LINCOLN COUNTY EMS and TCC PROTOCOLS C.O.P.S. INCLUDED 20Lincoln County MPD- Dr. Ron Appel Approved by DOH on 3/15/2018 LINCOLN COUNTY EMS PROTOCOLS 1 This page intentionally left blank LINCOLN COUNTY EMS PROTOCOLS 2 March 15, 2018 STATE OF WASHINGTON DEPARTMENT OF HEALTH PO Box 47853 • Olympia, Washington 98504- 7853 Dr. Ronald Appel, MPD 34197 Teel Hill Rd N Davenport, Washington 99122 Dear Dr. Appel: Please be advised that the Lincoln County MPD Protocols, dated March 2018, are approved. Wy will place an electronic copy on the MPD SharePoint site and a hard copy in our archives for reference. Prehospital patient care protocols are defined in WAC 246-976-010 as "department-approved, written orders adopted by the MPD under RCW 18.73.030(15) and 70.168.015(27) which direct the out-of• hospital care of patients. These protocols are related only to delivery and documentation of direct patient treatment. The protocols meet or exceed statewide minimum standards developed by the department in rule as authorized in chapter 70.168 RCW." Thank you for the hard work and collaboration demonstrated in completing this project. Please let me know if you have any questions or concerns. Regards, Catie Holstein, EMS Program Manager Office of Community Health Systems, Emergency Care System Washington State Department of Health POBox47853 Olympia, WA 98504-8753 Phone: (360) 236-2841 [email protected] LINCOLN COUNTY EMS PROTOCOLS 3 OUR MISSION STATEMENT TO SUPPORT THE CONTINUING DEVELOPMENT OF HIGH QUALITY PRE- HOSPITAL EMERGENCY MEDECAL CARE SERVICES IN LINCOLN COUNTY. Table of Contents LINCOLN COUNTY EMS PROTOCOLS 4 Approved Procedures and Skills (DOH 530-173) 9 Certification in Other Counties___ 15 Physician on Scene 15 MPD Delegates ____________16 Medical Control 16 Medication Considerations 17 Pre-Hospital Patient Transport Guidelines 18 Transport Issues 19 POLST 20 Inter-Hospital Transport 23 Cardiac: Cardiogenic Shock 25 Cardiac: Chest Pain 26 Cardiac: Asystole/PEA 28 Cardiac: CPR and Auto Pulse 29 Cardiac: V-Fib/Pulseless V-Tach 30 Cardiac: Symptomatic Bradycardia/Heart Blocks 32 Cardiac: Narrow Complex Tachycardia with Rate > 150 34 Cardiac: Wide Complex Tachycardia with a Pulse 36 Cardiac: Termination of Resuscitation 38 Medical: Abdominal Pain 41 Medical: Active Seizures 42 Medical: Altered LOC 44 Medical: Anaphylaxis and Allergic Reactions 45 Medical: Animal and Human Bites 47 Medical: Behavioral Emergencies 48 Medical: Bites and Stings 50 Medical: Carbon Monoxide Poisoning 52 Medical: Cold Injurie/Frostbite 54 Medical: Cyanide Poisoning 55 Medical: Diabetic Emergencies 57 Medical: Excited Delirium 59 Medical: Heat Cramps/Exhaustion 61 Medical: Heat Stroke 62 Medical: Hypothermia 64 Medical: Nausea/Vomiting 66 Medical: Near Drowning 67 Medical: Overdose or Toxic Exposure 69 Medical: Stroke 71 LINCOLN COUNTY EMS PROTOCOLS 5 OB/Gyn: Childbirth 73 OB/Gyn: Eclampsia 75 OB/Gyn: Pre-Term Labor (24-37 weeks) 76 OB/Gyn: Vaginal Bleeding 77 Pediatric: Emergencies, General 79 Pediatric: Airway Obstruction, Infant 80 Pediatric: Altered LOC 81 Pediatric: Anaphylaxis 82 Pediatric: Asthma, Acute 84 Pediatric: Asystole/PEA 85 Pediatric: Diabetic Emergencies 87 Pediatric: Hypoperfusion/Hypovolemia 89 Pediatric: Overdose or Toxic Exposure 90 Pediatric: Pain Management, Severe 92 Pediatric: Seizures, Active 94 Pediatric: Symptomatic Bradycardia 95 Pediatric: Tachycardia with Pulses and Poor Perfusion 97 Pediatric: V-Fib/Pulseless V-Tach 99 Procedural: Air Medical Utilization 101 Procedural: Airway Management 102 Procedural: Capnography 104 Procedural: CombiTube 106 Procedural: Conducted Energy Devices- Barb Removal 108 Procedural: CPAP 110 Procedural: EBOLA 111 Procedural: EBOLA Matrix 114 Procedural: Epinephrine Auto Injector 115 Procedural: Epinephrine Drip 116 Procedural: Evidentiary Blood Draw 117 Procedural: Helmet/Shoulder Pad Removal_____________________________________ 119 Procedural: I-Gel Airway 122 Procedural: Infusion Pump__________________________________________________ 125 Procedural: Intranasal Medication Delivery 128 Procedural: IO, Adult 129 Procedural: IO, Pediatric 131 Procedural: Intubation 133 Procedural: King Airway 134 LINCOLN COUNTY EMS PROTOCOLS 6 Procedural: Needle Thoracostomy 137 Procedural: Pain Management 138 Procedural: Restraints 140 Procedural: RSI 142 Procedural: Sedation 144 Procedural: Transcutaneous Pacing 145 Respiratory: Asthma, Acute 147 Respiratory: COPD Exacerbation 148 Respiratory: Pulmonary Edema, Acute 149 Trauma: General 151 Trauma: Abdominal Injuries 153 Trauma: Amputations 154 Trauma: Burns 155 Trauma: Chest Trauma 156 Trauma: Crush Injuries 158 Trauma: Electrical Injuries 159 Trauma: Extremity Injuries 161 Trauma: Eye Injuries 162 Trauma: Head and Facial Injuries 163 Trauma: Hemorrhage 164 