EMS Protocol Updated 06/05/2019 © 2019 Bradley D. Raetzke MD, FACEP Medical Director www.responsoft.com Preface Signature Page Preface Responsoft EMS Protocols Page 2 07/01/2018 Comments for Future Protocol Changes (Sticky Notes) Responsoft EMS Protocols Page 3 07/01/2018 Legend General Information Emergency Medical Technician Scope of Practice Advanced Emergency Medical Technician Scope of Practice Paramedic Scope of Practice Black or Heavy Lined Boxes contain important information All Drugs color coded in Dark Green. Example: Atropine Calculated Drugs are Blue. Example: 125 mg = Drug Shortage. This is found in Pharmacology Section drugs that DS may not be available and will link you to the Drug Shortage page for alternative drug(s) to be used. Use Dextrose 50% in place of Found in Pharmacology Section, listed drug is Dextrose 10% during shortages used only when there is a drug shortage General Information boxes Important Note: Pharmacology Section: Indications. This links where particular medication will be found in the protocol. Example; Albuterol Indications. Toxic Exposure. Not specifically used for Toxic Exposure, but is referenced being used if Smoke Inhalation/Co Poisoning and patient is wheezing, not used for other exposures typically. Responsoft EMS Protocols Page 4 07/01/2018 Table of Contents Table of Contents, Page 1 Table of Contents Cover 1 Signature Page Preface 2 Future Protocol Changes Preface 3 Legend Preface 4 Adult Section Adult Assessment Adult Assessment Adult Assessment 14 Body Substance Isolation Precautions (BSI) Adult Assessment 15 Safety & Scene Size-up Adult Assessment 16 Adult Primary Assessment Adult Assessment 17 Patient Assessment-Medical Adult Assessment 18 Patient Assessment-Trauma Adult Assessment 19 Cardiovascular Cardiovascular Cardiovascular 20 Asystole/PEA Cardiovascular 21 Bradycardia Cardiovascular 22 Cardiac Arrest Cardiovascular 23 Chest Pain/MI Cardiovascular 24 Dialysis Patients in Cardiac Arrest Cardiovascular 25 Narrow Complex Tachycardia (PSVT) Cardiovascular 26 Post Resuscitation Cardiovascular 27 Premature Ventricular Contractions (PVC's) Cardiovascular 28 V-Fib/Pulseless V-Tach Cardiovascular 29 Wide Complex Tachycardia (V-Tach w/Pulse) Cardiovascular 30 Environmental Environmental Environmental 31 Bites/Envenomations Environmental 32 Drowning/Near Drowning Environmental 33 Heat Syndrome Environmental 34 Hyperthermia/Heat Exposure Environmental 35 Hypothermia Environmental 36 Gastrointestinal Gastrointestinal Gastrointestinal 37 Renal Dialysis Gastrointestinal 38 General General General 39 Adult IV/IO General 40 Behavioral General 41 Epistaxis-Nosebleed General 42 Hyperglycemia/Hypoglycemia General 43 Diabetic Criteria General 44 Non-Traumatic Shock/Dehydration General 45 Table of Contents Table of Contents, Page 2 Table of Contents Pain Control General 46 Sepsis General 47 Unconscious/Unknown General 48 Universal Patient Assessment General 49 Neurological Neurological Neurological 50 CVA/Unconscious Neurological 51 CVA/Unconscious-continued Neurological 52 Seizure Neurological 53 OB/GYN OB/GYN OB/GYN 54 Abnormal Deliveries OB/GYN 55 Childbirth/Labor OB/GYN 56 Obstetric Emergencies-Eclampsia OB/GYN 57 Obstetric Emergencies-Vaginal Bleeding OB/GYN 58 Sexual Assault OB/GYN 59 Respiratory Respiratory Respiratory 60 Adult Airway Respiratory 61 Allergic Reaction/Anaphylactic Shock Respiratory 62 Esophageal Foreign Body Respiratory 63 Failed Airway Respiratory 64 Hyperventilation Respiratory 65 Pulmonary Edema/CHF Respiratory 66 Rapid Sequence Intubation (RSI) Respiratory 67 Respiratory Distress Respiratory 68 Toxicology Toxicology Toxicology 69 Carbon Monoxide Poisoning Toxicology 70 Overdose Toxicology 71 Toxic Exposure Toxicology 72 Trauma Trauma Trauma 73 Abdominal Trauma Trauma 74 Burns Trauma 75 Chest Trauma Trauma 76 Crush Syndrome Trauma 77 Spinal Injury Assessment Trauma 78 Dental Injuries Trauma 79 Extremity Trauma Trauma 80 Multiple Trauma Trauma 81 Neurological Trauma (Head) Trauma 82 Table of Contents Table of Contents, Page 3 Table of Contents Ocular Trauma Trauma 83 Trauma in Pregnancy Trauma 84 Pediatric Section Pediatric Assessment Pediatric Assessment Pediatric Assessment 86 Pediatric Scene Size-up Pediatric Assessment 87 Pediatric Primary Assessment Pediatric Assessment 88 Pediatric Assessment-Medical Pediatric Assessment 89 Pediatric Assessment-Trauma Pediatric Assessment 90 Pediatric Cardiovascular Pediatric Cardiovascular Pediatric Cardiovascular 91 Pediatric Bradycardia Pediatric Cardiovascular 92 Pediatric Pulseless Arrest Pediatric Cardiovascular 93 Pediatric Tachycardia Pediatric Cardiovascular 94 Pediatric General Pediatric General Pediatric General 95 Pediatric Brief Resolved Unexplained Event (BRUE) Pediatric General 96 Pediatric Behavioral