Prince William County Fire and Rescue System Patient Care Manual Effective Date: January 1, 2017 Revision Date: July 6, 2019 Preliminary Information Preliminary Information Overview ................................................................................................................ I Acknowledgements .............................................................................................. II Authorization ....................................................................................................... III General Principles for Medical Care ................................................................... IV ALS Intercept Guidelines .................................................................................... VIII Medical Transport Destination ............................................................................ IX Patient Care During Transport .............................................................................. X Medical Control Contact ..................................................................................... XI Automatic Notification of the Medical Director ................................................ XII Transfer of Care at Hospitals ............................................................................. XIII Document Guide for Written Format ................................................................ XIV Adult Protocols General Patient Care Protocol – Adult ................................................................. 1 Respiratory Emergencies: Dyspnea ................................................................................................................. 5 Acute Bronchospasm ............................................................................................. 7 Pulmonary Edema ................................................................................................. 8 Submersion Injury ............................................................................................... 10 Respiratory Failure .............................................................................................. 11 Failed Airway ....................................................................................................... 13 Cardiac Arrest: General Approach ............................................................................................... 15 Asystole/PEA ....................................................................................................... 17 V‐Fib/Pulseless V‐Tach ........................................................................................ 19 Post Resuscitation Care ....................................................................................... 21 Cardiac Emergencies: Acute Coronary Syndrome .................................................................................. 22 Bradycardia ......................................................................................................... 24 Regular Narrow Complex Tachycardia (SVT) ..................................................... 25 Irregular Narrow Complex Tachycardia (A‐Fib) ................................................. 26 Wide Complex Tachycardia ................................................................................. 27 Polymorphus V‐Tach (Torsades de Pointes) ...................................................... 29 Environmental Emergencies: Bites and Envenomation ..................................................................................... 30 Hyperthermia ...................................................................................................... 31 Hypothermia ........................................................................................................ 32 Hazardous Materials Exposure: General Approach ............................................................................................... 33 Cyanide Toxicity and Smoke Inhalation ............................................................. 35 i Nerve Agent WMD .............................................................................................. 37 Medical: Abdominal Pain ................................................................................................... 39 Allergic Reaction ................................................................................................. 40 Altered Mental Status/Syncope .......................................................................... 42 Behavioral Emergencies/Excited Delirium ......................................................... 43 Diabetic Emergencies .......................................................................................... 45 Seizure ................................................................................................................. 46 Sepsis ................................................................................................................... 47 Stroke Suspected ................................................................................................. 48 OB/GYN: Childbirth ............................................................................................................. 49 Pre‐Eclampsia/Eclampsia .................................................................................... 52 Vaginal Bleeding ................................................................................................. 53 Overdose and Poisoning: General Approach ............................................................................................... 54 Antidepressants ................................................................................................... 55 Antipsychotics/Acute Dystonic Reaction ............................................................ 57 Beta Blocker Toxicity ........................................................................................... 58 Calcium Channel Blocker ..................................................................................... 59 Carbon Monoxide ................................................................................................ 60 Cholinergic Organophosphate ........................................................................... 61 Pain Management: Medical/Trauma ................................................................................................. 62 Trauma: General Patient Care Protocol – Adult Trauma .................................................. 63 Abdominal Injuries .............................................................................................. 65 Burns .................................................................................................................... 66 Chest Injuries ....................................................................................................... 68 Extremity Injuries ................................................................................................ 70 Eye Injuries .......................................................................................................... 71 Head Injuries........................................................................................................ 72 Sexual Assault ..................................................................................................... 74 Traumatic Amputations ...................................................................................... 75 Pediatric Protocols General Patient Care Protocol – Pediatric .......................................................... 76 Pediatric Respiratory Emergencies: Dyspnea ............................................................................................................... 80 Acute Bronchospasm ........................................................................................... 81 Stridor .................................................................................................................. 82 ii Submersion Injury ............................................................................................... 84 Respiratory Failure .............................................................................................. 85 Pediatric Cardiac Arrest: General Approach .............................................................................................. 87 Asystole/PEA ....................................................................................................... 89 V‐Fib/Pulseless V‐Tach ........................................................................................ 91 Neonatal Resuscitation ....................................................................................... 92 Post Resuscitation Care ....................................................................................... 95 Pediatric Cardiac Emergencies: Bradycardia ......................................................................................................... 96 Tachycardia ......................................................................................................... 98 Hazardous Materials Exposure: Cyanide Toxicity and Smoke Inhalation ........................................................... 100 Pediatric Medical: Allergic Reaction ............................................................................................... 101 Altered Mental Status/Syncope ........................................................................ 102 Apparent Life‐Threatening Event ..................................................................... 103 Diabetic Emergencies