Smith College Emergency Medical Services

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					Smith College Emergency Medical Services Protocols

Contents Introductory note…………………………………2 General Purpose………………………………….3 Application……………………………………….3 Distribution………………………………………3 Clarification……………………………………...3 Amending………………………………………..3 Absence of Standard………………………….….3 Definitions……………………………………….3 Personnel Assignments…………………………4 Qualified Duty Assignments…………………....6 Occupational Safety and Health………………...7 Membership Duties…………………………….7 Responsibilities of a Member…………………..9 Injury or Death in the Line of Duty……………10 Termination of Service…………………………11 Standard of Conduct……………………………11 Prohibited Activity……………………………..12 Discipline………………………………………13 Radio Protocols…………………………………14 Regional Run Report……………………………15 Overall Protocols for Treatment………………..18 At the Scene of a Call…………………………...19 After a Call………………………………………19 Changing Shifts………………………………….19 Choking…………………………………………..21 Anaphylaxis (Allergic Reaction)…………………22 Asthma……………………………………………22 COPD/Emphysema………………………………..23 Hyperventilation…………………………………..24 Hypoxia………………………………………….25 Near Drowning………………………………..….26 Cardiac Arrest……………………………….……26 Arrhythmia—Asystole………………….……26 Arrhythmia—Brachycardia…………….……..27 Arrhythmia—PEA…………………………….27 Arrhythmia—Tachycardia…………………….27 Arrhythmia—Ventricular Fibrillation…………27 Chest Pain………………………………………28 Chest Trauma…………………………………...29 Hypovolemia/Shock……………………………..29 Head Injury……………………………………..30 Neurological Emergencies………………………31

Acute Deceration (C-spine)…………………….32 Orthopedic Injury………………………………33 Traumatic Amputations…………………………34 Gunshot Wounds………………………………34 Soft Tissue Injury………………………………35 Acute Abdomen………………………………..35 Seizure Activity………………………………..36 Heat-related Illness……………………………37 Hypothermia…………………………………..38 Intoxication……………………………………39 Poison…………………………………………40 Substance Abuse………………………………40 Hyperglycemia and Hypoglycemia…………….42 Obstetrics……………………………………..43 Hazardous Materials incident…………………43 Burns………………………………………….44 EMT Equipment list……………………………48 FR Equipment list……………………………….50

Edited by the Executive Board, November, 2002. This SCEMS Protocol Manual should be edited, and if needed re-written, by the Chiefs at the beginning of their term. This manual will be reproduced for all acting members of SCEMS. Copies must also be made available to Smith College Health Services Nursing Staff, the (Medical) Director of Health Services, and Smith College Public Safety. All members must read and follow these protocols exactly. This manual should be brought to all general meetings to serve as SCEMS handbook. Any questions on Protocol procedures should be directed toward the current Chief.

General Purpose In conjunction with the standard operating procedures (SOPs), it is the purpose of this document to provide each member of Smith College Emergency Medical Services (SCEMS) with a clear, written guide to follow in the everyday operations of the Department. Additionally, this document sets forth a standard of conduct and expectation for each member of the Department. Application Unless otherwise provided, these standards apply to all members of Smith College EMS. Distribution A copy of the standards, as well as SOPs, will be available to each member of the Department. It is the responsibility of each member to maintain, read and understand these documents. Clarification It is the intent of these standards and SOPs to define the Department‟s method of operation. It is the responsibility of each new member to familiarize themselves with these standards. These policies and SOPs will be reviewed with each new member as part of the orientation process. If, at any time, a member does not understand any of these standards or their intent, it is that member‟s responsibility to ask an officer for clarification. Amending The Chiefs office may amend this document as necessary and ensure that all copies of the document are undated. Absence of Standard In the absence of a standard or SOP pertaining to any aspect of the Department‟s operation, state of nationally accepted practices shall be followed. Definitions: Chief’s Office The Chief‟s Office is comprised of two Chief Officers appointed by the former Chiefs and, if needed, the (Medical) Director of Health Services. The Department The correct name is Smith College Emergency Medical Services, herein referred to as SCEMS. The Department Offices are located in the Elizabeth Mason Infirmary; therefore, all correspondence should be routed to 69 Paradise Road. Northampton. MA 01063. For the purpose of this document, the Department shall refer to the entire organization. Emergency Medical Services (EMS) The activity of the Department primarily involved with the treatment and facilitated transport of persons that are ill or injured. Health Services SCEMS is an outreach program of Health Services, the on-campus medical provider for Smith

College. Health Services is located in the Elizabeth Mason Infirmary and is the primary receiving facility for patients care for by SCEMS. Department of Public Safety This is the Department‟s dispatching center as well as the primary facilitator of patient transport to Health Services and/or Cooley Dickinson Hospital. Officers from the DOPS shall be present at all medical emergencies attended by SCEMS. Also known as “Security.” Member of the Department Any properly appointed First Responder or EMT, any person contributing to the Department and attending bimonthly trainings, or officer of the Department. Personnel without certification are considered members but are not active. Personnel on probation are considered members for the period of their probation, but certain restrictions may apply to their operations. Officer in Charge (O.I.C) The person, usually the Supervisor in charge of the crew. If the supervisor is not responding to a call, and thus serving as a back-up officer, then the EMT is the O.I.C. Orders Commands or instructions issued by an officer or O.I.C clearly invoking authority. These instructions may be written or oral. Policies Policies are the written rules and regulations for citing the expected conduct and responsibilities of each member to accomplish the objectives of the Department. Violation of policies may be cause for disciplinary action. Standard Operation Procedures (SOPs) Standard Operating Procedures are designed to give members acceptable methods of accomplishing specific tasks. Occasionally circumstances may dictate a deviation from the SOPs, but sound and justifiable reasoning must be the basis for any deviation. Standards “Standards” is the term used for levels of expected performance in the operation of the Department. Standards seek to support fairness and high operation and may be produced by local, state or national organizations. Personnel Assignments: Executive Board: Executive Board consists of the Chiefs and officers. Vacancies shall be filled by recommendation of the Department, subject to confirmation by the Chiefs‟ Office. Appointments shall be for one academic year. The chiefs may, at their discretion, appoint acting officers to serve in the capacity of a given rank. Acting officers shall be accorded all responsibilities and authority for the position designated. There will be monthly Executive Board meetings with the (Medical) Director of Health Services to review recent performance and general workings of the Department. Occasionally the Nursing Coordinator of Health Services, Director of Public Safety,

and a Public Safety officer will attend these meetings. Chief The Chief‟s Office is the head of the Department and is the final authority on all matters of policy, operations, and administration within the Department, subject to the laws of the Commonwealth of Massachusetts and local ordinances. The Chiefs are directly responsible to the head physician of Health Services, for the safe, effective and efficient operation of the Department, and bear the ultimate responsibility in all areas of administration and operations. The Chiefs shall also be responsible for the Department‟s long term planning. It is strongly recommended that there be two members elected to the position of Chief. Officers Lieutenants shall be responsible for the duties assigned to them at the lime of election by the general body. There shall be at least one, but not more than two, Officers in the positions of Personnel, Equipment and Budget, Communications, and Training Coordination. If necessary, the Executive Board or Chiefs may elect an additional member to the Board to assist with additional projects and miscellaneous tasks. In the absence of a Chief, an officer may assume the responsibilities of the absent Chief until relieved. Personnel The lieutenant in charge of personnel is responsible for the maintenance of personnel records for each member and any written review of a member‟s performance. The officer shall schedule members for regular shifts for the hours of operation of the Department, as well as for special events where SCEMS has been requested. Her duties shall include assigning all call signs to active members, posting a roster with phone numbers in the SCEMS office and Public Safety office, and posting and distributing a weekly crew schedule to the SCEMS office, Nursing Station, and Medical Director‟s mail box, and maintaining current information on all documents. Equipment and Budget: The officer in charge of equipment and budget is responsible for all equipment used by and the financial matters of the Department. She will maintain a current inventory listing the equipment owned by SCEMS. She is in charge of making purchases as needed and serves as a liaison between SCEMS and the Smith College Health Services purchaser. For purchases above one hundred dollars, a 2/3 vote in a regular meeting must be attained for approval. The officer is also responsible for the purchasing of uniforms and ID badges. It is recommended that there be two members elected to this position. Communications The officer in charge of communications is responsible for notifying all members of SCEMS of the time and location of all general body and Executive Board meetings via electronic, phone, or paper mail. She shall take minutes of the general meetings to be posted in the SCEMS office for at least two weeks after the meeting. These shall be collected in a minutes-log in the office. She is also responsible for documenting the written excuses for missed meetings and will send notices of reprimand to those members with unexcused absences. The officer is responsible for coordination fundraiser events with the Chiefs. She is also responsible for documenting the excuses for missed meetings and will send notices of reprimand to those members with unexcused absences and ensure that all active members attend 75% of general meetings each semester.

