2 Region IX 2 0 0 STANDARD OPERATING PROCEDURES/ 1 1 STANDING MEDICAL ORDERS 9 9 McHenry Western Lake County EMS System Healthcare delivery requires structure (people, equipment, education) and process (policies, protocols, procedures) that, when integrated, produce a system (programs, organizations, cultures) that leads to optimal outcomes (patient survival and safety, quality, satisfaction). An effective system of care comprises all of these elements—structure, process, system, and patient outcomes—in a framework of continuous quality improvement (AHA, 2015). These protocols have been developed and approved through a collaborative process involving the Advocate Lutheran General; Greater Elgin Area, McHenry Western Lake County, Northwest Community, Amita Saint Joseph Hospital, and Southern Fox Valley EMS Systems to reduce variation in practice and establish a Region-wide System of care. They shall be used: as the written practice guidelines/pathways of care approved by the EMS Medical Directors (EMS MDs) to be initiated by System EMS personnel for off-line medical control. as the standing medical orders to be used by Emergency Communications Registered Nurses (ECRNs) when providing on-line medical control (OLMC). in medium to large scale multiple patient incidents, given that the usual and customary forms of communication are contraindicated as specified in the Region IX disaster plan. System members are authorized to implement these orders to their scope of practice. OLMC communication shall be established without endangering the patient. Under no circumstances shall emergency prehospital care be delayed while attempting to establish contact with a hospital. In the event that communications cannot be established, EMS personnel shall continue to provide care to the degree authorized by their license, these protocols, drugs/equipment available, and their scope of practice granted by the EMS MD in that System. Patient care is by nature unpredictable. In all circumstances, on line physicians have the latitude to deviate from these guidelines if it is believed that deviation is in the best interest of the patient. Such deviations should in no way detract from the high level of patient care expected from EMS personnel. If a patient situation is not covered by these standing orders, initiate Initial Medical or Initial Trauma Care and contact the nearest System hospital as soon as possible for a physician's instructions. John Pacini, D.O. EMS MD McHenry Western Lake County EMSS Intentionally left blank (inside cover) Region IX SOPS/SMOs: Effective 2019 Table of Contents GENERAL PATIENT MANAGEMENT Eye emergencies / Facial trauma 50 Introduction 1 Head trauma 51-52 EMS Scopes of Practice 2 Musculoskeletal trauma 53 General Patient Assessment/IMC 3-4 Spine trauma/Equipment removal guidelines 54-55 Pain management / Drug alternatives 5 Multiple Patient Incidents (NR) 56 OLMC Report/Handover Reports 6 START & JumpSTART 57 Withholding or Withdrawing Resuscitation 7-8 Hazardous Materials Incidents 58 Elderly patients 9 Chemical Agents 59 Extremely obese patients 10 Chempack Requests 60 RESPIRATORY Active Assailant Response 61-62 Airway obstruction 11 Widespread disease outbreak 63 Advanced airways/DAI 12 Abuse and Maltreatment: Domestic/Sexual/Elder 64 Allergic Reaction/Anaphylactic Shock 13 Trauma in pregnancy 65 Asthma/COPD 14 OB Pts w/ tracheostomy/laryngectomy (adult & peds) 15 Childbirth 66 Acute Resp. Disorders (FLU – Pulm. embolism) 16 Newborn and post-partum care 67 CARDIAC Delivery complications 68 Acute Coronary Syndromes/STEMI 17 Newborn resuscitation 69 Bradycardia with a Pulse 18 OB complications 70 Narrow QRS Complex Tachycardia 19 PEDS Wide Complex Tachycardia with a Pulse 20 Peds initial medical care 71 Cardiac Arrest Management (Adult & Peds) 21-22 Peds IMC – Circulation / perfusion / GCS 72 Heart Failure/Pulmonary Edema/Cardiogenic Shock 23 Peds Secondary assessment/sedation/VS 73-74 Left ventricular assist device 24 Special Healthcare needs 75 MEDICAL Peds Airway Adjuncts (NR) 76 Acute Abdominal/Flank Pain 25 Peds Respiratory: FBO; 77 Dialysis/Chronic Renal Failure 25 Peds Respiratory Arrest, SIDS, BRUE 78 Alcohol Intoxication/Withdrawal 26 Peds Allergic Rx ; Anaphylactic Shock 79 Altered Mental Status/Syncope & Presyncope 27 Peds Asthma 80 Drug Overdose/Poisoning 28-29 Peds Croup/ Epiglottitis / RSV/ Bronchiolitis 81 Carbon monoxide (HBO)/Cyanide exposure 30 Peds cardiac SOPs 83-84 Environmental emergencies: Cold related 31 Peds medical SOPs 85-88 Environmental emergencies: Submersion 32 Peds Seizure – Sepsis & Septic Shock 89-90 Environmental emergencies: Heat related 33 Peds ITC/Trauma score/Trauma SOPs/Abuse 91-93 Glucose/Diabetes Emergencies 34 APPENDIX 94-117 Hypertension/Hypertensive crisis 35 CPR: Quality criteria; peds defib table 94 Psych/Behavioral Emerg/Agitated/Violent Pts 36-37 Ketamine dose chart 95 Stroke – Assessment checklist 38-39 Drug appendix 96-106 Seizures 40 Peds Defib/Drug & adult fentanyl dose tables. 