National Model EMS Clinical Guidelines Abstract These guidelines will be maintained by NASEMSO to facilitate the creation of state and local EMS system clinical guidelines, protocols or operating procedures. System medical directors and other leaders are invited to harvest content as will be useful. These guidelines are either evidence-based or consensus-based and have been formatted for use by field EMS professionals. NASEMSO Medical Directors Council All Rights Reserved V.11-14 www.nasemso.org Contents Introduction ................................................................................................................................................. 5 Purpose and Notes ....................................................................................................................................... 6 Target Audience ......................................................................................................................................... 6 Acknowledgements .................................................................................................................................... 7 Universal Care .............................................................................................................................................. 8 Universal Care Guideline ............................................................................................................................ 8 Functional Needs ..................................................................................................................................... 14 Patient Refusals ....................................................................................................................................... 18 Cardiovascular ............................................................................................................................................ 20 Adult and Pediatric Syncope and Presyncope .......................................................................................... 20 Chest Pain/Acute Coronary Syndrome (ACS)/ST-segment Elevation Myocardial Infarction (STEMI) ....... 24 Bradycardia .............................................................................................................................................. 27 Tachycardia with a Pulse .......................................................................................................................... 31 Suspected Stroke / Transient Ischemic Attack ......................................................................................... 36 General Medical ......................................................................................................................................... 39 Abuse and Maltreatment ......................................................................................................................... 39 Agitated or Violent Patient/Behavioral Emergency ................................................................................. 43 Anaphylaxis and Allergic Reaction............................................................................................................ 49 Altered Mental Status .............................................................................................................................. 54 Hypoglycemia/Hyperglycemia ................................................................................................................. 57 Pain Management .................................................................................................................................... 61 Seizures......................................................................................................................................................67 Shock…………………………………………………………………………………………………………………………………………………….72 Resuscitation .............................................................................................................................................. 78 Cardiac Arrest (VF/VT/Asystole/PEA) ....................................................................................................... 78 Adult Post-ROSC (Return of Spontaneous Circulation) Care .................................................................... 85 All Rights Reserved V.11-14 2 Determination of Death / Withholding Resuscitative Efforts ................................................................... 89 Do Not Resuscitate Status/Advanced Directives/Health Care Power of Attorney (POA) Status .............. 92 Pediatric Specific Guidelines....................................................................................................................... 99 Apparent Life Threatening Event (ALTE) .................................................................................................. 99 Pediatric Respiratory Distress (Bronchiolitis) ......................................................................................... 103 Pediatric Respiratory Distress (Croup) ................................................................................................... 108 Neonatal Resuscitation .......................................................................................................................... 113 GI/GU/Gyn................................................................................................................................................ 117 Childbirth ............................................................................................................................................... 117 Nausea/Vomiting ................................................................................................................................... 120 Obstetrical/Gynecological Conditions .................................................................................................... 122 Respiratory ............................................................................................................................................... 124 Airway Management .............................................................................................................................. 124 Bronchospasm (due to Asthma and Obstructive Lung Disease) ............................................................. 133 Pulmonary Edema .................................................................................................................................. 141 Trauma ..................................................................................................................................................... 145 General Trauma Management ............................................................................................................... 145 Blast Injuries........................................................................................................................................... 151 Burns……………………………………………………………………………………………………………………………….....................154 Extremity Trauma / External Hemorrhage Management ....................................................................... 157 Facial Trauma ......................................................................................................................................... 160 Head Injury ............................................................................................................................................. 163 Spinal Care ............................................................................................................................................. 168 Toxins and Environmental ........................................................................................................................ 175 Poisoning/Overdose Universal Care ....................................................................................................... 175 Acetylcholinesterase Inhibitors (Carbamates, Nerve Agents, Organophosphates) Exposure ................ 180 Radiation Exposure ................................................................................................................................ 189 Topical Chemical Burn ............................................................................................................................ 193 Stimulant Poisoning/Overdose .............................................................................................................. 197 Cyanide Exposure ................................................................................................................................... 200 Beta Blocker Poisoning/Overdose .......................................................................................................... 204 All Rights Reserved V.11-14 3 Bites and Envenomation ........................................................................................................................ 207 Calcium Channel Blocker Poisoning/Overdose ...................................................................................... 210 Carbon Monoxide/Smoke Inhalation ..................................................................................................... 213 Opioid Poisoning/Overdose ................................................................................................................... 216 Hyperthermia/Heat Exposure ................................................................................................................ 219 Hypothermia/Cold Exposure .................................................................................................................