Training The Training Coordinator shall be in charge of coordinating emergency medical training, including the J-term EMT class and continuing education. She shall also keep a file of current members‟ certifications. She shall coordinate classes for both SCEMS members and the Smith community, including CPR and First Responder, and will coordinate other educational opportunities for those interested. Supervisors: EMTs appointed by the Chief/Chiefs who serve as back-up officers to assist on calls when the on-duty EMT or FR fails to respond to a call or is unable to complete the shift, or when the call requires additional assistance. Supervisors will also respond to calls where the on-duty EMT or FR is newly trained. Qualified Duty Assignments Qualified Duty Assignments (QDAs) are specialized tasks in the Department that are accomplished by those trained and certified to do that task. Members are not required to obtain state certification to fulfill QDA; however, they are strongly encouraged to do so. First Responder (FR) A First Responder is any member who has successfully completed all training and certification requirements set forth by the American Red Cross. Emergency Medical Services Trainee (EMT-T) An EMS-T is any member currently enrolled in an EMT class or holding EMT certification in a state other than the Commonwealth of Massachusetts. EMS-T‟s are to observe patient care and participate up to the level of their training. They are to perform only tasks assigned by senior personnel. Emergency Medical Technician-Basic (EMT-B) A member will be qualified as an EMT-B upon satisfactory completion of all requirements as set forth by the Commonwealth of Massachusetts Division of EMS. Critical Incident Stress Management Team member Members wishing to serve on the Western Massachusetts Critical Incident Stress Debriefing Team must complete the CISD training offered by the team and pass an interview. This team provides debriefing to emergency responders following critical incidents. General Member Persons wishing to perform a service to the community buy not necessarily wishing to perform emergency medical procedures may apply to become General Members. These members will not be required to be on—call but will be asked to perform other duties associated with the maintenance of the Department and outreach engagements.

Occupational Safety and Health It is the policy of this Department to provide and operate with the highest possible levels of safety and health for all members. The prevention and reduction of accidents, injuries, and

occupational illnesses are the goals of this department and shall be the primary consideration at all times. This concern for safety and health applies to all members of the Department and to any other persons who may be involved in departmental activities. The responsibility for establishing and enforcing departmental safety rules and regulations rests with the Chiefs and officers. Enforcement implies that appropriate action, including disciplinary measures, will be taken to ensure compliance. An effective safety program requires commitment and support from all members. All members shall remain vigilant to situations and devices that may cause danger or that may have been overlooked by superiors. It is expected that these situations will be immediately reported to a superior officer. Membership Duties Eligibility Any person eighteen years or older who is enrolled at least as a part-time student at Smith College is eligible to apply to become a Department member. Under Massachusetts law, convicted felons and sex offenders cannot he considered for membership in the Department. Equal Opportunity In the interests of maintaining diversity within the Department, Smith College Emergency Medical Services does not discriminate in the recruitment of volunteers, hiring of personnel, or provision of services on the grounds of race, religion, gender, sexual orientation, ancestry, national origin, age, or physical handicap. Harassment In keeping with the spirit and the intent of federal and state law, Smith College Emergency Medical Services strives to provide a comfortable environment for its members. Offensive or harassing behavior will not be tolerated against any member. Those members in supervisory positions will be responsible for taking proper action to end such behavior. In an effort to prevent sexual and other forms of harassment from occurring, this policy against harassment will be communicated to each member of the Department. No member of the Department is exempt from this policy. Offensive conduct or harassment that is of sexual nature, based on race, religion, gender, sexual orientation, ancestry, national origin, age, or disability is prohibited. This includes but is not limited to: • Physical actions, written or spoken language and graphic communications. • Any type of physical contact in which the action is unwelcome or unwanted by the recipient. • Expectations, requests, demands, or pressure for sexual favors. • Slurs, jokes, posters, cartoons, and gestures. Any such offensive conduct will be considered a prohibited form of harassment when any or all of the following are true: • There is a promise or implied promise of deferential treatment or negative consequence regarding member status.

• Such conduct has the effect of creating an intimidating, hostile, or offensive environment, or unreasonably interferes with a member‟s performance. • A third party is offended by the sexual conduct or communications of others. Harassment is considered a form of misconduct. Disciplinary action, up to and including dismissal, will be taken with any member engaging in this type of behavior. Any officer who has knowledge of such behavior yet takes no action to end it is also subject to disciplinary action. Complaints should be made to the Chiefs, or any other officer the offended feels comfortable talking with. All complaints will remain as confidential as possible. No member will be penalized for reporting harassment in accordance with this policy when done in good faith. Issue of Equipment All members will be issued a paging radio and equipment on a duty crew basis. Each member will also be issued an identification card. All members shall sign for any equipment issued by the Department and exercise reasonable care for each item. Hepatitis Prevention All members will be offered the Hepatitis B vaccination series at half the cost of each injection for each individual as provided by Smith College Health Services. Members must be active in the Department for a period of at least one academic year to receive the vaccination series at half the cost. Members who receive the vaccination but do not remain with the Department for the specified time will be asked to pay the remaining cost for the injections. Members who refuse the vaccination must sign a release form. Influenza Vaccination The influenza vaccination is not offered by the Department but is strongly suggested due to the nature of the Department‟s interaction with the student body. The vaccination is available at Health Services. Training/ General Attendance An academic semester attendance rate of 75% is required at departmental trainings. These meetings are held at least bimonthly and shall include important departmental announcements, and a training whose topic shall pertain to the general activity of the Department. Certification Programs The Training Coordinator will be in charge of coordinating and planning for certification and re-certification programs. Addresses and Telephone Numbers Members should make every effort to inform the Personnel officer of any change in their addresses, telephone numbers or email addresses. Responsibilities of a Member Emergency Response Availability The Department relies on its volunteer on call personnel for response to emergency calls. All personnel shall respond to all calls during the period that they are scheduled unless a cover is

found. EMS personnel are required to be on the schedule for a minimum of one (1) shifts, or 12 hours, per month. Required hours may be accumulated by volunteering at special events attended by the Department. No member shall choose calls on the basis of the dispatch information given. Emergency Response Dress Code EMS personnel on runs are expected to present a clean, professional appearance. Shorts, sandals, shirtlessness, and/or excessive unprotected skin are prohibited. Cleanup and Maintenance All members are expected to meet their obligations with regard to cleanup and maintenance details, especially following emergency responses. This includes, but is not limited to, cleanliness of equipment and of the Department office. Public Safety Vehicle No member shall have emergency response equipment on their vehicle without conforming to the Department‟s relevant SOP. Period of Needed Service Members responding to an emergency are expected to stay and participate in the incident until released by the officer in charge of their unit or superior. As no activity has a guaranteed finish time, it is realized that this may occasionally conflict with other activities. If a member must leave for other mandatory needs, they should advise the officer in charge of their situation and request to be released. Orders in Emergency Situations Members shall obey orders given by their superiors in a rapid, efficient manner to the best of their ability, then report back to their immediate superior on completion of the task. No supervisor shall issue any order without first considering the risk involved. An acceptable level of risk is directly related to the potential to save lives. Where there is no potential to save lives, there is no justification to expose Department personnel to any avoidable risk. Supervisors must make this risk determination prior to setting strategy and issuing orders. Conflicting Orders Upon receipt of an order that conflicts with any previous order, the affected member shall advise the person issuing the conflicting order of the facts of the initial order. Responsibility for the countermanding of the original order will then rest with the person issuing the second order. Attitude During Emergencies All members shall conduct themselves in a calm, controlled, professional manner when operating during an emergency. Members shall be courteous and orderly in their dealings with the public and other members. Members should make every attempt to avoid inappropriate language when on emergency scenes and around patients. Conflicts that may arise with colleagues shall be handled in a calm and professional manner at all times. Any conflict with the public shall be referred to the Incident Commander or Chief Injury or Death in the Line of Duty Non-serious Injury to a Member