107-108 Shock - Septic 41 QT intervals; 12-lead changes in AMI 109 Shock – Hypovolemic 42 Medical abbreviations 110-111 TRAUMA (adult and peds) Differential of COPD/HF; CPAP ................................ 112 Initial trauma care (ITC)/GCS/RTS 43-44 Biologic, Nuclear, Incendiary & Chem agents ......... 113 Triage & transport criteria (table) 45 Bioterrorist Agents ..................................................... 114 Cardiac Arrest due to Trauma 46 Chemical Terrorism Agents ....................................... 115 Conducted electrical weapon (Taser) 46 Hospital Designations for Specialty Transports ........ 116 Burns 47-48 Pain scales ................................................................. 117 Dopamine Drug Chart 118 Chest trauma 49 Introduction Assumptions 1. All EMS personnel will function within their scope of practice as defined by the Illinois EMS Act, IDPH EMS Rules and Regulations promulgated by IDPH Division of EMS & HW Safety, and practice privileges authorized by the EMS MD of the System in which they are working. 2. These SOPs shall be evidence-based and revised as standards of practice or clinical practice guidelines change. They include recommendations from the National Association of EMS Physicians (National Model EMS Clinical Guidelines), Am Heart Association (CPR, ACLS/PALS), Am College of Surgeons (ATLS & PHTLS), Am College of Emergency Physicians (ITLS), Brain Trauma Foundation, Centers for Disease Control and Prevention, Dept. of Health & Human Services, EMS for Children; the National EMS Education Standards, Scope of Practice Model and EMS Core Content. 3. Italicized options may not be used in all Systems. Refer to the System-specific SOP documents. Those marked NR are non-region protocols that may or may not be adopted by each System or substituted with a System-specific document. 4. Levels of acuity: Definitions match Model of Clinical Practice of Emergency Medicine; in the Ntl EMS Core Content: Acuity level is essential for identifying care priorities in EMS setting. They are coded to NEMSIS standards and should be documented as such in the PCR/EHR. CRITICAL pts are TIME-SENSITIVE with black box notations in the SOPs. CRITICAL: Symptoms of a life threatening illness or injury with a high probability of mortality if immediate intervention is not begun to prevent further airway, respiratory, hemodynamic and/or neurologic instability. EMERGENT: Symptoms of illness or injury may progress in severity or result in complications w/ a high probability for morbidity if treatment is not begun quickly. These may be identified as time-sensitive on a case by case basis. LOWER ACUITY: Symptoms of an illness or injury that have a low probability of progression to more serious disease or development of complications. 5. Stable: Ability to maintain a steady state of equilibrium with VS that support adequate oxygenation, ventilation, perfusion, & mentation General guidelines 1. Abandonment: EMS personnel shall not knowingly abandon a patient. Abandonment is the unilateral termination of a health professional-patient relationship and/or the unreasonable discontinuation of care by the health care provider when there is still a need for continuing medical attention, contrary to the patient’s will, and/or without the patient’s knowledge. Abandonment for our purposes includes executing an inappropriate refusal, releasing a patient to a less qualified individual, or discontinuing needed medical monitoring before patient care is assumed by other professionals of equal or greater licensure than the level of care required by the patient. 2. Bus Accident: Refer to Region policy. 3. Consent: Decisional adults must consent to treatment. Consent must be informed or clearly implied via verbal agreement to the treatment or gestures indicating their desire for treatment. A patient's lack of refusal or physical resistance or withdrawal will be taken as consent. 4. Consent (Implied): Patients who are incapacitated so they cannot comply with the above provisions and do not exhibit the ability to make sound judgments, will be treated under implied consent. Patients who are obviously impaired with altered judgment who are unable to understand their decisions, have slurred speech, and/or ataxia; those suffering from mental illness; those who have made suicidal statements (to EMS personnel or persons physically present at the scene who will attest to the statements on a petition form) are to be treated under implied consent. They are not allowed to refuse treatment or transport. 5. Expanded