Basic and Intermediate Patient Care Protocols and Procedures Columbia and Walla Walla Counties Emergency Medical Services Lewis D. Neace, DO Medical Program Director Revised and Approved June 2019 Basic and Intermediate Protocols P a g e | 2 Table of Contents General Expectations ............................................................................................. 5 Safety .................................................................................................................. 5 Patient Care ........................................................................................................ 5 Documentation ................................................................................................... 5 Scope of Practice ................................................................................................... 6 EMS Providers and Dispatch .................................................................................. 7 Dispatch .............................................................................................................. 7 On Scene Incident Command .............................................................................. 7 Hospital Destination .............................................................................................. 8 Infectious Disease Prevention ................................................................................ 9 Treatment Rights / Refusals ..................................................................................10 Treatment Rights ...............................................................................................10 Refusals .............................................................................................................10 Death in the Field / Physician Orders for Life-Sustaining Treatment (POLST) ........11 Scene Times ..........................................................................................................12 Cancellation of ALS Unit ........................................................................................13 ALS Ambulance Rendezvous .................................................................................14 Interfacility Transfer .............................................................................................15 General Assessment .............................................................................................16 BLS (EMT) Pharmacology ......................................................................................17 Approved for Use ...............................................................................................17 Patient Prescribed Medications .........................................................................17 ILS (Advanced EMT (AEMT)) Pharmacology ..........................................................18 Approved for Use ...............................................................................................18 Glasgow Coma Scale .............................................................................................19 Cardiovascular Emergencies .................................................................................20 12 Lead ECG Acquisition .......................................................................................21 Adult Cardiac Arrest ..............................................................................................23 Pediatric Cardiac Arrest ........................................................................................24 Respiratory Emergencies ......................................................................................25 Allergic Reaction / Anaphylaxis .............................................................................26 Basic and Intermediate Protocols P a g e | 3 Asthma .................................................................................................................27 Chronic Obstructive Pulmonary Disease (COPD) ...................................................28 Continuous Positive Airway Pressure (CPAP) ........................................................29 Supraglottic Device / I-Gel ....................................................................................30 Stroke / CVA .........................................................................................................31 Nausea / Vomiting ................................................................................................33 Seizure / Convulsions ............................................................................................34 Psychiatric / Behavioral Emergencies....................................................................35 Physical Restraint ..................................................................................................36 Hypotension / Shock .............................................................................................37 Vaginal Bleeding ...................................................................................................38 Active Labor: Assisting Delivery ............................................................................39 Active Labor: Post-Partum Care ............................................................................40 Altered Mental Status ...........................................................................................41 Syncope ................................................................................................................42 Hypoglycemia .......................................................................................................43 Hyperglycemia ......................................................................................................44 Hypothermia .........................................................................................................45 Hyperthermia .......................................................................................................46 Overdose and Poisoning .......................................................................................47 Overdose: Carbon Monoxide Poisoning ................................................................48 Overdose: Sedatives / Hypnotics ..........................................................................49 Trauma: General Approach ...................................................................................50 Trauma: Spinal Cord Injury ...................................................................................51 Trauma: Spinal Precautions ..................................................................................52 Trauma: Athletic / Sports Injury ............................................................................53 Trauma: Facial ......................................................................................................54 Trauma: Head Injury .............................................................................................55 Trauma: Eye Injury ................................................................................................56 Trauma: Chest.......................................................................................................57 Trauma: Abdominal ..............................................................................................58 Trauma: Orthopedic..............................................................................................59 Basic and Intermediate Protocols P a g e | 4 Trauma: Pelvis ......................................................................................................60 Trauma: Amputation.............................................................................................61 Trauma: Burns ......................................................................................................62 Near Drowning......................................................................................................63 Sexual Assault .......................................................................................................64 Taser Dart Removal ..............................................................................................65 Abandoned Newborn ............................................................................................66 Start Triage Algorithm ...........................................................................................67 Tourniquet Application .........................................................................................68 Nasal Atomizer .....................................................................................................69 EZ-IO .....................................................................................................................70 Appendix A - BLS Pharmacology ............................................................................71 Acetylsalicylic Acid (Aspirin/ASA) ....................................................................72 Activated Charcoal (Actidose) .........................................................................73 Epinephrine 1:1,000 (Adrenalin) .....................................................................74 Glucose Gel (Oral Solution) .............................................................................76 Naloxone (Narcan) ..........................................................................................77 Oxygen (O2) ....................................................................................................79