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INTRODUCTION
The following standards / treatment protocols have been developed according to widely accepted treatment
practices at local, state, and national levels. These standards have been developed, reviewed and endorsed by
the Laurens County EMS Medical Control Physician, Director, and Education Coordinator and approved by the
South Carolina Department of Health and Environmental Control-EMS Division.
While treatment and transport decisions in the field vary, these guidelines can assist the prehospital provider by
standardizing procedures for the most common and routine emergencies encountered, and will be considered
the minimum standards by Laurens County EMS.
Therefore it is imperative that each provider develops a strong understanding of the etiology of an illness and the
application of these protocols. By doing so, providers will be able to evaluate each patient situation, as opposed
to blindly following the protocols. If any situation arises in which the provider is unsure of the most prudent
treatment sequence then that provider should contact medical control for guidance.
It is expected that good judgment be used by all personnel employed by Laurens County EMS in the
LAURENS COUNTY EMS
performance of these skills. Please understand that these standards are to be used in accordance with the level
of training and certification of the provider. The protocols herein encompasses procedures perform by all levels
of certified personnel employed by Laurens County EMS. Personnel may only perform the procedures outlined
within the protocols in accordance with their individual certification level. Some advanced procedures require
specialized learning and special permission from the Medical Control Physician, such as Adult IO Insertion.
Laurens County EMS personnel are required to annually pass a written examination with a minimum score of
80% to be able to function under the auspices of the Standing Orders/Patient Treatment Protocols. All
personnel are responsible for their own individual actions with regards to protocol compliance and any deviation
from the Standards stated herein must be documented and explained.
It is the individual provider’s responsibility to fully understand the Standards of Care and Treatment Protocols
established by the organization.
Information and guidance has been provided by the following organizations in the development of these
standards / treatment protocols:
SOUTH CAROLINA DEPARTMENT OF HEALTH AND ENVIRONMENTAL CONTROL-EMS DIVISION
DEPARTMENT OF TRANSPORTATION GUIDELINES FOR PREHOSPITAL CARE.
AMERICAN HEART ASSOCIATION ADVANCED CARDIAC LIFE SUPPORT.
AMERICAN COLLEGE OF EMERGENCY PHYSICIANS BASIC TRAUMA LIFE SUPPORT.
AMERICAN HEART ASSOCIATION PEDIATRIC ADVANCED LIFE SUPPORT.
AMERICAN HEART ASSOCIATION BASIC CARDIAC LIFE SUPPORT.
AMERICAN COLLEGE OF ORTHOPEDIC SURGEONS.
Laurens County EMS Standards and Treatment Protocols are reviewed on an annual basis and
revised when need dictates.
Randall Reinhardt, MD
Laurens County EMS Medical Control Physician
_____________________________________
Chad A. Burrell Sr.
Laurens County EMS Director
_____________________________________
Michael S. Sullivan
Laurens County EMS Education Coordinator
1
RECORD OF CHANGES/UPDATES
Laurens County EMS
Standards of Care & Treatment Protocols
Date of Date Page Supervisor
Details of Change
Change Entered Number Initials
EZ – I/O added
06-18-08 GP-3
LAURENS COUNTY EMS
Bone Injection Gun Removed
Lopressor and Zofran Added
06-18-08 GP-6-A
Promethizine Removed
Zofran Added
06-18-08 GP-6-B
Lopressor added
06-18-08 C-02-A
New protocol added for Adult Nausea/Vomiting
06-18-08 M-14
Updated to add Zofran to Peds Dosing reference
06-18-08 P-1
Updated Trauma Transport protocol to meet new
06-18-08 T-2
DHEC trauma Guidelines
11-03-08 GP-1 Added King Airways
11-03-08 GP-2 Added King Airways
11-03-08 GP-4-A Added King Airways
11-03-08 GP-5-A Added King Airways
11-03-08 GP-6-A Added Fentanyl
11-03-08 GP-6-B Added Fentanyl
01-01-09 C-02 Changed NTG dosing – 48hrs after ED meds
01-01-09 C-02-A Changed NTG dosing – 48hrs after ED meds
01-01-09 GP-1 Removed Intubation from Basic and EMT-I
01-01-09 GP-2 Removed Intubation from Basic and EMT-I
01-01-09 GP-4-A Removed Intubation from Basic and EMT-I
01-01-09 GP-5-A Removed Intubation from Basic and EMT-I
03-18-10 GP-6A Removed Cardiazem
03-18-10 C-09 Removed Cardiazem
03-18-10 C-10 Removed Cardiazem
03-18-10 GP-7 Added New protocol – Pain management
03-18-10 GP-8 Added new protocol – Blood draw
03-18-10 M-5 Updated NTG dosing info
1
Laurens County Emergency Medical Services
Standards Of Care/Treatment Protocols
TABLE OF CONTENTS
PROTOCOL PAGE ISSUE/
NUMBER I) GENERAL PROCEDURES NUMBER REVISION
DATE
GP-1 Adult-Airway Management 1 01/01/2009
GP-1A Continuous Positive Airway Pressure 2 12/01/2006
GP-2 Pediatric-Airway Management 3 01/01/2009
GP-3 Intravenous Access and Initiation 4 06/01/2008
GP-4 Adult Guidelines for ALS Skills 5 01/01/2006
GP-4A Adult Guidelines for ALS Skills-Adult Table 6 11/01/2009
GP-5 Pediatric Guidelines for ALS Skills 7 01/01/2006
GP-5A Pediatric Guidelines for ALS Skills-Pediatric Table 8 01/01/2009
GP-6 Guidelines for Pre-Hospital Medication Use 9 01/01/2006
GP-6A Guidelines for Pre-Hospital Medication Use – Adult Table 10 03/18/2010
GP-6B Guidelines for Pre-hospital Medication Use- Pediatric Table 11 11/03/2008
GP-7 Pain Management 12 03/18/2010
GP-8 Blood Lab Draw 13 03/18/2010
PROTOCOL PAGE ISSUE/
NUMBER II) CARDIAC EMERGENCIES- ADULT NUMBER REVISION
DATE
C-01 General Cardiac Guidelines 1 10/01/2006
C-02 Acute Coronary Syndrome 2 01/01/2009