In cases where a member receives a non-serious injury (no treatment or minor treatment required) in the line of duty, a written report, completed by the member on the departmental form shall be submitted to either Chief within 24 hours of the injury. Serious Injury to a Member In cases where a member receives an injury of a serious nature in the line of duty, the crew leader shall immediately noti1 the Incident Commander of the injury and the member‟s status. The incident Commander or Chief shall investigate, or cause an investigation of the injury. An injury report form should be completed by the member or their supervisor within 24 hours of the injury. Death of a Member In the case of the death of a member in the line of duty, the Incident Commander shall be notified immediately. In the event of a fatal injury, or an injury that could result in death, the Chief or an officer acting in the Chief‟s absence shall be notified as soon as possible. The Chief shall then notify the physician acting at the head of Health Services, in the event of an obvious fatality on scene, the coroner‟s office and local law enforcement must be notified. It shall be the responsibility of the Chief (or an officer acting in the place) to immediately make every effort to contact the head physician of Health Services and coordinate notification of the death to the Dean of the College and the family. The Western Massachusetts Critical Incident Stress Debriefing Team should be contacted to assist members of the Department. Confidentiality of the Injured At no time shall the name of an injured member, regardless of the condition, be given over the radio. The name of the injured shall not be released to the public or media without authorization of the Chief in coordination with the head of Health Services. Security of Involved Equipment In the event of a serious line of duty injury or fatality, all personal protective equipment in use at the time of the injury shall be marked and placed out of service in a secure location until an investigation can be completed. Termination of Service Resignation Any member may resign from the Department at anytime by submitting in writing their intent, stating the date of resignation and the reason for the resignation. All issued equipment shall be turned into the Chief Public Safety Vehicle permits must be removed from all vehicles belonging to the resigning member. Any member who voluntarily resigns without delinquency or misconduct may apply to be reinstated within twelve months of the effective date of resignation. Leaves of Absence There are four types of leaves of absence available to members: medical, personal, educational, and military. Any member who is unable to perform their duties or is deemed unable to perform their duties for more than a two week period will be placed on medical leave from departmental activities. To return to service after medical leave, the member must submit a permission to return letter from their physician. Any member who expects to be unable to participate in

required departmental activities due to personal reasons may request a personal leave The request must be made in writing to the Chief and include an expected return date. Personal leaves may not exceed six months and will not be granted to non-active members. Educational leaves are for those members who expect to be unable to participate in required departmental activities due to an educational commitment or academic probation. These leaves may not exceed twelve months and must be requested in writing. Military leaves are subject to the same regulations as personal leaves except they may take up to twelve months. Standard of Conduct All members shall conduct their private and professional lives such as to avoid bringing discredit to Smith College, the Department, or other members. All members shall perform their duties as required or directed. Conduct towards other Members and the Public All members shall treat each other with dignity and respect. Members shall be courteous and civil at all times in their professional relationship with one another. All members shall be courteous and orderly in their dealings with the public. They shall perform their duties in a calm, professional manner and avoid inappropriate language. Upon request from a member of the public, members shall provide their name and position in a polite manner. Members must remember that the public will base its perception of the Department on the conduct of its members. Impartial Attitudes All members shall remain completely impartial in their dealings with anyone in need of the Department‟s services. All persons are guaranteed equal protection under the law. Political Activity No member of the Department, whether on or off duty, shall use their official authority or influence to coerce or endorse political action. When off duty, members should not display departmental emblems while engaged in political rallies without the permission of the Chief. Commercial Testimonials Members shall not knowingly permit their names or photographs to be used to endorse any product or service that is connected in any way with EMS, nor shall they allow their names or photographs to be used in any commercial testimonial which alludes to their position or employment in this Department without the written permission of the Chief Manner of Issuing Orders To help foster a healthy working team atmosphere, all orders given shall be issued in a civil tone, in clear and understandable language, and in the pursuit of departmental activities. When operating at emergency scenes, there may be times when an order is issued in a loud tone of voice to overcome background noise. At all other times, orders must be issued in a calm and professional manner. Criticism of Orders Members shall not criticize instructions or orders they have received. If a member has a problem with an order, or its manner of issuance, it should be discussed with the person issuing the order

after the task has been completed. Report of Unjust, Unlawful, or Unsafe Order Any member may report an order that they feel is unjust, unlawful, or unsafe to the Chief. Members must discuss the order with the Chief as well as submit a written statement concerning the order as soon as possible after the incident. If the order was issued by a Chief and the member feels uncomfortable speaking directly to that member, then the issue may be brought to the head physician at Health Services. These situations are rare in their occurrence but are serious in nature. As such, they will be thoroughly investigated by the Department. Prohibited Activity Intoxication and Drug Use It is the policy of the Department to maintain a workplace that is free from the effects of drug and alcohol abuse. No member shall be found to be under the influence of any type of intoxicant, including alcohol and/or drugs of any kind, while on duty for the Department or while wearing the badge, uniform, or official insignia of the Department. In addition, members shall be prohibited from off-premises use of alcohol and possession, use, or sale of illegal drugs when such activities will adversely affect job performance, job safety, or the Department‟s reputation in the Community. Any member who responds to a call and is thought to be intoxicated or under the influence of drugs while operating at an emergency or training will be removed from the scene and will face disciplinary action. Possession of Intoxicating Substances No member shall bring alcohol or other intoxicating substances into the Department office or Health Services. Rewards During the course of duty, members will occasionally be offered gifts from the public for their services. Individual members may accept gifts up to a fifty dollar value, such as flowers, candy, cookies, etc. Discipline Types of Disciplinary Action Disciplinary action for any member of the Department shall generally consist of on of the following • informal or verbal reprimand. • formal or written reprimand, which is placed in the member‟s personnel file. • suspension from duty. • reduction in rank • dismissal. Generally, most problems that arise within the Department can be dealt with informally. Lieutenants and acting officers may issue verbal reprimands to a member, and may recommend

stronger action to either Chief in a written report. In the rare occasion that an incident warrants a stronger response from, the Chief will decide on the most appropriate course of action. Meetings will be scheduled with the member(s) in question as well as with the referring officer to get all sides of the issue. Written accounts from all parties will be requested. After reviewing all of the pertinent information, the Chiefs will then decide upon the most appropriate course of action. If a suspension. demotion, or dismissal is warranted, the Chiefs must discuss the issue with the head physician at Health Services prior to any action. The Chiefs will then meet with the member to discuss the disciplinary action. At this time, the member will receive a written copy of the written report regarding the action. These meetings are considered closed and the disciplinary report considered confidential. Reports Whenever a formal disciplinary action is taken or is being recommended by an officer, a written report containing the following must be submitted to the Chiefs: • name, rank, and assignment of the person subject to disciplinary action. • the date, approximate time and location of the incident. • the policy, standard or SOP that was violated. • a complete statement of the facts associated with the incident. • action taken at the time by the officer submitting the report. • recommendation for further action, if any. Suspension for Criminal Charges Any member arrested for criminal activity will be suspended until acquittal or conviction. If the member is convicted misdemeanor, the Chiefs shall have the option of allowing the member to return to duty. Dismissal for Inactivity Members who allow their activity level to drop below the 75% training attendance rate, and who do not sign up on the EMS schedule (EMS certified members only) over the period of one academic semester will be contacted by the Chief to schedule a meeting regarding their inactivity. The purpose of the meeting is to discuss commitment to the Department and the individual‟s ability to maintain the requirements for active service. If no response is made to the Chief‟s request for a meeting within fourteen (14) days, the member shall automatically be dismissed from the Department. Radio Protocols Non-Emergencies: 1. A radio check must be completed with Public Safety between 19:45 and 20:15 hrs. each shift. The Public Safety dispatcher will page both crew members between 19:45 and 20:15 hrs. using the #133 page code. 2. If by 20:30 hrs. the dispatcher has not conducted a radio check, the FR must call Public Safety x2490 to request a radio check for both crew members.

