Seneca County Emergency Medical Services Medical Protocols Index SECTION / TOPIC PAGE GENERAL STANDARDS 5 Scope and Purpose Communications Transport Procedures Legal Considerations Refusal Policy Life Flight Policy DOA Policy Physician on Scene Direct Admission Policy Universal Standard of Care Needleless System Haz-Mat Situations DNR Comfort Care MEDICAL PROCEDURES / EQUIPMENT Oropharyngeal Airway 21 Nasopharyngeal Airway 22 Tracheal Suctioning 24 Advanced Airway Management King LTSD 25 Intubation 27 Pediatric Intubation 29 Visualized Intubation 30 Nasotracheal Intubation 31 Needle Thoracentesis 32 Surgical Cricothyroidotomy 33 Pediatric Cricothyroidotomy 34 Nebulizer 36 KED 36 Respiratory Mask 38 Auto Vent 3000 40 Pulse Oximeter 42 Traction Splint 42 External Cardiac Pacing 46 Intraosseous Needle 46 CPAP 51 ECG Transmission 53 October 2017 1 Seneca County Emergency Medical Services Medical Protocols EZ-IO Appendix ReQPod (Thoracic Impedance Device) Appendix Post Intubation Management 49 SECTION / TOPIC PAGE TRAUMA EMERGENCIES 54 Transport Life Threatening Adult Trauma Major Trauma Abdominal Trauma Amputations Chest Trauma Tension Pneumothorax Eye Injuries Extremity Trauma Face and Neck Trauma Head Trauma Shock – Traumatic Spinal Trauma Burns Pain Management (Non-cardiac) MEDICAL EMERGENCIES 76 Abdominal Pain Altered Mental States CVA Coma / Unconscious Diabetic Hypertension Hyperthermia Hypothermia Poisons and Overdose Seizures Shock – Medical Vomiting and Diarrhea Syncope CARDIAC EMERGENCIES 101 Cardiac Arrest Acute Pulmonary Edema Ventricular Fibrillation/Pulseless Ventricular Tachydardia Pulseless Electrical Activity Asystole October 2017 2 Seneca County Emergency Medical Services Medical Protocols Automatic Implantable Cardioverter Defibrillator Traumatic Cardiac Arrest Hypothermic Cardiac Arrest Bradycardia Third Degree Heart Block/Type II Second Degree AV Block Unstable Tachycardia Narrow Complex Tachycardia & Paroxysmal Supraventricular Tachycardia Monomorphic or Polymorphic Ventricular Tachycardia Wide Complex Tachycardia Atrial Fibrillation / Flutter Tachycardia Cardiogenic Shock Acute Coronary Syndromes 12 Lead ECG ICE Protocol (modified) RESPIRATORY EMERGENCIES 125 Anaphylaxis Asthma COPD Drowning / Near Drowning PEDIATRIC EMERGENCIES 132 Pediatric Tables Respiratory Distress Asthma Allergy / Anaphylaxis Cardiac Arrest Ventricular Fibrillation/Pulseless V-tach Pulseless Electrical Activity Asystole Traumatic Cardiac Arrest Hypothermic Cardiac Arrest Bradycardia Symptomatic Tachycardia Premature Ventricular Contractions IV / IO Seizures Poisoning and Overdose OBSTETRICAL EMERGENCIES 155 Deliveries & Neonate Resuscitation October 2017 3 Seneca County Emergency Medical Services Medical Protocols Normal Delivery Infant Abandonment Abdominal Pain – Third Trimester Sexual Assault Vaginal Bleeding PHARMACOLOGY Adenocard 162 Amiodarone 162 Aspirin 164 Atropine 164 Benadryl 165 Dextrose 166 Diazepam (Valium) 172 Epinephrine 166 Fentanyl 171 Glucagon 167 Lasix 167 Lidocaine 168 Morphine Sulfate 168 Narcan 169 Nitroglycerin 169 Sodium Bicarbonate 170 Ventolin 170 Versed 172 Fentanyl 171 Zofran 172 Instant Glucose 173 October 2017 4 Seneca County Emergency Medical Services Medical Protocols GENERAL STANDARDS SCOPE AND PURPOSE The purpose of the protocols in the Seneca County system is to establish guidelines for the Paramedic, EMT-Intermediate, EMT-Basic, and Medical Control for the management, treatment and transport of specific medical emergencies. The protocols set forth are not designed nor intended to limit the Paramedic, EMT-Intermediate, or EMT-Basic in the exercise of good judgment or initiative in taking responsible action in extraordinary circumstances. These protocols are intended to assist in achieving excellent consistent pre-hospital care for the patient. Pre-hospital care is a shared responsibility between the Physician and the Emergency Medical Technician. The services which the Emergency Medical Technicians are authorized to perform pursuant to the Ohio Revised Code shall be performed by the Emergency Medical Technician to his/her training level only pursuant to the written or verbal authorization of the Medical Director or Medical Control. The Department of Transportation (DOT) National Standard Curriculum approved by the National Highway Traffic and Safety Administration shall constitute the standard of care and procedures in the Seneca County EMS system, in all cases where written protocols, directives, and policies do not address patient care or disposition. Our objective is not only to serve the people of our community, but also to give them our best possible services. We will measure up to the high standard required of emergency medical service only by coordinating our operations, working