C-02-A Acute Coronary Syndrome ECG Stratification & Treatment 2-A 01/01/2009
C-03 Ventricular Ectopy 3 01/01/2006
C-04 Ventricular Fibrillation/Pulseless Ventricular Tachycardia 4 10/01/2006
C-05 Asystole 5 10/01/2006
C-06 Pulseless Electrical Activity (PEA) 6 10/01/2006
C-07 Ventricular Tachycardia-Unstable 7 10/01/2006
C-08 Ventricular Tachycardia-Stable 8 10/01/2006
C-09 Supraventricular Tachycardia-Unstable 9 03/18/2010
C-10 Supraventricular Tachycardia-Stable 10 03/18/2010
C-11 Symptomatic Bradycardia 11 10/01/2006
C-12 Do Not Resuscitate (DNR) 12 01/01/2006
PROTOCOL PAGE ISSUE/
NUMBER III) MEDICAL EMERGENCIES- ADULT NUMBER REVISION
DATE
M-01 General Medical Guidelines 1 10/01/2006
M-02 Altered Level of Consciousness 2 06/01/2006
M-02-A Stroke Protocol 2-A 06/01/2006
M-03 Anaphylactic/Allergic Reaction 3 01/01/2006
M-04 Bronchospasms Moderate/Severe 4 01/01/2006
M-05 Pulmonary Edema/Congestive Heart Failure 5 03/18/10
M-06 Medical Hypotension 6 01/01/2006
M-07 Seizures 7 12/01/2006
M-08 Poisoning/Overdose 8 01/01/2006
M-09 Psychiatric Emergencies 9 01/01/2006
M-10 Obstetrical Emergencies 10 01/01/2006
M-11 Hyperthermia 11 01/01/2006
M-12 Hypothermia 12 12/01/2006
M-13 Acute Abdomen 13 01/01/2006
M-14 Nausea and Vomiting 14 06/01/2008
TABLE OF CONTENTS i
Laurens County Emergency Medical Services
Standards Of Care/Treatment Protocols
ISSUE/
PROTOCOL PAGE REVISION
NUMBER IV) PEDIATRIC EMERGENCIES NUMBER DATE
P-01 General Guidelines 1 06/01/2006
P-02 Pediatric Vital Signs Table 2 10/01/2006
P-03 Neonatal Resuscitation 3 10/01/2006
P-04 Asystole/Pulseless Electrical Activity 4 10/01/2006
P-05 Ventricular Fibrillation/Pulseless Ventricular Tach 5 10/01/2006
P-06 Symptomatic Bradycardia 6 10/01/2006
P-07 Pediatric Hypotension 7 01/01/2006
P-08 Seizures 8 12/01/2006
P-09 Altered Level of Consciousness 9 01/01/2006
P-10 Asthma/Restrictive Airway Disease 10 01/01/2006
P-11 Pediatric Poisoning/Ingestion 11 01/01/2006
P-12 Anaphylactic/Allergic Reaction 12 01/01/2006
ISSUE/
PROTOCOL PAGE REVISION
NUMBER V) TRAUMA MANAGEMENT NUMBER DATE
T-01 General Trauma Guidelines 1 10/01/2006
T-02 Trauma Transport Protocol 2 06/30/2008
T-03 Multiple Trauma/Hypovolemic Shock 3 01/01/2006
T-04 Traumatic Arrest 4 01/01/2006
T-05 Tension Pneumothorax/Pleural Decompression 5 01/01/2006
T-06 Burns/Thermal Injuries 6 01/01/2006
T-07 Head Trauma 7 01/01/2006
T-08 Near Drowning 8 01/01/2006
T-09 Snake Bites/Envenomations 9 01/01/2006
T-10 Extremity Trauma/Amputation 10 01/01/2006
Various Appendences
TABLE OF CONTENTS ii
LAURENS COUNTY EMS
GENERAL
PROCEDURES
STANDARDS OF CARE
&
TREATMENT PROTOCOLS
GENERAL PROCEDURES- ADULT AIRWAY
TREATMENT PROTOCOLS MANAGEMENT
ISSUED: 01/01/06 ______________________________________
GP-1 Randall Reinhardt, MD
Revised: 01/01/09 Laurens County EMS Medical Control Physician
PATIENT ASSESSMENT DEFINITIONS:
Open and clear the airway. Protect cervical spine, if any
suspicion of trauma. Obtain Pulse Oximetry reading (if Mild Distress = Dyspnea with Normal Work
available). Assess for the following; of Breathing
Dyspnea Moderate/Severe Distress = Wheezes, Rales, Stridor,
Wheezes Cyanosis, Retraction, etc.
Rales PULSE OXIMETRY SCALE:
Stridor
Cyanosis 95-100% Normal
Retraction, Unequal or Diminished Breath Sounds 91-94% Mild Hypoxia
History; Asthma, COPD, CHF, Allergies, Envenomations 86-90% Moderate Hypoxia
LAURENS COUNTY EMS
or Exposure to Toxins 85% or Less Severe Hypoxia
MANAGEMENT
EMT-BASIC EMT-INTERMEDIATE EMT-PARAMEDIC
Airway Obstruction: Continue / Initiate: Basic Continue / Initiate: Basic &
BLS Procedures Management Intermediate Management
Direct Laryngoscopy/Magill
Forceps/Suction
Respiratory Rate >10/min Apenic, Hypoxic, Severe Distress, If patient is Apneic, Hypoxic, Severe
Administer Oxygen as Indicated: Comatose, Unable to Maintain Distress, Comatose, Unable to
Mild Distress Respirations, Semi-Conscious- Maintain Respirations, Semi-
Nasal Cannula 2-6 LPM Provide and Maintain Respirations by Conscious- Provide and Maintain
Appropriate Means: Respirations by Appropriate Means:
Moderate/Severe Distress
NRB Mask 10-15 LPM
Oral or Nasal Intubation
COPD: History of COPD and is NOT LMA
Cyanotic or in Severe Distress; LMA
Nasal Cannula 2 LPM King Airway
King Airway
TRAUMA: Mechanism of Injury and/or
Severe Trauma;
End Tidal CO2 Detector or End Tidal CO2 Detector or
NRB MASK 10-15 LPM
CHF/Pulmonary Edema: equivalent must Be Utilized with equivalent must Be Utilized with
All Advanced airways All Advanced airways/Intubations
Consider CPAP per protocol
Apenic, Hypoxic, Severe Distress,
Comatose, Unable to Maintain
Respirations, Semi-Conscious-
Provide and Maintain Respirations by
Appropriate Means:
Ventilation Rate 12-20 per Minute
Bag Valve Mask/Reservoir/O2
Oro or Nasal Pharyngeal Airway
LMA/King Airway
Cardiac and/or Respiratory
Arrest Only
Request Paramedic Assistance
End Tidal CO2 Detector or
equivalent must Be Utilized with
All Advanced airways
1
GENERAL PROCEDURES- Continuous Positive Airway Pressure
TREATMENT PROTOCOLS CPAP
ISSUED: 12-01-06 ______________________________________
GP-1A Randall Reinhardt, MD
Laurens County EMS Medical Control Physician
Continuous Positive Airway Pressure (CPAP)
Approved for application by all certification levels
Paramedics must attend patients during transport
Continuous Positive Airway Pressure has been shown to rapidly improve vital signs, gas exchange, the work of breathing,
and decrease the sense of dyspnea which may decrease the need for endotracheal intubation in the patients who suffer
from shortness of breath due to pulmonary edema and CHF. In patients with CHF, CPAP will improve the patients’
hemodynamics by reducing preload and afterload.