3. After hearing the beep and the dispatcher‟s message, switch the radio to channel 2. The EMT will respond first and the First Responder second by saying “EMTIFR # loud and clear”. 4. After hearing the dispatcher reply “Received” turn the radio back to channel 1. Leave the radio on channel 1 until beeped again. The radio must be kept switched on and within hearing distance throughout the shift. Emergencies 1. The dispatcher will page both crew members on duty simultaneously using the #133 page code. 2. The radio will beep and the patient information will immediately follow. Upon completion of the patient information, turn the radio to channel 2. The receipt of the information should be acknowledged first by the EMT and then by the First Responder by saying “EMT/FR # received”. 3. The radios must be kept on channel 2 until the termination of the call. 4. If a Public Safety officer is not on the scene when you arrive, the first crew member on scene should announce the arrival of SCEMS by contacting the dispatcher and saying “SCEMS arrived‟. 5. When the patient has either signed a release form, has been taken to Health Services or has been transported off the scene by an ambulance, the crew should terminate the call. The dispatcher should be contacted and one of the crew members will announce that “SCEMS is clear”. Return the radios to channel 1 until beeped again. Other Radio-related information: 1. Requesting an ambulance: SCEMS may request that the Public Safety officer on scene call for an ambulance. The nature of the call, patient(s) current status, vital signs, age, sex, location, along with other relevant information should be relayed to AMR via the Public Safety dispatcher. If Public safety is not present at the scene and an ambulance is needed, a crew member may request it over the radio. Arrival of the ambulance to the scene should be acknowledged to the dispatcher. 2. The chargers should be kept in the office at all times. Dead batteries must be returned to the charger in Health Services as soon as possible. 3. If during the radio check the dispatcher cannot hear you or if our radio begins to beep (and it is not the signal for a call), it is most likely that you need a new battery. Replace the dead battery and return it to Health Services. Regional Run Report Instructions 1. Ambulance Service/company name. 2. Ambulance Unit # if more than one rig belonging to the service. 3. Date of the call. 4. Location of responding unit at time of dispatch.

5. Time Dispatched, please use 24hr time or indicate am/pm 6—9. Indicate specific times as requested using 24 hour time or indicating am or pm. 10. Check here if standing orders were performed. 11. The medical control # of the physician giving orders to the EMTs. 12. Hospital of the physician in #11. 13. Where the patient was taken. 14. Check box corresponding to the type of communication used with the hospital. 15. Indicate the transmission quality by checking the appropriate box (0 not able to reach hospital, P = poor, F = fair, G = good). 16. If anyone assisted at the scene, indicate by checking the appropriate box(es). Also note if CPR was in progress upon arrival. 17. Identify First Responder on scene, if applicable. 18. Name of the patient 19. Patient‟s home address 20. Patient‟s age 21. Check appropriate sex 22. Patient‟s date of birth 23. Patient‟s telephone number 24. Address at which the patient was picked up (ie: Mass Pike, exit 25. The reason the ambulance was called. This is generally a physical complaint (ie: chest pain) by the patient, but it may be the mechanism of injury (MVA) or an observation by a• witness (patient unresponsive). 26. Time at which the incident occurred, if available. This should be obtained from the patient or bystanders, NOT the dispatcher. This is NOT the time the ambulance was called. 27. Patient‟s regular physician. If the patient has a number of physicians, list the one currently treating the patient. 28. Food or Medication Allergies. Check box ONLY if patient denies any allergies. If you are unable to obtain the information, write N/A. 29. Medications being currently taken by the patient. Check box ONLY if patient denies taking any medications. If you are unable to obtain the information, write N/A. 30. All vital signs should be recorded, ALONG WITH THE TIME TAKEN. Blood pressure obtained by palpation should be recorded as 4t##/P (l20/P). If the vitals are not attempted or cannot be obtained, make note 31. Indicate pupil state by checking boxes; if lung sounds are taken, indicate results. 32. Indicate the color, condition, and temperature of the skin (ie: warm, dry, pale). 33. This area makes up a numerical grading system for estimating the severity of the patient‟s

condition. EYE OPENING: (If eyes are closed due to swelling/injuries, record in the comments) Spontaneous — opens eyes without stimulation To voice—if closed, eyes open when patient spoken to or shouted at To Pain—if eyes do not respond to voice, try applying painful stimulus, such as firm pressure to the nail bed None —no eye opening VERBAL RESPONSE: Oriented — patient knows who he/she is, where he/she is and what year and month it is Confused — patient is not able to answer the previous questions correctly, but can produce sentences and phrases and conversational exchanges. Inappropriate— patient speaks or exclaims only a word or two (often swear words). Response is usually obtained only by physical stimulation. Incomprehensible — responses consist of groans, moans, mumbling, etc. None - no verbal response to stimulus pain in the left arm. Patient was collared, placed on a short board, extricated from the vehicle to the long board and secured. Patient‟s arm was placed in a padded ladder splint. “C-Spine immobilized, patient extricated” is NOT sufficient. 39. Check appropriate box if extrication of patient was lengthy (over 10 minutes). If yes, explain in space provided. 40. Signature of each crew member; level of each crew member (student, basic, intermediate, paramedic, defib); and 6 digit STATE number (NOT the med con # or service assigned #). 41. Impression of the crew regarding patient‟s condition. 42. Indicate by checking appropriate box the level at which the crew is functioning. This is not necessarily the highest level of ENT on the crew. Your level of function is tied to the service license as well as staffing (i.e., a paramedic + basic = intermediate crew).V 43. A brief list of BLS equipment used (may supplement #38). EXAMPLE: 4x4, OPA, short & long board, etc. Use the boxes to indicate which of the listed equipment was used. Use the lower line to indicate 02 use and type of mask/cannula. ALS Intubation information including type of airway used (ie: ET, NT, EOA or EGTA), size used, MA EMT of ALS provider performing airway management, time airway adjuncts inserted and number of attempts made. If no attempts are successful, record in #38. 44. Record Mast use including time of leg/abdomen inflation, /\ inflation stage (1 = bleeding control, 2 = splint or full), and MA EMT # inflating MAST. 45. ALE IV or 10 — note information requested, any failures and / MA ENT # of provider. ALE Medication: note information requested. ALE Cardiac Monitoring, Defibrillation and Pacing: note time, strip interpretation (even if no therapy is needed or takes place), joules/inV and EMT # of provider performing skill(s). Strip runs should be attached to the back of the run report.

Check box if semi-automatic defibrillator (SAD) was applied to patient. Identify 1st Responder if 1st Responder SAD was used and identify EMT utilizing the SAD. Paramedics check appropriate boxes of optional skills performed. Note: The Ambulance report is a legal document used by the hospital for treatment and for statistical analysis. Please write completely and clearly.

Overall Protocols for Patient Treatment 1) All calls will be received by Smith College Public Safety via x800 number. 2) After receiving the call and determining the nature of the call to be a medical emergency, Public Safety will dispatch SCEMS. a. If the call depicts a true, life-threatening emergency (list provided) then the Public Safety dispatcher will dispatch Northampton Ambulance before dispatching SCEMS, but then will dispatch SCEMS. b. If the call depicts an emergency, which is not as serious, the Security dispatcher will only dispatch the on-duty SCEMS personnel. 3) Once the SCEMS personnel arrive on the scene of the incident, they will re-asses the situation and administer care as needed according to the protocols for each medical/trauma emergency. a. If the care provided by the SCEMS personnel resolves the situation and the patient feels that he/she needs no further medical care, the SCEMS personnel can terminate the call provided that they feel comfortable with the termination of the situation. b. if the efforts of the SCEMS personnel do not resolve the situation or if further care is needed: i. If the situation is of a serious or life-threatening nature requiring advanced life support (ALS) measures, or if the patient is unresponsive, the SCEMS personnel should contact security to dispatch Northampton Ambulance to the scene before continuing care. ii. If the situation is not serious or life threatening but further medical care is needed by the patient, then the SCEMS personnel should escort the patient to Health Services. Health Services should be notified of the arrival of the patient. 4) If the protocols can‟t be adhered to, the supervisor and/or Health Services should be notified prior to taking actions. Shift protocols for SCEMS 1) Signing in a. Sign in logbook. II a weekday shift, you must sign in before, but no later than 8:00pm. b. Sign out equipment. Make sure that the jump-kit contains all the equipment in the checklist. The equipment, including a radio and extra battery, should be with you at all times throughout the duration of the shift. 2) Make sure that a radio check is performed within the first hour of the shift. a. if the dispatcher does not conduct the radio check, the First Responder must contact Public Safety and request a radio check. b. Follow the procedures detailed in the Radio Protocols. 3) Stay in campus for the duration of the shift. a. At night, you must sleep with clothes on (the uniform shirt and a pair of pants). Also, shoes, equipment and jacket must be placed next to your bed. Taking showers is not allowed during the shift as the response time is increased dramatically.

