v2020.3 Connecticut Department of Public Health Office of Emergency Medical Services Legend Definition EMR Emergency Medical Responder (EMR) EMT Emergency Medical Technician (EMT) AEMT Advanced Emergency Medical Technician (AEMT) P Paramedic CAUTION – Red Flag topic Telephone Medical Control Pediatric PEARLS Blue underline Text formatted as a hyperlink Table Of Contents (hyperlinks back to table of contents) This document is the Statewide Emergency Medical Services Protocols for Connecticut Pre-hospital Medical Providers version 2020.3. These protocols are a “living document” developed and drafted by the Statewide EMS Protocols Sub- Committee of the Connecticut EMS Medical Advisory Committee in conjunction with and in cooperation with the five Connecticut Regional EMS Councils and their Medical Advisory Committees. At the option of the Office of EMS and the Medical Advisory Committee, they can be edited and updated at any time. However, they are formally reviewed, edited, and released every two years. These protocols have been approved unanimously by the CT EMS Medical Advisory Committee in an effort to establish the standard of EMS patient care in the State of Connecticut. Any deviation from these protocols must be approved in writing by the CT EMS Medical Advisory Committee and the CT Office of EMS. Please Note: For visual clarity, trademark and registered symbols have not been included with drug, product, or equipment names. Questions and comments should be directed to: State of Connecticut Department of Public Health Office of Emergency Medical Services 410 Capitol Avenue MS#12EMS P.O. Box 340308 Hartford, CT 06134-0308 p | 860-509-7975 e | [email protected] This document may not be amended or altered; however, it may be reproduced and distributed without permission. DISCLAIMER: Although the authors of this document have made great efforts to ensure that all the information is accurate, there may be errors. The authors cannot be held responsible for any such errors. For the latest corrections to theses protocols, visit the Statewide EMS Protocols page on the Connecticut OEMS website at: http://www.portal.ct.gov/DPH/Emergency-Medical-Services/EMS/Statewide-EMS-Protocols 2 v2020 . Connecticut Statewide Protocols v2020.3 – Table of Contents 3 Page Dedication and Acknowledgement……………………………...….......……................. 7 Preface…………………………………………………………………….......…...……................ 8 Revision and Update Procedure..…………………………...……..…...……............…... 10 SECTION 1 – Routine Patient Care Page 1.0 Routine Patient Care………………..………..………………………...………..…............ 11 1.1 Routine EMR Patient Care…………………..………………….…....…………................ 14 1.2 Exception Protocol…………………………..…………………….…...…………….............. 17 SECTION 2 – Medical Page 2.0A Abdominal Pain…………….………………………..……………......………….................. 18 2.1 Adrenal Insufficiency - Adult/Pediatric……………………………...…........…................. 19 2.2 Alcohol Withdrawal - Adult..………………………………………...………….................... 20 2.3A Allergic Reaction/Anaphylaxis - Adult............................................................................ 21 2.3P Allergic Reaction/Anaphylaxis - Pediatric………………....……...………....................... 22 2.4 Brief Resolved Unexplained Event (BRUE)............................................................. 23 2.5A Asthma/COPD/RAD – Adult………………………………………….………….................. 24 2.5P Asthma/Bronchiolitis/Croup – Pediatric………………..…………….………..................... 25 2.6 Behavioral Emergencies – Adult/Pediatric………………….....................……….....…… 26 2.7 Childbirth & Newborn Care………………………………......………...……......…............. 27 2.8A NEW Fever - Adult.........…………………………………..…… …................................... 29 2.8P Fever - Pediatric.........…………………………………..……………….............................. 30 2.9 Hyperglycemia - Adult/Pediatric…………………………………...…………..................... 31 2.10 Hyperkalemia…………………………………………………………...………..................... 32 2.11 Hyperthermia (Environmental) – Adult & Pediatric…….……....…….............................. 33 2.11.1 Exertional Heat Stroke…….............................………………....................................... 34 2.12A Hypoglycemia – Adult………………………………………………….............................. 35 2.12P Hypoglycemia – Pediatric………………………………………………............................ 36 2.13 Hypothermia (Environmental) – Adult & Pediatric……………………………................ 37 2.14 Nausea/Vomiting – Adult & Pediatric…………………………………….........……........ 38 2.15A Nerve Agent/Organophosphate Poisoning – Adult……..……........…………….............. 39 2.15P Nerve Agent/Organophosphate Poisoning – Pediatric…………………................…..... 40 3 v2020 Connecticut Statewide Protocols v2020.2 – Table of Contents . 3 2.16 RESERVED FOR FUTURE USE...