⇒ Consider Positive Pressure Ventilations and Intubation if patient is unresponsive to verbal stimuli (GCS is <9) or
patient does not improve or worsens within 5 minutes.
LAURENS COUNTY EMS
Indications: MUST document
1. Any patient who presents with hypoxia or impending hypoxia and has SOB/Dyspnea consistent with pulmonary
edema/CHF and:
• Able to maintain sitting position
• Is awake and oriented
• Is over 12 years old and is able to fit the CPAP mask
• Has the ability to maintain an open airway (GCS>9) and able to follow commands
• Has a respiratory rate greater than 24 breaths per minute
• Has a systolic blood pressure > 90 mmHg
Contraindications
• Patient is in respiratory arrest
• Patient is suspected of having a pneumothorax
• Patient has a tracheotomy
Procedure
1. EXPLAIN THE PROCEDURE TO THE PATIENT
2. Ensure adequate oxygen supply to ventilate device (1000 in tank when establishing CPAP)
3. Place the patient on continuous pulse oximeter
4. Instruct patient to breath in through their nose slowly and exhale through their mouth as long as possible
5. Allow patient to place the delivery device over the mouth and nose
6. Explain to the patient, “You are going to feel some pressure from the mask but this will help you breathe easier.”
7. Slowly titrate setting to desired effect. Max of 10 cm H20 of PEEP. Document settings
8. Secure the mask with provided straps or the other provided devices
9. Check for air leaks
10. Monitor Cardiac activity, pulse ox and document the patient’s respiratory response to the treatment
11. Monitor and document vital signs q 5 minutes during administration of CPAP
12. Continue with Pharmacological intervention as indicated per protocol
13. Continue to coach patient to keep mask in place and readjust as needed
14. Most patients will improve within 5 minutes. If no improvement within this time, consider intermittent positive pressure
ventilation
15. Notify receiving hospital to advise the respiratory department
16. If respiratory status deteriorates, remove device and consider intermittent positive pressure ventilation with or without
endotracheal intubation
Removal Procedure
Enroute
1. CPAP therapy needs to be continuous and should not be removed unless the patient cannot tolerate the mask
or experiences continued or worsening respiratory failure
2. Intermittent positive pressure ventilation and/or intubation should be considered if the patient has to be removed
from CPAP therapy
At Hospital
1. Do not remove CPAP until hospital therapy is ready to be placed on patient
1
GENERAL PROCEDURES- PEDIATRIC AIRWAY
TREATMENT PROTOCOLS MANAGEMENT
ISSUED: 01/01/06 ______________________________________
GP-2 Randall Reinhardt, MD
Revised: 01-01-09 Laurens County EMS Medical Control Physician
PATIENT ASSESSMENT DEFINITIONS:
Open and clear the airway. Protect cervical spine, if any
suspicion of trauma. Obtain Pulse Oximetry reading (if Mild Distress = Dyspnea with Normal Work
available). Assess for the following; of Breathing
Dyspnea Moderate/Severe Distress = Wheezes, Rales, Stridor,
Wheezes Cyanosis, Retraction, etc.
Rales PULSE OXIMETRY SCALE:
Stridor
Cyanosis 95-100% Normal
Retraction, Unequal or Diminished Breath Sounds 91-94% Mild Hypoxia
Tracheal Tugging / Tripod Positioning 86-90% Moderate Hypoxia
LAURENS COUNTY EMS
History; Asthma, Allergies, Fever, Obstructions, Illness, 85% or Less Severe Hypoxia
Envenomations or Exposure to Toxins
MANAGEMENT
EMT-BASIC EMT-INTERMEDIATE EMT-PARAMEDIC
Airway Obstruction: Continue / Initiate: Basic Continue / Initiate: Basic &
BLS Procedures Management Intermediate Management
Respiratory Rate >12/min Airway Obstruction: If the patient is Apenic, Hypoxic,
Administer Oxygen as Indicated: Direct Laryngoscopy/Magill Severe Distress, Comatose, Unable to
Mild Distress Forceps/Suction Maintain Respirations, Semi-
Pediatric Nasal Cannula 2-4 LPM Conscious- Provide and Maintain
Respirations by Appropriate Means:
Moderate/Severe Distress
Pediatric Mask 6-10 LPM
Oral Intubation
Blow By Oxygen Administration- Apenic, Hypoxic, Severe Distress,
Oxygen Flow @ 5 LPM Comatose, Unable to Maintain
½ inch – Approximately 80% Respirations, Semi-Conscious-
End Tidal CO2 Detector or
1 inch – Approximately 60% Provide and Maintain Respirations by
equivalent must Be Utilized with
2 inch – Approximately 40% Appropriate Means:
All Advanced airways, including
Ventilation Rate 20-30 per Minute
Intubaton
Apenic, Hypoxic, Severe Distress, Bag Valve Mask/Reservoir/O2
Comatose, Unable to Maintain
Oro-Pharyngeal Airway
Respirations, Semi-Conscious-
Provide and Maintain Respirations by LMA
Appropriate Means: King Airway
Ventilation Rate 20-30 per Minute
DO NOT VISUALIZE IF
Bag Valve Mask/Reservoir/O2 EPIGLOTITIS IS SUSPECTED
Oro-Pharyngeal Airway
Request Paramedic Assistance
End Tidal CO2 Detector or
equivalent must Be Utilized with
All Advanced airways
2
GENERAL PROCEDURES- INTRAVENOUS
TREATMENT PROTOCOLS ACCESS AND INITIATION
ISSUED: 01/01/06 ______________________________________
GP-3 Randall Reinhardt, MD
Revised: 06/01/08 Laurens County EMS Medical Director
PATIENT ASSESSMENT GENERAL
♦ Assess Patient for Indications and Use Aseptic Technique. Alternate IV sites may be used for any life or limb threatening
situation when upper extremity veins are inaccessible.