b. At night, the radios should be placed on channel 1 with the volume turned on high. c. Personnel should not consume alcohol, use recreational drugs, or be in any environment where these are the main activities. Personnel should also be in an area that would not permit them to hear the radio. 4) Answer the radio and go to all calls that you are called for. At the Scene of a Call, your Duties are: 1) Maintain a professional conduct exemplary of SCEMS and the affiliates. This means to keep your cool and be assertive but kind. 2) Keep in mind that your first priority is your safety. 3) Assure that the lines of communication are maintained, between the Public Safety officers and the crew. Keep each other informed of developments as the call progresses. 4) Make sure that the patient feels at ease. This includes providing a private area for patient assessment and questioning. Also explain to the patient what steps you are taking to resolve the situation. 5) Reassure the patient that we uphold the strictest confidentiality guidelines. This is very important, especially if you know the patient. After Termination of the Call 1) The EMT shall contact Public Safety to announce that SCEMS is back in service following the radio protocols. 2) Signing out a. Must sign out before 10:00 am. b If weekend this must be done at 8:00 am. c. Sign out the logbook and equipment book. Return the jumpkit, if any supplies were used, replace them and write them down. Place any dead batteries in charger. Changing Shifts If for some reason you cannot cover a shift assigned to you, it is your responsibility to find a replacement and to contact the Personnel Officer to inform her of the change. Bylaws If two people have shifts that follow each other during the weekend, there is an optional shift change. The persons involved may might set up a meeting place to exchange the jump-kit and radio. For the person terminating the shift, she must sign out before noon. For the person beginning the shift, she must sign in before the end of her shift. Uniforms 1. Pants: either uniform pants or jeans; provided that the blue jeans are clean and have no holes or patches. 2. Shirts: clean SCEMS shirt should be worn tucked in during the entire shift. 3. Shoes: only closed-toe, laced, non-slip rubber sole (sneakers, hiking boots, docs, etc)

should be worn. 4. Appearance: long hair should be tied back, no heavy make-up, no perfume and no dangly jewelry. 5. The SCEMS jacket should be worn when the weather is cold. A long sleeve, solid-colored shirt may be worn under the SCEMS shirt if weather is cold.

Choking Mechanism 1. Tongue 2. Food/small objects 3. Trauma to neck 4. Swelling/spasm of throat 5. Exposure to toxins Signs and Symptoms 1. Stridor 2. Inability to speak 3. Cyanosis 4. Unconsciousness 5. Absence of air movement 6. Wheezing in children Treatment —Conscious Patient 1. Encourage patient to cough it out 2. If patient cannot cough, deliver up to five abdominal thrusts/chest thrusts 3. Use gravity to advantage 4. If unable to clear airway call for an ambulance, otherwise send to Health Services. Treatment —Unconscious Patient 1. Make sure that an ambulance has been called 2. Place patient supine 3. Open airway 4. Attempt to ventilate 5. Reposition head if still can not ventilate 6. Attempt to ventilate again 7. Deliver up to five abdominal thrusts 8. Finger Sweep 9. Attempt to ventilate 10. Repeat sequence until airway cleared or arrive at hospital

Anaphylaxis An Anaphylactic Reaction may present itself as a mild to severe response; management is based upon severity. Assessment Priorities 1. Maintain patient airway, assist ventilations 2. Administer high concentration oxygen by mask 3. Ascertain appropriate history related to event; any previous exposure to antigen, prior medical history, medications, drugs, allergies 4. Determine if patient is in mild or severe distress: Mild Distress—itching, isolated uticaria, no respiratory distress Severe Distress—stridor, bronchospasm, respiratory distress, shock (systolic blood pressure below 90), generalized uticaria Treatment 1. Make sure that an ambulance has been called. 2. Airway management, suction, oxygen to assist ventilations as needed (utilize airway adjuncts —oral/nasal airways when appropriate). a. Elevate lower extremities b. Maintain !!normal!! body temperature c. Administer high flow oxygen (100%) d. NPO (nothing by mouth) 3. Contact Health Services a. In case of severe allergic reaction, if there are signs of shock or respiratory distress, administer epinepherine by auto—injection if ordered by Health Services. Asthma Mechanism/Etiology 1. Degree of respiratory failure 2. Medications, last time taken 3. Past history 4. Anaphylaxis, trauma, epiglottitis Treatment 1. If patient is in respiratory distress call an ambulance 2. ABCs a. If peak flow is less than 250 1pm, call an ambulance

b. If peak flow is greater than 250 1pm, send to Health Services 2. Oxygen, moderate flow 3. Vital signs 4. Breath sounds 5. Comfortable and sitting up COPD/Emphesyma Etiology/ History 1. How typical is this incident 2. Medication, including home oxygen 3. History of respiratory distress 4. History of cardiovascular disease Treatment 1. If patient is in respiratory distress call an ambulance 2. ABCs 3. Oxygen, start at 1-3 1pm and contact Med Con 4. Vital Signs 5. Breath sounds 6. Contact Health Services PULMONARY EDEMA (fluid in the lungs) Mechanism/Etiology 1. Congestive heart failure 2. Overhydration 3. Aspiration of irritating material 4. Inhalation of toxic fumes 5. Drowning 6. Acute myocardial infarction 7. Narcotics overdose 8. Sepsis Signs and Symptoms 1. Dyspnea (difficulty breathing) 2. Anxiety or combativeness

3. Coughing! foamy sputum 4. Tachypnea ( rapid breathing) 5. Abnormal breath sounds 6. Tachycardia (rapid pulse) 7. Cyanosis 8. Pedal edema 9. May progress to cardiac arrest Treatment 1. Make sure an ambulance has been called 2. ABC‟s 3. Place patient in sitting position, as upright as possible 4. Assist ventilation as needed, with positive pressure oxygen at 6-10 1pm 5. Monitor, transport without delay Hyperventilation Mechanism/ Etiology 1. Anxiety and/or stress 2. Metabolic imbalance 3. Head injury Signs and Symptoms 1. Rapid respirations 2. Tingling feeling in mouth, hands, and feet 3. Muscle spasm—hands flexed with thumb toward palm 4. Syncope (fainting) 5. May have feeling of being unable to „catch breath‟ 6. May have a sharp stabbing pain in chest 7. Pulse and blood pressure essentially within normal limits 8. If conscious, patient‟s skin color will be normal Treatment 1. Assess patient for possible causes of hypoxia or shock 2. Calm and reassure patient, try to get patient to slow breathing 3. If no evidence of hypoxia or shock, have patient try to breathe into her own cupped hands

4. If step #3 doesn‟t work, use a simple oxygen mask 5. Contact Health Services Hypoxia/Shock (Diminished Oxygen Delivery to the Body) Mechanism/Etiology 1. Respiratory distress 2. Internal bleeding 3. Multiple trauma (Hypovolemia) 4. Seizures 5. Head injury, Intercranial bleeding, Drug OD 6. Burns affecting the respiratory system 7. Heart failure 8. Environmental—asphyxiation, CO poisoning Signs and Symptoms 1. Air hunger —rapid respirations 2. Altered mental status 3. Weakness, dizziness, visual disturbance 4. Rapid pulse 5. Cyanosis (in later stages) Treatment 1. Make sure that an ambulance has been called 2. Recognize the possibility of hypoxia in ALL patients. Treating it quickly may forestall shock. 3. Maintain a patient airway 4. Give oxygen —moderate flow, 4-6 lpm. Increase as necessary. If COPD, start at 1-3 1pm. 5. Treat any and all injuries 6. Maintain patients body temperature 7. Monitor vital signs, level of consciousness, and any changes until ambulance arrives. Near Drowning Mechanism/Etiology