………………………………………........................ n/a 2.17 Newborn Resuscitation………………………………................…………………............. 41 2.18 Obstetrical Emergencies…………………………………................................................ 43 2.19A Pain Management – Adult…………………………………………................….….......... 45 2.19P Pain Management – Pediatric……………………………………............………......…... 47 2.20A Poisoning/Substance Abuse/Overdose – Adult………………......................……........ 50 2.20P Poisoning/Substance Abuse/Overdose – Pediatric……........…………….................... 52 2.21A Seizures – Adult……………………………………………………....………..................... 54 2.21P Seizures – Pediatric……………………………………………………………....…........... 55 2.22A Septic Shock – Adult………………………………………………………..….......…........ 56 2.22P Septic Shock – Pediatric……………………………………………………….................. 57 2.23 Shock (Non-Traumatic).…………………………………………………...……................. 58 2.24A Smoke Inhalation – Adult……………………………………………..………................... 59 2.24P Smoke Inhalation – Pediatric………………………………………..……….................... 60 2.25 Stroke – Adult & Pediatric……………………………………………..……..................... 61 2.26 Syncope – Adult/Pediatric………………………………………...…………..…................. 63 SECTION 3 – Cardiac Page 3.0 Acute Coronary Syndrome – Adult……………….…………………........….................... 64 3.1A Bradycardia – Adult ………………………………………………….........…...………....... 67 3.1P Bradycardia – Pediatric……………………………………………...........……………....... 68 3.2A Cardiac Arrest – Adult..................................………...…………............…………....... 69 3.2A Cardiac Arrest – Adult/Team Focused CPR………...…………............………….......... 72 3.2P Cardiac Arrest – Pediatric……………………………………….............…...……....…..... 74 3.3 Congestive Heart Failure (Pulmonary Edema)…....………........................................... 75 3.4 Post Resuscitative Care...……………………………………........................................... 76 3.5A Tachycardia – Adult…………………………………………............………………...…..... 77 3.5P Tachycardia – Pediatric………………………………….........……...……………….…..... 79 4 v2020 . Connecticut Statewide Protocols v2020.2 – Table of Contents 3 SECTION 4 – Traumatic Page 4.0A Burns (Thermal) – Adult……………………………………………………………............ 80 4.0P Burns (Thermal) – Pediatric……………………………………………….……..….......... 82 4.1 Drowning/Submersion Injuries – Adult & Pediatric….…………………....…………...... 84 4.2 Eye & Dental Injuries – Adult & Pediatric………………………………………....…....... 85 4.3 Musculoskeletal Injuries……………………….…………………………………….......... 86 4.3.1 NEW Prophylactic Cefazolin for Open Fracture or Major Wounds.............…...... 87 4.4 Shock – Trauma Adult & Pediatric …………….……………………………….…........... 88 4.5 Spinal Trauma.............................................................................................................. 89 4.6 Thoracic Injuries – Adult & Pediatric……………………………………...….....……....... 93 4.7 Traumatic Brain Injury – Adult & Pediatric……….…………………….....…....….......... 94 SECTION 5 – Airway Page 5.0 Airway Management..........................…………………………………............................ 96 5.1A Airway Management Adult..................................….……………………........................ 98 5.1P Airway Management Pediatric.…….…......................………………….......................... 99 5.2 CPAP.......................................……………………………………………........................ 100 5.2.1 NEW Bilevel Positive Airway Pressure - Adult..........................….........….............. 101 5.3.1A Cricothyrotomy - Surgical............................…………………………......................... 102 5.3.2 NEW Cricothyrotomy - Percutaneous..........................………………....….............. 103 5.3.3 NEW Cricothyrotomy - Percutaneous - Pediatric.......................……....….............. 104 5.4 Gum Elastic Bougie……………...................................................……...….….............. 106 5.5 Nasotracheal Intubation……………………………………………………....................... 107 5.6 Orotracheal Intubation..……………………………………………….............................. 109 5.7 Quantitative Waveform Capnography………………………………......................…..... 111 5.8A Rapid Sequence Intubation (RSI) - Adult...........….………….................…................... 112 5.8P Rapid Sequence Intubation (RSI) - Pediatric.…….………….................…................... 114 5.9 Suctioning of Inserted Airway...………………………………………….......................... 116 5.10 Supraglotic Airway - Adult/Pediatric………………………………………....…................ 117 5.11 Tracheostomy Care…………………………………………………………....................... 119 5.12 Ventilator..………………………………………………………………….…..…................ 120 5 v2020 . Connecticut Statewide Protocols v2020.2 – Table of Contents 3 SECTION 6 – Other Procedures Page 6.0 12-Lead ECG Acquisition………………………………………………...…............…......