♦ Select Appropriate Size Catheter
♦ IV Attempts are limited to (3) three on Non-Critical Patients. Cardiac Arrest
Severe Trauma
♦ The Paramedic or EMT-Intermediate may establish IV access Shock and/or Hypotension
in any patient not specifically addressed in these protocols, if Severe Burns
venous access is deemed necessary, based on history,
examination, and/or mechanism of injury Intraosseous Access
Pt must be hemodynamically unstable (shock) with a
documented decreased level of consciousness.
Confirm BGL prior to any attempts of IO access in
LAURENS COUNTY EMS
non-traumatic situations. Site not to be used solely
for hypoglycemic treatment.
MANAGEMENT
EMT-BASIC EMT-INTERMEDIATE EMT-PARAMEDIC
EMT-Basic’s are not allowed to Saline-Lock: For IV Access. External Jugular Vein
establish Intravenous Access. May be used in place of D5W Adult
Flush with 1-2 cc’s of Normal Pediatric > 2 years of age
If Intravenous Access is Deemed Saline.
May be converted to appropriate Intraosseous Infusion:
Necessary: EMT-P’s must be cleared by training
fluid as patient condition warrants.
department prior to performing in the
Request Paramedic Assistance Normal Saline (0.9% Sodium field.
Chloride): IO Indications:
Unstable Patients Shock with obvious decreased level
Hypotensive Patients of consciousness after (2) two
Cardiac Arrest attempts to start peripheral IV’s are
Trauma Patients unsuccessful or 90 seconds
Largest Catheter Possible
Two Sites Preferred Cardiac/Respiratory Arrest after (2)
Lactated Ringers two attempts to start peripheral IV’s
Burns are unsuccessful or 90 seconds
Trauma Patients
Largest Catheter Possible IO Limited to Proximal Anterior
Two Sites Preferred Tibia
Saline-Lock or D5W KVO
Congestive Heart Failure
♦ Patients < 3 kg
Pulmonary Edema Standard hand driven device
Jamshidi
Dialysis Patients
Blood Drawn (EMT-I/Paramedic ♦ Patients 3 - 39 kg
EZ-IO PD
Discretion) If IV placed, attempt
Min 5 cc bolus required prior to med
to obtain blood samples on all or fluid administration
patients who are being Place wrist band
transported to Laurens County Monitor site and surrounding area
Hosp. Label with the following: for signs of infiltration
Patient Name
Date/Time collected ♦ Patients =/> 40 kg
SS# or DOB EZ-IO AD
EMT-I Name Minimum 10 cc bolus required prior
to med or fluid administration
Lower Extremities- Adult & Place wrist band
Pediatric. Monitor site and surrounding area
for signs of infiltration
Request Paramedic Assistance
3
GENERAL PROCEDURES- ADULT
TREATMENT PROTOCOLS GUIDELINES FOR ALS SKILLS
ISSUED: 01/01/06 ______________________________________
GP-4 Randall Reinhardt, MD
Laurens County EMS Medical Control Physician
The advanced life support (ALS) skills listed in the APPROVED SKILL’s LIST - ADULT have been
approved for prehospital use by Laurens County EMS under the authority of the Laurens County EMS
Medical Director, and the Department of Health and Environmental Control - Division of Emergency
Medical Services (DHEC).
THE USE OF UNAUTHORIZED SKILLS OR PROCEDURES, WHETHER ORDERED BY A
PHYSICIAN OR NOT IS PROHIBITED. If a skill or procedure is used that is not listed on the skill’s
list, personnel are operating outside the approved scope of practice for Laurens County EMS and
possibly in violation of State Law.
LAURENS COUNTY EMS
• STANDING ORDER SKILLS (“OFF-LINE MEDICAL CONTROL”)
ALS skills with an X listed under the heading of “STANDING ORDERS” may be initiated and used prior to
contacting a hospital or Medical Control. [ONLY IF THE PATIENT MEETS THE REQUIREMENTS
OUTLINED IN THE APPROPRIATE STANDING ORDER.]
• PHYSICIAN ORDERED SKILLS (“ON-LINE MEDICAL CONTROL”)
ALS skills with X under the heading of “PHYSICIAN ORDERS” may be initiated and used if ordered by a
licensed South Carolina physician.
A physician may elect to authorize a skill or procedure in addition to Standing Orders (i.e., the physician
may order MAST application on a patient suffering from a head injury and hypotension).
Physicians have the authority to order a skill or procedure based on the patient’s presenting condition
from information relayed by the prehospital provider, other medical personnel, or personal exam. If the
order is appropriate, no known contraindications exist and the ordering physician will sign the DHEC
report, follow the order. Laurens County EMS personnel may not initiate a procedure that they are not
allowed to perform by State guidelines, even if ordered by a physician.
• CERTIFICATION LEVEL
Laurens County EMS employs three levels of Emergency Medical Technicians within the organization. All
personnel are required to follow the individual guidelines appropriate for their level of certification.
Personnel may not perform procedures that are not within their individual certification level scope of
practice.
Emergency Medical Technician-Basic
Emergency Medical Technician-Intermediate
Emergency Medical Technician-Paramedic
The established Laurens County EMS Patient Treatment Protocols encompass Basic, Intermediate, and
Paramedic Levels of care. All personnel are required to understand and be familiar with the Patient
Treatment Protocols. Personnel shall only perform the procedures outlined within the Patient Treatment
Protocols in accordance with their individual certification level.