1. Duration of submersion 2. Water temperature and type 3. Trauma, particularly cervical Treatment 1. Make sure that an ambulance has been called 2. ABCs 3. Cervical immobilization if indicated 4. Heimlich maneuver if indicated 5. High flow oxygen, non-rebreather mask if available Cardiac Arrest (TWO PERSON) Treatment 1. Make sure that an ambulance has been called 2. Determine unresponsiveness and the absence of respiration and pulse 3. If appropriate, initiate CPR using the airway adjuncts and the oxygen. NOTE: NEVER STOP CPR ONCE STARTED -Always start CPR if patient codes after your arrival regardless of any orders to the contrary by family or doctors. -Always begin CPR unless you can prove the patient has conclusive signs of death. Arrhythmia—Asystole Etiology 1. Cardiac disease 2. Trauma 3. Electrical shock Treatment 1. Make sure that an ambulance has been called 2. ABCs Arrhythmia—Brachycardia Etiology 1. Cardiac disease

2. Evidence of trauma 3. Medications Treatment 1. Make sure that an ambulance has been called 2. ABCs Arrhythmia—Pulseless Electrical Activity (PEA) Etiology 1. Cardiac disease 2. Hypovolemia, cardiac tamponade, tension pneumothorax, MI/Cardiac/Septual rupture, Hypoxia, Pulmonary embolus, Hypothermia, Drug overdoses, acidosis, hyperkalemia Treatment 1. Make sure that an ambulance has been called 2. ABCs Arrhythmia—Tachycardia Etiology 1. Cardiac disease 2. Trauma 3. Previous similar episodes 4. History of W-P-W Treatment 1. Make sure that an ambulance has been called 2. ABC Arrhythmia—Ventricular Fibrillation— Pulseless Ventricular Tachycardia Etiology 1. Cardiac disease 2. Trauma Treatment 1. Make sure that an ambulance has been called 2. ABCs

Chest Pain Mechanism/Etiology 1. Cardiac disease 2. Pulmonary disease 3. Pathological rib or sternum fracture 4. Trauma to thorax 5. Gastrointestinal disease Signs and Symptoms 1. Substernal pain or pressure possibly radiating to arm(s) or jaw 2. Dyspnea 3. Diaphoresis (profuse perspiration) 4. Anxiety, confusion, or lethargy 5. Nausea 6. History of heart disease or COPD 7. Possible abnormal vital signs 8. Quality of pain 9. Mode of onset 10. Routine meds, when last taken 11.Trauma Treatment 1. a) If there is an irregular rhythm/pulse, pain radiating to jaw or arm, or history of heart disease, make sure that an ambulance has been called. b) Otherwise, contact Health Services. 2. ABCs 3. Oxygen high flow 8-10 1pm, if COPD start at 1-3 1pm 4. Try to determine what aggravates and what alleviates the pain 5. Place patient in position of comfort Chest Trauma Mechanism/Etiology 1. Motor vehicle accidents 2. Falls 3. Penetrating wounds, impaled objects

4. Blunt trauma 5. Coughing, lifting, turning Signs and Symptoms 1. Pain, especially on inspiration and/or expiration 2. Dyspnea and/or rapid, shallow breaths 3. Paradoxical breathing and/or asymmetry in chest 4. Diminished or absent breath sounds 5. Neck vein distention 6. Tracheal shift from midline 7. Gurgling sounds with sucking chest wound 8. Shock and hypoxia 9. Unequal right and left pulses and blood pressures 10. Subcutaneous emphysema Treatment 1. Make sure that an ambulance has been called 2. ABCs 3. Treat sucking chest wound by covering the wound immediately with a three-sided occlusive dressing. Check for exit wound. 4. Oxygen by mask, 8-10 1pm, if COPD, start at 1-3 1pm. 5. Assume cervical spine injury and immobilize accordingly 6. Complete secondary survey expeditiously 7. Treat any other open wounds 8. Splint any deformities 9. Monitor vital signs 10. Secure, but do not remove, impaled objects Hypovolemia/Shock (Diminished Blood Volume) Mechanism/Etiology 1. Open wounds with extensive bleeding 2. Internal injuries 3. Fracture and/or dislocations particularly involving hips, pelvis, or femurs. 4. Burns involving greater than 10% of the body

5. Motor vehicle accidents (multiple trauma) 6. Vomiting or diarrhea (severe) 7. Diabetes ketoacidosis, characterized by excessive thirst, hunger, urination, vomiting Signs and Symptoms 1. Evidence of hypoxia 2. Diaphoresis (profuse perspiration) 3. Lowered BP, elevated pulse 4. Decreased consciousness or cardiac arrest 5. Internal and/or external bleeding 6. Capillary refill slow or absent 7. Evidence of pelvic or long bone fractures Treatment 1. Make sure that an ambulance has been called 2. Insure a patient airway 3. CPR if necessary 4. Control bleeding 5. Splint any suspected fractures 6. Administer oxygen at 4-6 1pm, if COPD start with 1-3 1pm 7. Monitor vital signs Head Injury Mechanism/Etiology 1. Motor vehicle accident 2. Blunt trauma 3. Falls 4. Penetrating injuries (bullet wounds) 5. Athletic or diving injuries Signs and Symptoms 1. Lacerations or other wounds found on the head 2. Ecchymosis (discoloration of the skin due to internal bleeding) 3. Blood or cerebro-spinal fluid from ears, nose, mouth or open wound 4. Diminished level of consciousness or combative behavior 5. Abnormal or unequal pupils

6. Elevated BP, with slow bounding pulse 7. Diaphoresis 8 Shape of head not symmetrical, evidence of depressions 9. Periorbital bilateral symmetrical ecchymosis ( raccoon‟s eyes) 10. Mastoid ecchymosis (battle signs) 11. Weakness in grip strength! paralysis 12. Headache, dizziness, double or blurred vision, or vomiting Treatment 1. Make sure that an ambulance has been called 2. ABC 3.Assume neck injury and institute cervical immobilization 4. Place patient supine on full spine board 5. Give moderate 6-8 liters oxygen by mask, if COPD start with 1-3 1pm 6. Hyperventilate by assisted ventilation if patient is unresponsive to verbal stimuli 7. Monitor vital signs Neurological Emergencies Mechanism/Etiology 1. Cerebrovascular accident —stroke or intracranial bleed 2. Transient ischemic attack —little stroke 3. Brain tumor 4. Meningitis, Encephalitis 5. Coma Signs and Symptoms 1. Paralysis, hemiparesis, hemiplegia (unequal grip strength) 2. Confusion, apprehension 3. Aphasia, speech disorders 4. Elevated BP with bradycardia 5. Changing level of consciousness 6. Shock, coma 7. Seizures 8. May have elevated body temp Treatment

1. Make sure that an ambulance has been called 2. ABCs 3. Administer moderate to high flow of oxygen by mask. If COPD start with 1 -3 1pm 4. Explain everything being done to the patient. The patient can often hear and understand even if they cannot speak. 5. Monitor vital signs Acute Deceleration (Injuries at risk for cervical spine injury) Note WHEN THE MECHANISM INDICATES THE POSSIBILITY OF SPINAL INJURY, TREAT AS BELOW REGARDLESS OF PREHOSPITAL NEUROLOGICAL FINDINGS. ALL PATIENTS IN MOTOR VEHICLE ACCIDENTS MUST BE C-SPINE IMMOBILIZED PRIOR TO TREATMENT. Mechanism/Etiology 1. All motor vehicle accidents 2. Falls 3. Abuse or assault 4. Athletic or diving injuries 5. Lightning or electrical accidents Sign and Symptoms 1. Presence of multiple trauma 2. Presence of head or facial injuries 3. Unconsciousness following trauma 4. Presence of shock or hypoxia 5. Patient may display no signs and symptoms at first Treatment 1. Make sure that an ambulance has been called 2. ABCs, keep patient from moving his/her head. Place patients head in neutral in-line position without forcing it. Apply cervical collar. 3. Secondary survey 4. Strap patient, supine, to full spine board 5. Place blanket roll on either side of head