Emergencies Pediatric General 97 Pediatric Fever Pediatric General 98 Pediatric Hypovolemic Shock Pediatric General 99 Pediatric IV/IO Pediatric General 100 Pediatric Pain Control Pediatric General 101 Universal Pediatric Assessment Pediatric General 102 Pediatric Neonatal Pediatric Neonatal Pediatric Neonatal 103 Pediatric Neonatal Care Pediatric Neonatal 104 Pediatric Neurological Pediatric Neurological Pediatric Neurological 105 Pediatric Seizures Pediatric Neurological 106 Pediatric Unconscious/Hypoglycemic Pediatric Neurological 107 Pediatric Respiratory Pediatric Respiratory Pediatric Respiratory 108 Pediatric Airway Pediatric Respiratory 109 Pediatric Allergic Reaction Pediatric Respiratory 110 Pediatric Respiratory Distress (Lower Airway) Pediatric Respiratory 111 Pediatric Respiratory Distress (Upper Airway) Pediatric Respiratory 112 Pediatric Toxicology Pediatric Toxicology Pediatric Toxicology 113 Pediatric Toxic Overdose Pediatric Toxicology 114 Pediatric Trauma Pediatric Trauma Pediatric Trauma 115 Pediatric Burns Pediatric Trauma 116 Table of Contents Table of Contents, Page 4 Table of Contents Pediatric Chest Trauma Pediatric Trauma 117 Pediatric Child Abuse Pediatric Trauma 118 Pediatric Head Trauma Pediatric Trauma 119 Pediatric Multiple Trauma Pediatric Trauma 120 Pharmacology Adenosine (Adenocard) Pharmacology 122 Afrin (Oxymetazoline) Pharmacology 123 Albuterol (Proventil Ventolin) Pharmacology 124 Amiodarone (Cordarone) Pharmacology 125 Aspirin Pharmacology 126 Atropine Pharmacology 127 Calcium Chloride Pharmacology 128 Dexamethasone (Decadron) Pharmacology 129 Dextrose (D10) Pharmacology 130 Dextrose (50) Pharmacology 131 Diazepam (Valium) Pharmacology 132 Diltiazem (Cardizem) Pharmacology 133 Diphenhydramine (Benadryl) Pharmacology 134 Epinephrine 1:1,000 Pharmacology 135 Epinephrine 1:10,000 Pharmacology 136 Epinephrine Infusion Pharmacology 137 Etomidate (Amidate) Pharmacology 138 Fentanyl (Sublimaze) Pharmacology 139 Glucagon Pharmacology 140 Ibuprofen (Motrin, Advil) Pharmacology 141 Ipratropium (Atrovent) Pharmacology 142 Ketamine (Ketalar) Pharmacology 143 Lidocaine (Xylocaine) Pharmacology 144 Magnesium Sulfate Pharmacology 145 Methylprednisolone (Solu-Medrol) Pharmacology 146 Midazolam (Versed) Pharmacology 147 Morphine Pharmacology 148 Naloxone (Narcan) Pharmacology 149 Nitroglycerin Pharmacology 150 Normal Saline Pharmacology 151 Ondansetron (Zofran) Pharmacology 152 Oral Glucose (Glutose 15 Insta-Glucose) Pharmacology 153 Oxygen Pharmacology 154 Promethazine (Phenergan) Pharmacology 155 Racemic Epinephrine 2.25% Pharmacology 156 Rocuronium (Zemuron) Pharmacology 157 Sodium Bicarbonate Pharmacology 158 Table of Contents Table of Contents, Page 5 Table of Contents Succinylcholine (Anectine) Pharmacology 159 Tetracaine Pharmacology 160 Tranexamic Acid (TXA) Pharmacology 161 Vecuronium (Norcuron) Pharmacology 162 Drug Substitutions (DS) Pharmacology 163 Drug Substitutions (DS)-continued Pharmacology 164 Clinical Standards Accidental Death, Murder, Suicide Clinical Standards 166 Accidental Death, Murder, Suicide-continued Clinical Standards 167 Athletic Pre-Planning Clinical Standards 168 Child Abuse Clinical Standards 169 Child Abuse-continued Clinical Standards 170 Consent, Refusal or Treatment/Transport Clinical Standards 171 Consent, Refusal of Treatment/Transport Part B Clinical Standards 172 Controlling Protocol and In-Charge Paramedic Clinical Standards 173 COTS Exceptions to Trauma Transport and Caveats Clinical Standards 174 Ohio Trauma Triage-Adult Clinical Standards 175 Ohio Trauma Triage-Geriatric Clinical Standards 176 Ohio Trauma Triage-Pediatric Clinical Standards 177 Criteria for Death or Withholding Resuscitation Clinical Standards 178 Dangerous Weapons Clinical Standards 179 Diversion of Psychiatric Patients Part A Clinical Standards 180 Diversion of Psychiatric Patients Part B Clinical Standards 181 DNR-Advanced Directive Part A Clinical Standards 182 DNR-Advanced Directive Part B Clinical Standards 183 DNR-Advanced Directive Part C Clinical Standards 184 DNR-Advanced Directive Part D Clinical Standards 185 Documentation of a Patient Encounter Clinical Standards 186 Documentation of a Patient Encounter-continued Clinical Standards 187 Domestic Violence and Elderly Abuse Clinical Standards 188 Domestic Violence and Elderly Abuse-continued Clinical Standards 189 Emergency Transport Plan Clinical Standards 190 Emergency Transport Plan-continued Clinical Standards 191 EMS Branch Operations Part A Clinical Standards 192 EMS Branch Operations Part B Clinical Standards 193 EMS Branch Operations Part C Clinical Standards 194 EMS PPE Recommendations for Managing Opioid Exposure Clinical Standards 195 Interfacility Transfers Clinical Standards 196 Interfacility Transport