................................... I-8 5.00 Responsibilities .......................................................................................................................... I-8 6.00 Guidelines .................................................................................................................................. I-9 6.01 #1 Rule : Holder Rule ....................................................................................................... I-9 6.02 Ambulance Diversion ....................................................................................................... I-9 6.03 Communication ............................................................................................................... I-10 6.04 Confidential Patient Information ..................................................................................... I-10 6.05 Controlled Substances Accountability ............................................................................ I-11 6.06 Documentation ................................................................................................................ I-11 6.07 Emergency Transfers (One Emergency Dept. to Another) ............................................. I-13 6.08 Equipment on Each Run ................................................................................................. I-13 6.09 Family Centered Care ..................................................................................................... I-13 6.10 Physical Restraints .......................................................................................................... I-14 6.11 Helicopter Utilization ...................................................................................................... I-15 6.12 Hospital Destination Decisions ....................................................................................... I-16 6.13 Identification Badges ...................................................................................................... I-20 6.14 Infection Control Precautions ......................................................................................... I-20 6.15 Multiple Casualty Management ...................................................................................... I-20 6.16 Non-Transports ............................................................................................................... I-20 6.17 Out-of-Hospital DNR Orders .......................................................................................... I-24 6.18 Patient Belongings .......................................................................................................... I-27 6.19 Physician Intervener at the Scene ................................................................................... I-27 6.20 Requesting Assistance ..................................................................................................... I-27 6.21 Riding In Charge ............................................................................................................. I-29 6.22 Termination of Resuscitation .......................................................................................... I-30 6.23 Voluntary Self Reporting of Medical Errors ................................................................... I-31 7.00 Skills .........................................................................................................................................II-1 7.01 Patient Assessment ...........................................................................................................II-3 7.02 Airway Management ........................................................................................................II-8 7.03 Medication Administration ............................................................................................II-16 7.04 Cardiac Electrical Therapy.............................................................................................II-19 7.05 Cardiopulmonary Resuscitation .....................................................................................II-21 7.06 Hemorrhage Control ......................................................................................................II-24 7.07 Extremity Splinting Skills ..............................................................................................II-24 7.08 Eye Irrigation .................................................................................................................II-25 7.09 Radio Report ..................................................................................................................II-25 SUBJECT : PATIENT CARE GUIDELINES AND STANDING ORDERS FOR BLS AND ALS UNITS I-2 REFERENCE NO. III-01 PUBLICATION : 7/10/16 8.00 Protocols / Standing Orders .....................................................................................................III-1 8.01 General Principles for Protocols / Standing Orders ........................................................III-2 8.02 Cardiac Arrest Emergencies ............................................................................................III-3 8.03 Medical Emergencies ....................................................................................................III-15 8.04 Trauma Emergencies .....................................................................................................III-59 9.00 Reference Section ...................................................................................................................IV-1 9.01 Pharmacology Guide .......................................................................................................IV-3 9.02 Common Abbreviations ................................................................................................IV-46 9.03 Equipment Requirements ..............................................................................................IV-49 9.04 Procedure for Downloading AED and LifePak 15 Data ...............................................IV-53 9.05 Approved Hospital Destinations and Hospitals With Specialty Facilities ....................IV-55 9.06 Revisions to Protocol ....................................................................................................IV-57 Tables 6-1 Estimated LifeFlight Time from Request to Arrival at Hermann Hospital ..................... I-16 6-2 Hospital Destination Decision ........................................................................................ I-18 6-3 Criteria for Trauma Center Transport ............................................................................. I-19 7-1 Bag-Valve-Mask Ventilation ............................................................................................II-4 7-2 AVPU Mental Status Exam ..............................................................................................II-5 7-3 OPQRST Questions .........................................................................................................II-5 7-4 AMPLE History ...............................................................................................................II-6 7-5 BTLS Secondary Survey ..................................................................................................II-6