6. Secure head to board with kling, cravats, or tape 7. Moderate to high flow oxygen, if COPD start with 1-3 1pm 8. Maintain patients body temperature 9. Monitor vital signs Orthopedic Injury Mechanism/ Etiology 1. Falls 2. MVA 3. Interpersonal violence 4. Industrial accidents 5. Pathological brittle bones, and bone cancer 6. Sports Signs and Symptoms 1. Pain 2. Asymmetry, deformity, angulation 3. Swelling, ecchymosis 4. Point tenderness, crepitus 5. Inability to use extremity 6. Shortening or rotation of extremity 7. Bone fragments exposed Treatment 1. If there is any exposed bone or a high likelihood of fracture, call for an ambulance 2. ABCs 3. Stop obvious bleeding 4. C—collar if indicated 5. Check distal pulses, skin temperature, and capillary refill prior to splinting 6. Attempt to straighten but minimize movement. Splint affected area above and below adjacent joints. If joint is injured, splint in position found. DO NOT force exposed bones back under skin. 7. Re-check distal pulses and capillary refill 8. Apply cold compress if distal pulses and capillary refill are normal after splinting. 9. Contact Health Services 10. Monitor vital signs

Traumatic Amputations Mechanism/Etiology 1. MVA 2. Snow blower or lawn mower accident 3. Industrial machinery accident 4. Explosions Treatment 1. Make sure that an ambulance has been called 2. ABC‟s 3. Control bleeding by direct pressure and elevation. Use tourniquet as last resort. 4. Oxygen at low flow 5. Find amputated part if possible 6. If part is found: a. rinse part with saline b. wrap in saline! sterile water moistened gauze c. seal in plastic bag d. place plastic bag on ice ( cover entire part with ice packs) 7. Monitor vital signs Gunshot Wounds Signs and Symptoms 1. Powder burns if close range 2. Small entrance wound— may have large exit wound 3. Suspect fractures 4. Expect serious internal damage Treatment 1. Make sure that an ambulance has been called 2. ABC 3. Look for exit wound if possible 4. Manipulate patient as little as possible— complete immobilization with full spine board. 5. Give oxygen and monitor vital signs, including capillary refill

Soft Tissue Injury Mechanism/Etiology 1. Blunt trauma 2. Impaled or penetrating trauma 3. Occupational or sports injuries Signs and Symptoms 1 .Bleeding, external 2. Bruising, swelling 3. Tenderness Treatment 1. ABC‟s 2. Visualize area (cut away or remove clothing) 3. Control external bleeding 4. Dress wound and bandage 5. Apply cold pack 6. Elevate if extremity and check distal pulses 7. Contact Health Services 8. Monitor vital signs Acute Abdomen Mechanism/Etiology 1. Blunt or penetrating trauma 2. Appendicitis 3. Cholecystitis 4. Ectopic pregnancy 5. Perforated viscera 6. Aortic aneurysm 7. Other GU or GI pathology Signs and Symptoms 1. Pain which may radiate 2. Nausea or vomiting 3. Tenderness or rigidity on palpation of abdomen 4. Fever

5. Patient may be agitated Treatment 1. If there is a penetrating injury, make sure that an ambulance has been called 2. ABC‟s 3. Oxygen at moderate to high flow, if COPD start with 1-3 1pm. 4. If there is a penetrating injury: a. cover open wound b. treat eviscerated area with dressings soaked in saline or sterile water covered with a bulky dressing. DO NOT try to replace into body. c. if object is impaled, stabilize and leave in place 5. Allow patients to have nothing by mouth 6. Place in position of comfort, monitor vital signs and L.O.C 7. Contact Health Services Seizure Activity Mechanism / Etiology 1. Idiopathic Seizure Disorder ( Epilepsy) 2. Head Injury 3. Alcohol, drug withdrawal 4. Heat stroke 5. Generalized hypoxia 6. Brain Tumor 7. Psychogenic Signs and Symptoms 1. Twitching of part or entire body, ,au be progressive 2. Loss of consciousness —lack of memory of event. 3. Incontinence 4. Post seizure confusion 5. Patient may report „aura „ prior to seizure 6. Irregular heartbeat 7. Initial apnea may occur 8. May have transient cyanosis Treatment

1. Make sure an ambulance has been called. 2. ABC‟s 3. Prevent patient from harming himself. DO NOT force a bite block into the mouth. 4. Moderate to high flow oxygen by mask, if COPD, start with 1-3 1pm 5. Be aware of the possible presence of status epilepticus (two seizure without an intervening period of consciousness) Heat-related Illness Mechanism/Etiology 1. Sustained exposure to intensive heat and/or humidity 2. Sustained physical exertion in a warm environment Signs and Symptoms 1. Changes in level of consciousness 2. Cramps 3. Nausea 4. Dehydration 5. Elevated Temp 6. Shock 7. Abnormal skin temperature 8. Dizziness Treatment 1. ABC‟s 2. Get patient to cool place ASAP 3. Have patient lie down and elevate legs 4. Oxygen at 4-6 1pm cannula, if COPD start with 1-3 1pm 5. Remove excess clothing 6. Monitor vital signs 7. Contact Health Services 8. Sponge face and extremities Hypothermia Mechanism / Etiology 1. Prolonged exposure to low temperatures, especially with windy and wet conditions.

2. Total immersion in cold water 3. Alcoholic population in winter, late fall, and early spring 4. Elderly persons or newborns in poorly heated homes 5. Spinal cord shock 6. Hypovolemic shock 7. Patient on phenothiazines 8. Patient with poor peripheral circulation Signs and Symptoms —Moderate Hypothermia 1. Conscious but apathetic, unable to perform simple tasks 2. Shivering (in early state) 3. Skin pale and cool to the touch Signs and Symptoms —Severe Hypothermia 1. May be unconscious 2. Skin pale and cool to the touch 3. BP low or unobtainable —heart sound may be inaudible 4. Very slow respirations and heart rate Treatment 1. If moderate or severe hypothermia, call an ambulance 2. ABCs 3. Get the patient out of the cold immediately 4. Remove wet clothing— cut clothes away if patient is unresponsive 5. Place the patient on a long spine board and reduce the amount of manipulation you do 6. Cover with blankets and cover the head 7. Administer oxygen and assist ventilations if the rate is less than 5/minute. Do not ventilate too quickly. Keep rate at 8-10/minute 8. Contact Health Services 9. REMEMBER: THE HYPOTHERMIA PATIENT IS NOT DEAD UNTIL HE/SHE IS WARM AND DEAD Intoxication Mechanism / Etiology I. Rapid consumption of an Alcohol Signs and Symptoms

1. Impaired judgment 2. Relaxed inhibitions 3. Impaired motor coordination 4. Significant behavioral change Historical Data Needed 1. Time of last oral intake 2. What did they drink? How much? In what time span? 3. Is there a possibility of any other drug interaction? (Example: Did they smoke pot? Take “ecstasy”? Did anyone slip anything into his or her drink?) Treatment 1. ABC‟s 2. Keep patient awake 3. Maintain airway 4. Prevent aspiration 5. Monitor vitals 6. Transport to either Health Services or CDH depending on severity: • Intoxicated patients who CANNOT walk on their own, and/or have lost consciousness at anytime (before or during examination), must be transported to CDH. • Patient who NEED TO BE “WATCHED,” CANNOT BE LEFT ON—SCENE. They must be transported to either Health Services or CDH, depending on severity. • Patients, who do not need to be “watched” by anyone, may be left on scene. If you feel, in anyway, that a patient needs to be checked on, they are NOT on of these patients. Use this transport decision carefully. When leaving a patient on-scene be sure to explain your decision in detail in your report. BEFORE LEAVING A PATIENT ON SCENE, CLEAR DECISION WITH NURSE ON DUTY AT HEALTH SERVICES. • When in doubt, contact Health Services for transport or follow-up care directions. Poison Mechanism / Etiology 1. Landscape or farm accidents 2. Chemical or hazardous materials transport accident 3. Industrial accident 4. Accidental or intentional ingestion 5. Fires (release of toxic substances) Signs and Symptoms