4
GENERAL PROCEDURES- ADULT-TABLE
TREATMENT PROTOCOLS GUIDELINES FOR ALS SKILLS
ISSUED: 01/01/06 ______________________________________
GP-4-A Randall Reinhardt, MD
Revised: 11/01/09 Laurens County EMS Medical Control Physician
STANDING PHYSICIAN
APPROVED SKILL ORDER ORDER EMT EMT-I PARAMEDIC
AIRWAY MANAGEMENT
Oral Intubation X X X
Nasal Intubation X X X
LMA X X X X X
King LTD/LTSD X X X X X
Sterile Suctioning X X X X X
End Tidal CO2 Detector X X X X X
CPAP X X X X X
LAURENS COUNTY EMS
MEDICATION ADMINISTRATION
Mix / prepared medications X X X
Administration Routes
Intravenous (IV) X X X
Intraosseous (IO) X X X
Endotracheal (ET) X X X
Subcutaneous (SQ) X X X
Intramuscular (IM) X X X
Mouth (PO) X X X
Sublingual (SL) X X X
Inhalation (IH) X X X
Patient Assisted Medications X X X X X
VASCULAR ACCESS
Upper Extremity Insertion X X X X
Lower Extremity Insertion X X X X
External Jugular Vein Insertion X X X
Intraosseous Insertion X X X
CARDIORESPIRATORY
Interpretation of Cardiac Monitor X X X
Defibrillation X X X
Synchronized Cardioversion X X X
External Pacemaker X X X
OTHER
Pleural Decompression X X X
MAST Suit Application X X X X X
Blood Glucose Analysis X X X X X
Draw Blood Sample X X X X
Application of Pulse Oximeter X X X X X
CO2 Detector X X X X X
5
GENERAL PROCEDURES- PEDIATRIC
TREATMENT PROTOCOLS GUIDELINES FOR ALS SKILLS
ISSUED: 01/01/06 ______________________________________
GP-5 Randall Reinhardt, MD
Laurens County EMS Medical Control Physician
The advanced life support (ALS) skills listed in the APPROVED SKILL’s LIST - PEDIATRIC have been
approved for prehospital use by Laurens County EMS under the authority of the Laurens County EMS
Medical Director, and the Department of Health and Environmental Control - Division of Emergency
Medical Services (DHEC).
THE USE OF UNAUTHORIZED SKILLS OR PROCEDURES, WHETHER ORDERED BY A
PHYSICIAN OR NOT IS PROHIBITED. If a skill or procedure is used that is not listed on the skill’s
list, personnel are operating outside the approved scope of practice for Laurens County EMS and
possibly in violation of State Law.
LAURENS COUNTY EMS
• STANDING ORDER SKILLS (“OFF-LINE MEDICAL CONTROL”)
ALS skills with an X listed under the heading of “STANDING ORDERS” may be initiated and used prior to
contacting a hospital or Medical Control. [ONLY IF THE PATIENT MEETS THE REQUIREMENTS
OUTLINED IN THE APPROPRIATE STANDING ORDER.]
• PHYSICIAN ORDERED SKILLS (“ON-LINE MEDICAL CONTROL”)
ALS skills with X under the heading of “PHYSICIAN ORDERS” may be initiated and used if ordered by a
licensed South Carolina physician.
A physician may elect to authorize a skill or procedure in addition to Standing Orders (i.e., the physician
may order MAST application on a patient suffering from a head injury and hypotension).
Physicians have the authority to order a skill or procedure based on the patient’s presenting condition
from information relayed by the prehospital provider, other medical personnel, or personal exam. If the
order is appropriate, no known contraindications exist and the ordering physician will sign the DHEC
report, follow the order. Laurens County EMS personnel may not initiate a procedure that they are not
allowed to perform by State guidelines, even if ordered by a physician.
• CERTIFICATION LEVEL
Laurens County EMS employs three levels of Emergency Medical Technicians within the organization. All
personnel are required to follow the individual guidelines appropriate for their level of certification.
Personnel may not perform procedures that are not within their individual certification level scope of
practice.
Emergency Medical Technician-Basic
Emergency Medical Technician-Intermediate
Emergency Medical Technician-Paramedic
The established Laurens County EMS Patient Treatment Protocols encompass Basic, Intermediate, and
Paramedic Levels of care. All personnel are required to understand and be familiar with the Patient
Treatment Protocols. Personnel shall only perform the procedures outlined within the Patient Treatment
Protocols in accordance with their individual certification level.
6
GENERAL PROCEDURES- PEDIATRIC-TABLE
TREATMENT PROTOCOLS GUIDELINES FOR ALS SKILLS
ISSUED: 01/01/06 ______________________________________
GP-5-A Randall Reinhardt, MD
Revised: 01-01-09 Laurens County EMS Medical Control Physician
STANDING PHYSICIAN
APPROVED SKILL ORDER ORDER EMT EMT-I PARAMEDIC
AIRWAY MANAGEMENT
• Oral Intubation X X X
• Sterile Suctioning X X X X X
• End Tidal CO2 Detector X X X X
• LMA X X X X
• King LTD/LTSD X X X X X
LAURENS COUNTY EMS
MEDICATION ADMINISTRATION
Mix / prepared medications X X X
Administration Routes
• Intravenous (IV) X X X
• Endotracheal (ET) X X X
• Subcutaneous (SQ) X X X
• Intramuscular (IM) X X
• Mouth (PO) X X
• Sublingual (SL) X X
• Rectal (Rec) X X
• Intraosseous (IO) X X X
• Inhalation (IH) X X X
VENOUS ACCESS
• Upper Extremity Insertion X X X X
• Lower Extremity Insertion X X X X
• External Jugular Vein Insertion X X X
• Intraosseous Insertion X X X
CARDIORESPIRATORY
• Interpretation of Cardiac Monitor X X X
• Defibrillation X X X
• Synchronized Cardioversion X X X
• External Pacemaker X X X
OTHER
• Pleural Decompression X X X
• MAST Suit Application X X X X X
• Blood Glucose Analysis X X X X X
• Draw Blood Sample X X X X
• Application of Pulse Oximeter X X X X X
7
GENERAL PROCEDURES- GUIDELINES FOR
TREATMENT PROTOCOLS PREHOSPITAL MEDICATION USE
ISSUED: 01/01/06 ______________________________________
GP-6 Randall Reinhardt, MD
Laurens County EMS Medical Control Physician
The listed medications have been approved for prehospital administration by Laurens County EMS Paramedics
under the authority of the Laurens County EMS Medical Director, and the Department of Health and Environmental
Control - Division of Emergency Medical Services (DHEC).
Only approved medications and administration routes will be used. (i.e. a physician orders a medication administered
IM that is only approved for IV use). If personnel administer the medication as ordered, and is not an approved
medication or route of administration they are operating outside the approved scope of practice for Laurens County
EMS and in violation of the State Law.