Trauma: Hypoperfusion/Hypovolemia 165 Trauma: Spinal Injuries 167 Medication List, Lincoln County 169 Medication Formulary 170 Medication Infusion 172 Adenosine 173 Albuterol 174 Amiodarone 175 Ammonia Inhalants 176 Aspirin 177 Atropine 178 Dextrose (D25/D50) 180 Diphenhydramine (Benadryl) 181 Epinephrine 182 Fentanyl 183 Furosemide 184 LINCOLN COUNTY EMS PROTOCOLS 7 Glucagon 186 Lidocaine 187 Magnesium Sulfate 188 Midazolam___ 189 Naloxone 190 Nitroglycerine 191 Norepinephrine 192 Ondansetron__ 194 Oxygen 195 Rocuronium 196 Sodium Bicarbonate 197 Succinylcholine 198 Spanish 199 Mnemonics/Assessment Tools 202 Phone Numbers 204 Approved Procedures and Skills for Certified EMS Providers DOH 530-173 LINCOLN COUNTY EMS PROTOCOLS 8 EMS Scope of Practice Guidelines- Authorizes EMS certified provider (EMR, EMT, AEMT, Paramedic) scope of practice is addressed is three specific areas. Medical Direction (18.71.205 RCW, 246.976.920 WAC), environment of practice (246.976.182 WAC) and training (18.73.081 RCW). In general, EMS certified providers are only authorized to provide care under the authority of the Medical Program Director (MPD) and compliance with Department of Health (DOH) approved MPD protocols. MPD’s are appointed by the Secretary of the Department of Health. EMS certifies providers are only authorized to provide care in the pre-hospital emergent environment unless practicing under programs authorized by RCW 35.21.930. EMS certified providers are authorized to perform skills and procedures listed in this guidance document (below) if a department approved MPD patient care protocol is in place. Legend DOH 530-173 N- National indicates the skill is listed in the interpretive guidelines of the National EMS Scope of Practice Model which defines the practice of EMS certified providers as a minimum national standard. (National scope of practice). W- Washington Initial Training indicated the skill is not listed in the interpretive guidelines of the National Scope of Practice Model, however, Washington State DOH approves the skill to be included Washington State Amended Curriculum. (Not in national scope, but is in Washington Amended Curricula for initial training and is mandatory). W*- Washington Special Training Required indicates the skill is approved for use by DOH certified EMS providers through specialized training and authorized by WAC 246.976.024. Personnel must have completed a DOH and MPD approved training course and demonstrated knowledge and skill competency to the level of satisfaction of the MPD. The MPD authorizes the skill through DOH approved MPD patient care protocols. (Not in national scope, MPD specialized training required and is optional). W**- Washington State Endorsement on a Certification is Required indicates the skill is approved for use by DOH certified EMS providers through specialized training and authorized by WAC 246.976.024. Personnel must have completed a DOH and MPD approved training course and demonstrated knowledge and skill competency to the level of satisfaction of the MPD. The MPD authorizes the skill through DOH approved MPD patient care protocols. The DOH requires a course application and approval for these skills and issues an endorsement to the provider’s certification. Currently, endorsements are only required for EMT-IV and SGA skills. (Not in national scope, MPD option to implement, specialized training required, course application must be submitted and approved by the DOH, an endorsement added to the credential by the DOH). Blank Space- If the space is blank, the skill is not authorized. Airway EMR EMT AEMT PARA Head tilt/Chin Lift N N N N Modified Chin Lift N N N N Jaw Thrust N N N N LINCOLN COUNTY EMS PROTOCOLS 9 Cricoid Pressure N N N N Oral Airway N N N N Nasal Airway N N N Nasal Cannula N N N N Non-rebreather Mask N N N N Partial Re-breather Mask N N N Venturi Mask N N N Humidified O2 N N N Pocket Mask N N N N Positive Pressure Ventilation- Bag Valve Mask N N N N Positive Pressure Ventilation- Manually Triggered Demand N N N Valve Positive Pressure Ventilation- Automatic Transport Ventilator N N N (Auto Vent, CAREvent, UniVent, Pneupac VR1). EMT and AEMT are limited are limited to the initiation during resuscitative efforts of ventilators that only adjust rate and tidal volume. Positive Pressure Ventilation- Transport ventilator with N adjustments beyond rate and tidal volume. Continuous Positive Airway Pressure- CPAP W* W* N Bi-level Positive Airway Pressure- BiPAP N Airway obstruction Removal- Manual N N N N Airway obstruction Removal- Direct Laryngoscopy N Airways not intended for insertion into the trachea W** N N (Esophageal/Tracheal Multi-Lumen Airways such as CombiTube, King LT, i-gel) Nasal Endotracheal Intubation N Oral Endotracheal Intubation N Pharmacological