1. Respiratory distress 2. Epigastric distress or substernal distress 3. Violent or antisocial behavior or lethargy 4. Profuse sweating and salivation 5. Muscle twitching, weakness, or paralysis 6. Altered level of consciousness or coma 7. Abnormal pupil size or reactivity 8. Abnormal skin color Treatment 1. Make sure an ambulance has been called 2. Determine if the environment is safe for you and your patient. If not, remove or have the patient removed by protected rescuers from the dangerous area. 3. ABCs 4. Try to determine type of exposure, estimated dose, and time 5. If suspected ingestion, ascertain if patient has any remarkable odors, especially around mouth; bring labels or containers Substance Abuse Mechanism / Etiology 1. Stimulants 2. Depressants 3. Hallucinogens 4. Narcotics Signs and Symptoms —Stimulants 1. Jittery, hyperactive, restlessness, talkative 2. Loss of appetite 3. Sleeplessness 4. Tachycardia, tachypnea, hypertension 5. Tremor 6. Dilated pupils 7. Patient may exhibit paranoia or violent behavior Treatment— Stimulants 1. ABCs

2. „Talk person down” —keep your voice quiet and calm 3. Contact Health services, unless patient is unconscious then call an ambulance. 4. Be aware that patients with stimulant ingestion may have significant potential for violence Signs and Symptoms— Depressants and Narcotics 1. Respiratory depression 2. Hypotension 3. Decreased levels of consciousness 4. Pinpoint pupils with narcotics Treatment— Depressants and Narcotics 1. Make sure an ambulance has been called 2. ABCs 3. Keep patient awake 4. Maintain airway 5. Prevent aspiration 6. Oxygen by cannula 6. Monitor vitals Signs and Symptoms— Hallucinogens 1. Panic —agitation 2. Hallucinations, visual, auditory, tactile 3. Rapid mood swings 4. Loss of motor coordination 5. Tachycardia —elevated BP 6. Pupils dilated 7. Chills, shivering, fever, sweating 8. Hypersalivation 9. Diminished sensitivity to pain 10. Patient may be violent or paranoid Treatment— Hallucinogens 1. ABC‟s 2. Provide emotional support —keep talking —keep orienting patient 3. Keep stimulation to a minimum 4. Do not leave patient alone 5. Contact Health Services

6. Be aware that patients with Hallucinogen ingestion may have significant potential for violence. Hyperglycemia and Hypoglycemia Mechanism / Etiology 1. Diabetes 2. Acute Pancreatitis 3. Alcoholism and other liver disease 4. Stress Signs and Symptoms— Hyperglycemia (Diabetic Ketoacidosis) 1. Excess urine output 2. Excessive thirst 3. Nausea, vomiting 4. Tachycardia 5. Deep, rapid respirations 6. Warm, dry skin 7. Acetone breath 8. Sometimes fever, abdominal pain, falling blood pressure Signs and Symptoms-—Hypoglycemia (Low Blood Sugar) 1. Weak, rapid pulse 2. Cold, clammy skin 3. Weakness and loss of coordination 4. Headache 5. Irritable, nervous, or bizarre behavior 6. Seizures and comas in severe cases Historical Data Needed 1. Last meal 2. Presence of hunger, thirst or recent stress 3. Is the patient on insulin or oral medication for diabetes? what amounts? 4. Medic Alert Tag? 5. Previous similar history? 6. Was onset sudden or gradual? Treatment

1. If patient is unconscious make sure that an ambulance has been called 2. ABC‟s 3. Ascertain if patient is known diabetic 4. Ascertain time of last meal and/or presence of stress 5. How is diabetes controlled? Insulin? Oral Meds? Diet? Dosage and when? 6. Give glucose containing liquid orally if patient is conscious and can swallow on command. 7. Moderate to high flow oxygen by mask, if COPD, start with 1-3 1pm 8. Contact Health Services 9. Monitor vital signs 10. Keep warm Obstetrics (Pregnancy/Birth) Treatment 1. Make sure that an ambulance has been called Hazardous Materials (Hazmat) Incidents Mechanism 1. Transportation accident 2. Storage tank leaks 3. Industrial accidents 4. Nuclear or biological accidents Hazard Identification 1. Solid, liquid, or gas 2. How exposed? 3. Hazard type: a. Flammable b. Toxic c. Corrosive d. Radioactive e. Reactive f. Infectious 4. Hazard effects: a. Thermal

b. Blast c. Pulmonary d. Mechanical e. Contamination f. Asphyxiation Treatment 1. Make sure that an ambulance has been called Burns Mechanism/Etiology 1. Fire 2. Electricity 3. Lightning 4. Hot fluids! Scalding water 5. Chemical! Hazardous materials Signs and Symptoms 1. Pain —if first or second degree 2. Skin —red, or charred, or leathery or blistered 3. Charred clothing 4. Swelling in throat, coughing, wheezing, or dyspnea (if chest or airway burns are present) 5. Changes in normal speaking voice Treatment 1. For second and third degree burns make sure that an ambulance has been called 2. ABC‟s 3. Ascertain weight of patient (by asking if possible) 4. Estimate percent of body burned, and to what degree 5. Give all burn patients high flow humidified oxygen 6. For THERMAL BURNS: a. Put the fire out on the patient b. Remove patient to a safe, smoke free area c. Rings and all metal should be removed d. Cool moist dressings may be applied to burns of the head and face, or to burns of less than 15% body surface area

7. For CHEMICAL BURNS: a. Flush affected area for at least five minutes b. Remove contaminated clothing 8. For ELECTRICAL BURNS: a. Safely remove patient from source b. Anticipate fractures and splint c. Locate and treat entrance and exit wounds 9. For LIGHTNING: a. Make sure that an ambulance has been called b. Anticipate cardiac arrest and treat c. Anticipate respiratory arrest and treat d. Anticipate fractures and splint e. Look for and treat entrance and exit wounds f. Anticipate cervical spine injury g. Treat any open wounds

EMT Bag Equipment List: Clipboard: Basic protocols EMT guidebook Parking permit Run reports Notes on scene forms Refusal Forms Map of campus Equipment lists Pens Notebook Top Flap: Biohazard bags Sterile burn sheet Chest seal Trauma dressing Thermal blanket Long Back Compartment: OB/GYN kit BVM Suction Non-rebreather mask Nasal Canula Pocket Mask Cervical Collar Left Compartment: Stethoscope Automatic BP/pulse machine Adult BP cuff Child BP cuff Sam splint Middle Compartment: Hot packs Cold packs Gauze sponges Gauze pads Ace bandage

Right Compartment: Airway module (left to rightCatheters for suction Lubricant Connector for tubing to O2 tank (green) Connector for BVM to mask (clear) NPA‟s O2 tank tubing NPA‟s Blue moduleTriangular bandages Ace bandages Tape Rolled gauze Red moduleNon-latex gloves Goggles Pen-lights Green moduleAntiseptic toweletts Bacitracin Ointment Finger splints Trauma sheers Band-Aids Small bandage sheers Tweezers Skin closures Yellow moduleMedicated chest rub-rub under nose if smell of vomit/blood gets too strong Activated charcoal Oral glucose Saline Peak flow meter Peak floe meter mouth pieces Digital thermometer Sterile thermometer covers Outside Side Compartment: Latex gloves Biohazard bags

FR Bag Equipment List: Clipboard: Basic protocols Run reports SCEMS report forms Notes on scene forms Refusal Forms Map of campus Equipment lists Pens Notebook Top Flap: Sterile burn sheet Trauma dressing Thermal blanket Main Compartment: Pocket mask Stethoscope Adult BP cuff Child BP cuff Sam splint Hot packs Cold packs Gauze sponges Gauze pads Ace bandage Triangular bandages Ace bandages Tape Rolled gauze Non-latex gloves Pen-lights Antiseptic toweletts Bacitracin Ointment Finger splints Trauma sheers Band-Aids Small bandage sheers Tweezers Skin closures Saline Oral Glucose

Digital thermometer Sterile thermometer covers Latex gloves Biohazard bags