• STANDING ORDER MEDICATIONS (“OFF-LINE MEDICAL CONTROL”)
LAURENS COUNTY EMS
The medication with an X listed under the heading of “STANDING ORDERS” may be administered prior to contacting
a hospital or Medical Control [ONLY IF THE PATIENT MEETS THE REQUIREMENTS OUTLINED IN THE
APPROPRIATE STANDING ORDER].
As a paramedic with Laurens County EMS, you are responsible for all information regarding each medication
published in the STATE APPROVED DRUG LIST prepared by DHEC. A copy of the approved drug list, in which
Laurens County EMS is authorized to administer and maintain, is listed in the appendix section of this manual.
• PHYSICIAN ORDER MEDICATIONS (“ON-LINE MEDICAL CONTROL”)
The medication with an X listed under the heading of “PHYSICIAN ORDERS” may be administered if ordered by a
license South Carolina physician. It is the responsibility of all paramedics employed with Laurens County EMS to be
aware of each medication approved dosage range that is printed on the STATE APPROVED DRUG LIST.
A physician may elect to issue a medication order in addition to the standing orders. (i.e. the physician orders
Lidocaine drip prior to termination of ventricular arrhythmia). If the order and route is appropriate, and the physician
will sign the DHEC, follow the order.
Physicians have the authority to order a medication based on the patient’s presenting condition and on information
received from prehospital provider, other medical personnel, or past history of the patient. Unless there is a known,
listed contraindication or route discrepancy, per DHEC guidelines, Laurens County EMS personnel shall follow the
order.
EMT-Intermediates and EMT-Basics may assist patients in taking prescribed medications as outlined in the Adult
Medication Table. The medication must be prescribed for the individual patient and the patient must have the
medication in his/her possession. The EMT-Intermediate or EMT-Basic must verify the following:
The Medication is Prescribed for the Patient
Medication is Not Expired
Patient is Alert/Oriented
No Contraindications are Present
The following Listed medications are approved for “Patient Assisted” administration and are not carried on the
ambulance by the EMT-Intermediate or EMT-Basic:
Epi Auto-Injector
Nitroglycerin
Prescribed Inhaler (Albuterol, Ventolin, Bronksol, Alupent, Metaprel, Proventil)
The following listed medications are carried on the ambulance and are approved for administration by EMT-
Intermediate and EMT-Basic:
Activated Charcoal
Oxygen
Oral Glucose
8
GENERAL PROCEDURES- ADULT TABLE FOR
TREATMENT PROTOCOLS PREHOSPITAL MEDICATION USE
ISSUED: 01/01/06
GP-6-A ______________________________________
Revised: 03/18/10 Randall Reinhardt, MD
Laurens County EMS Medical Control Physician
STANDING PHYSICIAN
MEDICATION ORDERS ORDERS APPROVED ROUTES
IV IO ET SQ IM PO SL INH
Activated Charcoal X
Adenosine X X
Albuterol Sulfate X
Aspirin X
Atropine Sulfate X X X X
Calcium Gluconate X X
Dextrose 50% X X
LAURENS COUNTY EMS
Diphenhydramine X X X
Dopamine X X
Epinephrine 1:10,000 X X X
Epinephrine 1:1,000 X
Fentanyl X X X
Furosemide X X X
Glucagon X
Heparin X
Lidocaine X X X
Lopressor X X
Lorazepam X X X
Magnesium Sulfate X X
Morphine X X X
Naloxone X X X X X
Nitroglycerin X
Procainamide X X
Solu-Medrol X
Sodium Bicarbonate X X
Syrup of Ipecac X
Thiamine X
Zofran X X
PATIENT ASSISTED/EMT MEDICATIONS
Activated Charcoal X
Epi Auto-Injector X
Nitroglycerin (pt. assist) X
Oral Glucose X
Prescribed Inhaler X
LEGEND:
IV Administered via established peripheral Intravenous Line.
IO Administered via established Intraosseous line.
ET Administered via established Oral or Nasal Tracheal Tube.
SQ Administered via Subcutaneous Injection
IM Administered via Intramuscular Injection
PO Administered via Mouth
SL Administered via Sublingual Route
INH Administered via Nebulized Aerosol or Inhalation Therapy
9
GENERAL PROCEDURES- PEDIATRIC TABLE FOR
TREATMENT PROTOCOLS PREHOSPITAL MEDICATION USE
ISSUED: 01/01/06 ______________________________________
GP-6-B Randall Reinhardt, MD
Revised: 11-03-08 Laurens County EMS Medical Control Physician
STANDING PHYSICIAN
MEDICATION ORDERS ORDERS APPROVED ROUTES
IV IO ET SQ IM PO SL INH
Activated Charcoal X
Albuterol Sulfate X
Atropine Sulfate X X X
Dextrose D25 or D50 X X
Diphenhydramine X X X
Dopamine X X
Epinephrine 1:10,000 X X X
LAURENS COUNTY EMS
Epinephrine 1:1,000 X X X X
Fentanyl X X X
Furosemide X X X
Glucagon X
Lidocaine X X X
Lorazepam X X X
Morphine X X X
Naloxone X X X X X
Racemic Epinephrine X
Sodium Bicarbonate X X
Solu-Medrol X
Syrup of Ipecac X
Zofran X X X
PATIENT ASSISTED/EMT MEDICATIONS
Activated Charcoal X
Epi Auto-Injector X
Oral Glucose X
Prescribed Inhaler X
LEGEND:
IO Administered via established Intraosseous Line
IV Administered via established peripheral Intravenous Line.
ET Administered via established Oral or Nasal Tracheal Tube.
SQ Administered via Subcutaneous Injection
IM Administered via Intramuscular Injection
PO Administered via Mouth
SL Administered via Sublingual Route
INH Administered via Nebulized Aerosol or Inhalation Therapy
10
GENERAL PROCEDURES- PAIN MANAGEMENT
TREATMENT PROTOCOLS
ISSUED: 03/18/10 ______________________________________
GP-7 Randall Reinhardt, MD
Laurens County EMS Medical Control Physician
This protocol was developed to provide our Documentation
personnel with a standard of care for assessing,
documenting and treating complaints of pain. Providers shall evaluate/document the following
When evaluating/treating pain, providers should when managing patients complaining of pain
keep the following in mind: Baseline Vital Signs/SpO2
Many times pain is subjective (ie. Pain that may Repeat V/S according to protocol
be minor to one person may be more severe to Baseline Pain Scale (1-10)
someone else). Current medications being taken, prescription
Although the pain may not be unbearable, easing and non-prescription
the pain may help the patient relax and thus be
beneficial to the overall situation.