together, and maintaining a high degree of professionalism. EMT personnel are expected to use the protocols up to their level of training. The fact that there is a protocol for a given procedure/treatment does not imply that an individual without training in that procedure/ treatment is authorized to do the procedure/treatment. When in doubt concerning the performance of a procedure/treatment the EMT individual must contact Medical Control. COMMUNICATIONS A. Medical Control Notification It is the responsibility of the squad personnel to contact Medical Control and report your patient assessment to the Emergency Department staff. Your verbal report should start with the age, sex, and Chief Complaint of the patient. Next, you should give the vital signs, level of consciousness, and a brief history of present illness. Third, you should describe the skin’s color, temperature and moisture; lung sounds and effort; heart sounds; and abdominal exam. Fourth, you should report all treatment being provided to the patient. Fifth, your E.T.A. And last, allergies, if medication is being requested. B. Communications Failure Pursuant to Ohio Revised Code 4765.40, if there is a communications failure that prevents contact with Medical Control, the Paramedic may proceed with the Medical Protocols past the point in the Standing Orders where contacting Medical Control is indicated, if the life of the patient is in immediate danger. Such a communication failure should be documented and forwarded to the Seneca County EMS Director. October 2017 5 Seneca County Emergency Medical Services Medical Protocols Utilize the EMS Charts SPECIAL REPORT to document any field communications failures. If you are unable to utilize the EMS Charts Special Report – please complete the following form to report any failure of the Seneca County Communications system. SENECA COUNTY EMS COMMUNICATION FAILURE INCIDENT REPORT SQUAD____________________________ INCIDENT#_________________ DATE___________________ TIME OF OCCURANCE___________________________ DESCRIBE THE COMMUNICATION FAILURE_________________________________________________ WHAT ATTEMPTS WERE MADE TO CORRECT THE PROBLEM? ________________________________ DID YOU HAVE TO GO BEYOND STANDING ORDERS DUE TO FAILURE? YES_____ NO_____ WHAT PROTOCOLS DID YOU INSTITUTE AND WHY? ________________________________________ PATIENT NAME_______________________________________________________ NATURE OF CALL_____________________________________________________ SIGNED _____________________________________________ Medic/Intermediate/Basic ______________________________________________ Medic/Intermediate/Basic ______________________________________________ Medic/Intermediate/Basic ______________________________________________EMS Coordinator ____________________________ EMS Director DATE_________ _____________________________Medical Director DATE_________ October 2017 6 Seneca County Emergency Medical Services Medical Protocols TRANSPORT PROCEDURES All patients that are assessed by Seneca County EMS Personnel will be transported to area hospitals based upon location and patient condition. A patient may not wish to be transported to the closest medical facility, but the EMT must decide the appropriate hospital based upon what condition the patient presents to them. An ill or injured patient may refuse care from Seneca County EMS personnel. The EMT must deem the patient competent and of legal age to make said decision. All patients not competent to refuse care will be transported by Seneca County EMS to an appropriate hospital. The patient who is not of legal age, age 18, will be transported to a medical facility if a parent or legal guardian is not available. SPECIAL NOTE: (The emergency physician or medical control may also ask that you transport the patient to another hospital when overcrowding occurs or when local emergency department resources dictate such a diversion to benefit/facilitate patient care. Example: During a disaster and the hospital is operating under disaster protocol.) In the event you are directed to transport to another hospital, contact Seneca County Sheriff’s Dispatch and notify them that you have been directed to transport to another hospital. LEGAL CONSIDERATIONS I. CONSENT A. A mentally competent patient has the right to consider or refuse treatment and/or transport. B. Consent is “implied” when the patient is unable to consent to treatment do to: 1. Age 2. Mental Status 3. Medical Condition C. In no event should legal consent procedures be allowed to delay treatment. If the time delay is due to obtaining lawful consent from an authorized person, that would present a: 1. Serious risk of death 2. Serious impairment of health 3. Would prolong pain or suffering D. Age of consent is 18 years of