EMT-Basic Protocols Region 6 TABLE OF CONTENTS Cardiac Emergencies Special Situations Chest Pain ........................................ A02 Abuse and Neglect ............................D02 Cardiopulmonary Arrest.................... A03 Behavioral Emergencies ...................D03 Elder Abuse.......................................D04 Medical Emergencies SIDS ..................................................D05 Initial Medical Care ........................... B02 Airway Obstruction............................ B03 Traumatic Emergencies Alcohol-Related Emergencies .......... B04 Glascow Coma Scale ........................E02 Allergic Reaction/Anaphylaxis .......... B05 Initial Trauma Care............................E03 Altered Level of Consciousness ....... B06 Amputation ........................................E04 CVA (Stroke)..................................... B07 Burns .................................................E05 Diabetic Emergencies....................... B08 Chest Injuries ....................................E06 Drug Overdose ................................. B09 Field Triage .......................................E07 Frostbite............................................ B10 Head or Spine Injury..........................E08 Hazardous Materials......................... B11 Load and Go Situations.....................E09 Heat Cramps..................................... B12 Painful, Deformed Extremity..............E10 Heat Exhaustion ............................... B13 Shock (Traumatic) .............................E11 Heat Stroke....................................... B14 Traumatic Arrest................................E12 Hypothermia (Moderate)................... B15 Trauma Field Death Declaration .......E13 Hypothermia (Severe)....................... B16 Hypothermic Arrest ........................... B17 Pediatric Emergencies Hypertensive Crisis........................... B18 Initial Pediatric Care ..........................F02 Hyperventilation ................................ B19 Pediatric Coma Scale........................F03 Near Drowning.................................. B20 Abuse and Neglect ............................F04 Poisoning .......................................... B21 Airway Care.......................................F05 Respiratory Difficulty......................... B22 Allergic Reaction/Anaphylaxis ...........F06 Seizures............................................ B23 Altered Level of Consciousness ........F07 Sexual Assault .................................. B24 Burns .................................................F08 Shock (Non-Traumatic)..................... B25 Cardiopulmonary Arrest ....................F09 Shunts, Grafts, and Fistulas ............. B26 Environmental Hyperthermia.............F10 Syncope............................................ B27 Epiglottitis ..........................................F11 Frostbite ............................................F12 Obstetrics and Gynecology Hypothermia (Moderate) ...................F13 APGAR Scoring Chart ...................... C02 Hypothermia (Severe) .......................F14 Imminent Delivery ............................. C03 Load and Go Situations.....................F15 Malpresentation ................................ C04 Near Drowning ..................................F16 Meconium Aspiration ........................ C05 Poisoning/Drug Overdose .................F17 Neonatal Resuscitation..................... C06 Respiratory Distress ..........................F18 Non-Imminent Delivery ..................... C07 Seizures ............................................F19 Pre-Eclampsia .................................. C08 Shock ................................................F20 Pre-Term Delivery............................. C09 Tracheostomy....................................F21 Prolapsed Umbilical Cord ................. C10 Shoulder Dystocia............................. C11 General Protocols Vaginal Bleeding............................... C12 BLS Intercept Criteria ........................G02 BLS Radio Report .............................G03 Patient Refusal ..................................G04 Triple Zero .........................................G05 EMS Involvement in Crime Scene.....G06 CARDIAC EMERGENCIES BLS Section A 1 Section A 1 Chest Pain Cardiac NOTE: If patient presents with chest pain that is clearly pleuritic or muscular in description, such as pain that worsens with movement or breathing, perform Initial Medical Care and call Medical Control. CRITERIA: 1. Chest pain consistent with cardiac ischemia; may include: a. Respiratory difficulty b. Nausea and vomiting c. Diaphoresis d. Dizziness e. Epigastric, neck, jaw, or arm pain. 2. Systolic blood pressure > 90 mmHg. EXCLUSION: 1. Cardiogenic shock (SBP < 90 mmHg, dyspnea, lung crackles; also known as “rales”). Call for intercept. TREATMENT: 1. Initial Medical Care protocol. 