Other pertinent information
Steps taken by the patient to mitigate the pain
LAURENS COUNTY EMS
In some cases, effective pain management may
Concurrent Alcohol use
facilitate overall patient management.
The quality of care received is often judged based
on the effectiveness of the pain management Note: When contacting on-line MD for medication
methods. orders, it may be helpful to advise them of the
medications that we have available on our units.
MANAGEMENT
EMT-BASIC EMT-INTERMEDIATE EMT-PARAMEDIC
Assist patient in finding position of comfort. Continue / Initiate: Basic &
Intermediate Management
In the case of fractures/orthopedic injuries
elevation may help limit swelling/reduce pain Consider:
splinting injury may reduce pain Pharmacologic Interventions
provide padding with blanket, towels or foam blocks if this will help
reduce pain ON-LINE MEDICAL CONTROL
ORDER REQUIRED:
Place cold pack, wrapped in towel on fracture site to minimize swelling and
pain Fentanyl 25-50mcg IV/IO
Slow administration
Titrate to patient response
Max administration 100mcg
Faster onset/ shorter duration
than Morphine
Less vasodilatation than Morphine
Morphine Sulfate 5-15mg IV/IO
Slow administration
Titrate to patient response
Max administration 15 mg
May cause vasodilatation /
hypotension
1
GENERAL PROCEDURES- BLOOD LAB
TREATMENT PROTOCOLS DRAW
ISSUED: 03/18/10 ______________________________________
GP-8 Randall Reinhardt, MD
Laurens County EMS Medical Control Physician
Blood Lab Draw
Laurens County EMS currently uses the Sarstedt - Monovette Blood Draw System.
This system is designed to facilitate drawing blood by allowing the provider to provide
gentile vacuum, thus decreasing the chance of collapsing the vein or the catheter.
In addition this gentile vacuum also decreases the possibility that the blood cells will be
damaged while being drawn into the collection tube.
This protocol applies to any patient that is being transported to Laurens County Hospital,
when the EMT-I or EMT-P in care establishes venous access via IV or INT.
LAURENS COUNTY EMS
o Once the IV catheter is in place, attach the adapter unit to the hub of the catheter.
o Attach the blood tube to the adapter using the “twist-lock” technique.
o Gently pull back on the plunger to create a vacuum, drawing the blood into the tube.
o Once the plunger has been fully withdrawn, it will “lock” into position.
o Once the tube has stopped filling, it may be removed and replaced with the next tube.
o Tubes shall be drawn in the following order
BLUE
RED
GREEN
PURPLE
o Please try to draw ALL tubes on ALL patients being transported to LCH.
o Once all of the tubes have been drawn connect the IV tubing as usual
After drawing the blood, be sure to label it as follows.
o Patient Name
o Patient Date of Birth
o Date Drawn
o Time Drawn
o EMS Unit number of employee drawing the blood– place in “Ref. No.” section
Example (EMSC-7, EMS B-3) etc.
Once the tubes are completely labeled, place them in a small zip-lock bio-hazard bag and
turn them over to the receiving nurse when you arrive at the hospital.
When completing the run report, please be sure to document any time you attempt to draw
blood in the flowchart, and document any problems/difficulties in the narrative section.
1
LAURENS COUNTY EMS
CARDIAC
EMERGENCIES
STANDARDS OF CARE
&
TREATMENT PROTOCOLS
CARDIAC EMERGENCIES-ADULT GENERAL CARDIAC
TREATMENT PROTOCOLS GUIDELINES
ISSUED: 01/01/06 ______________________________________
C-01 Randall Reinhardt, MD
Revised: 09/30/06 Laurens County EMS Medical Control Physician
• Initiate patient assessment and treatment. Vital signs will be assessed and documented q 5 min for unstable
patients and q 15 min for stable patients.
• Recognize or rule-out need for additional equipment or personnel.
• Personnel shall enter every scene with the following equipment: medical bag, oxygen, and monitor. Crews
should also carry Portable suction however, may be utilized according to dispatch information.
• Airway is a top priority in all-patient contact situations. Oxygen administration is of paramount importance in the
treatment of the cardiac patient.
• All cardiac patients should be assessed for and have documented level of consciousness, vital signs, associated
signs/symptoms (pertinent positives and negatives), and onset of signs and symptoms.
•
LAURENS COUNTY EMS
The differentiation of cardiac and non-cardiac chest pain is often made based on history. The following are
considered essential elements of history:
Specific location of the chest pain (mid-sternal, sub-sternal, shoulder, etc.)
Radiation of pain
Duration of pain
Factors that precipitated the pain
Type/Quality of pain
Associated symptoms
Anything that alleviates/aggravates/changes pain
Previous episodes of similar pain
• Past Medical History, Medications, and allergies.
• IV access should be obtained as soon as possible in cardiac patients and prior to transport, unless special
circumstances exist.
• Nitroglycerin sublingual may be administered prior to IV access at the paramedics discretion, if patient is stable
with BP>100 and is prescribed nitroglycerin for use by a physician.
• Cardiac scene times should be limited to 25 minutes for non-cardiac arrest situations. Scene times greater than
25 minutes should be documented on the PCR.
• Initial management of arrhythmias should be treated with oxygenation and then appropriate medications.
• Cardiac arrest patients shall have all Advanced Cardiac Life Support procedures initiated in accordance with the
appropriate protocol prior to being loaded for transport.
• Cardiac/respiratory arrest patients, in which endotracheal intubation is performed prior to initiation of transport,
shall be immobilized with full spinal precautions.
• In the event that all procedures are failing, patient should be loaded and transported immediately.
• Paramedics may discontinue or withhold resuscitation efforts in any of the following situations:
Presence of Rigor Mortis.
Major or significant trauma with no signs of life upon initial assessment.
Properly completed “Do Not Resuscitate” order.
Patient assessment does not warrant initiation of resuscitative efforts.
extended down time, etc.
Asystole (Non-responsive to ACLS after 20 minutes or 3 rounds of drug therapy)
Ordered by a Physician.
• The following medications may be administered via endotracheal tube as a last resort route of administration. If
utilized, give 2.0 to 2.5 times the IV dose followed by 5 cc fluid and 5 ventilations.