2. Airway and high flow OXYGEN at 15 liters per minute (LPM) via non-rebreather mask. Apply pulse oximeter if available. 3. Assessment & history. 4. Monitor electrocardiogram (EKG) if available. 5. For apparent cardiac related chest pain with SBP > 90 mmHg, administer NITROGLYCERIN 0.4 mg sublingually (SL). Repeat NITROGLYCERIN every 3-5 minutes to maximum of 3 doses as long as chest pain persists and SBP > 90 mmHg. 6. Administer ASPIRIN 325 mg orally (PO) or 81mg tablets x 4 PO. 7. Transport – consider ALS intercept. 8. Contact Medical Control. -------------------------------------------------- BLS Section A 2 Section A 2 Cardiopulmonary Arrest Cardiac NOTE: If AED is on scene, place AED on the patient within one minute of arrival. CRITERIA: 1. Patient must be pulseless, apneic, and unresponsive. EXCLUSION: 1. Indication of obvious death. a. Rigor (stiffening of limbs) b. Lividity (purplish discoloration of skin caused by pooling of stagnant blood) c. Decapitation 2. Assess patient for resuscitative viability. If any questions or family is adamant about resuscitative efforts, begin CPR. TREATMENT: 1. Check airway, breathing, and circulation. 2. Start CPR. 3. CPR until AED (if available) is attached, then check pulse and analyze. 4. Defibrillate as directed by AED. 5. Consider intercept per BLS Intercept Criteria. 6. If no pulse, resume CPR for two minutes and perform advanced airway control measures as available. 7. Hyperventilate with BVM with airway in place. 8. Check pulse and analyze. If shockable rhythm, repeat shocks as directed by AED. 9. Continue CPR 10. Contact Medical Control. 11. Check pulse and analyze. If shockable rhythm, repeat shocks as directed by AED. 12. Continue CPR. 13. Initiate transport upon: a. Return of spontaneous pulse. b. Six total shocks delivered c. 3 “No Shock Advised” messages. -------------------------------------------------- BLS Section A 3 Section A 3 MEDICAL EMERGENCIES BLS Section B 1 Initial Medical Care Medical CRITERIA: 1. Any patient presenting with signs and/or symptoms that is non-traumatic in origin. TREATMENT: 1. Place the patient in a position of comfort and loosen any tight clothing. Reassure and calm the patient. Sit the patient in an upright position if more comfortable and not hypotensive. 2. Administer OXYGEN at 15 LPM via non-rebreather mask or as indicated. Apply pulse oximeter if available. 3. If the patient refuses non-rebreather, administer OXYGEN at 4 LPM via nasal cannula and inform Medical Control. 4. Obtain SAMPLE history and vital signs. Check for medical alert tags or cards. Repeat and record vital signs every 5 to 10 minutes and relay any significant changes to persons who continue patient care. 5. Consider blood sugar determination. 6. Transport – consider intercept per BLS Intercept Criteria. 7. Contact the receiving hospital. 8. If patient arrests, begin CPR. Manage the airway and follow Cardiopulmonary Arrest protocol. -------------------------------------------------- BLS Section B 2 Airway Obstruction Medical CRITERIA: 1. Respiratory distress with suspected foreign body airway obstruction (FBAO). TREATMENT: Conscious patient – able to speak 1. Leave the patient alone; offer reassurance. 2. Encourage coughing. 3. OXYGEN at 15 LPM via non-rebreather or 4 LPM via nasal cannula. 4. Suction as needed to control secretions. 5. Transport without agitating the patient. 6. Contact Medical Control. Conscious patient – unable to cough or speak 1. Ask the patient if he/she is choking. 2. Administer abdominal thrusts until the foreign body is expelled or until the patient becomes unconscious. 3. After the obstruction is relieved, reassess the airway, lung sounds, skin color, and vital signs. 4. Administer OXYGEN at 15 LPM via non-rebreather or 4 LPM via nasal cannula. 5. Transport. 6. Contact Medical Control. Patient who becomes unconscious/Patient found unconscious 1. Roll patient to supine position; open the airway (tongue-jaw lift), perform finger sweep. 2. Attempt bag-valve mask (BVM) ventilations; if unable to ventilate, perform 30 chest compressions. 3. Perform finger sweep and attempt to ventilate; perform 30 chest compressions and continue sequences until foreign body is relieved. Perform advanced airway control measures as available. Apply pulse oximeter if available. 4. Monitor EKG if available. 5. Transport – consider intercept per BLS Intercept Criteria. 6. Contact Medical Control. -------------------------------------------------- BLS Section B 3 Alcohol Related Emergencies Medical CRITERIA (any of the following): 1. Odor of alcohol. 2. Admitted consumption of alcohol. EXCLUSION: 1. Altered level of consciousness (LOC) – refer