Epinephrine
Atropine
Lidocaine
Narcan
1
CARDIAC EMERGENCIES-ADULT Acute Coronary Syndrome
TREATMENT PROTOCOLS
Issued: 07/16/07 ______________________________________
C-02 Randall Reinhardt, MD
Revised: 01/01/09 Laurens County EMS Medical Control Physician
PATIENT ASSESSMENT Risk Factors:
Patients may present with or without typical chest Male Gender Post-Menopausal Female Cocaine Use
discomfort/pain. Utilize signs and symptoms, along with Obesity Smoking Diabetes Hypertension
risk factors, to determine if possible ACS patient. 12- Family/Pt. Relevant Sedentary History of
Lead analysis will be performed on all patients who History of MI age > 40 y/o Life Style ↑ Cholesterol
present with possible cardiac involvement. Utilize ECG Common Signs and Symptoms:
findings along with assessments to determine proper Discomfort Pressure - squeezing, tightening, crushing
treatment. Consult with Medical Control at any time. Pain – sharp, stabbing, aching, burning
Radiation Left shoulder, neck, mandible, arm, hand, or
LCEMS Standard of Care back
Any patient who presents with possible cardiac Epigastric Indigestion, heartburn, belching
involvement will have a complete assessment, Other Dyspnea, nausea/vomiting, weakness,
LAURENS COUNTY EMS
initial interventions, and a 12 lead interpretational dizziness, diaphoresis, arrhythmia, altered level
of consciousness, syncope
stratification performed within 10 minutes of
Elder Pt’s May present with “other” s/s rather than
patient contact. discomfort
MANAGEMENT
EMT-BASIC EMT-INTERMEDIATE EMT-PARAMEDIC
Request: Paramedic Assistance Continue / Initiate: Basic Continue / Initiate: Basic &
Management Intermediate Management
Monitor ECG- Lead II
Initiate: Airway Management Initiate: Intravenous Access
Protocol Protocol If patient presents with discomfort
Initiate O2 Therapy thought to be cardiac in nature:
Maintain sats > 90% Administer:
Aspirin 324 mg’s PO
With discomfort/pain, may be
Patient Assisted Medications given prior to IV and 12 lead
Nitroglycerin 0.4 mg SL If ASA use within last 12 hours,
give additional to achieve 324 mg.
Contraindication: Impotence
drug use within 48 hours Perform 12 lead
(ex.-Viagra, Levitra, Cialis) Stratify based upon interpretation:
Patient has prescribed GOAL: Completed within 10 min of
sublingual Nitroglycerin tablets patient arrival
or spray available. STEMI / presumably new BBB
Verify that the medication is the STEMI Alert = ST seg. ↑ > 2
mm in two or more
patient’s own. contiguous leads without
Verify that the medication has BBB
not expired. Possible STEMI= ST seg. ↑
Patient is Alert/Oriented 1- 2 mm in two or more
contiguous leads
Systolic BP >100 Possible New BBB = QRS >
Patient has not exceeded the 120ms in V-1
maximum dose of 3 tablets or ST segment depression / Dynamic
sprays. T-wave inversion
Possible Ischemia = ST
seg. ↓ > 1-2 mm and/or
Initiate Fibrinolytic checklist dynamic T-wave inversion in
two or more contiguous leads
Normal / Non-diagnostic
Further treatment based upon ECG
stratification. See Cardiac
Emergencies Protocol C-02-A and
continue as indicated
CARDIAC EMERGENCIES-ADULT Acute Coronary Syndrome
TREATMENT PROTOCOLS ECG Stratification & Treatment
Issued: 07/16/07 ______________________________________
C-02-A Randall Reinhardt, MD
Revised 01/01/09 Laurens County EMS Medical Control Physician
Anatomical Location GENERAL INFORMATION
Inferior: Leads II, III, AVF STEMI = ST seg ↑ > 2mm in two or more contiguous leads without BBB
Reciprocal Leads: I & AVL Contact Heart Center Directly and Advise of STEMI Alert
Utilize LCEMS STEMI Alert Notification
Septal: Leads V1 & V2
Possible STEMI = ST seg ↑ > 1mm in two or more contiguous leads
Anterior: Leads V3 & V4 Possible New BBB = QRS > 120ms in V-1
Contact Heart Center Directly for MD consult
Lateral: Leads V5, V6, I, & AVL
Reciprocal Leads: II, III, AVF Possible Ischemia = ST seg ↓ > 1-2mm or dynamic T-wave inversion in
two or more contiguous leads
Right Side: Lead V4R Contact Medical Control for consult or Heart Center
Posterior: V8 & V9 Normal / Non-diagnostic = ECG without class 1 or class 2 stratification
Reciprocal Leads: V1-V4 findings
Contact Medical Control for consult
LAURENS COUNTY EMS
Greenville Spartanburg Self
864-455-7705 (CP Center) 864-560-5427 (ER) 864-725-5738 (ER)
STEMI / ST Depression / Normal /
Possible New BBB Dynamic T-wave inversion Non-diagnostic
S T E M I PROTOCOL If ST segment ↓ noted in any Consider:
Complete Fibrinolytic checklist leads of V1-V4 Aspirin 324 mg’s PO
Attempt two peripheral IV lines for Fibrinolytic Perform 15 lead ECG If not already given and
candidates. Analyze V8 & V9 discomfort / pain truly
Limit IV attempts to two if Heparin is considered thought to be cardiac in
ST seg ↑ = Posterior Wall MI nature
If Inferior Wall MI: II, III, AVF
Perform 15 lead ECG prior to Nitro RE-STRATIFY AS STEMI and Consider:
Analyze V4R continue treatment Nitroglycerin 0.4 mg SL
ST seg ↑ = Right side involvement Administer: PRN q 5 min
! Ensure patent IV capable of rapid fluid bolus Aspirin 324 mg’s PO Discomfort / pain truly
prior to Nitro or Morphine If not already given thought to be cardiac in
Consider 250cc bolus if no contraindications May give without discomfort/pain nature
with R side involvement for ECG recognized ischemia If > 40 and have other
Administer: Aspirin 324 mg’s PO Administer: risk factors
If not already given Limit to 3 unless
Nitroglycerin 0.4 mg SL prn q 5 notable decrease in
May give without discomfort/pain for ECG
min discomfort / pain
recognized STEMI
Only for discomfort/pain under Systolic BP >100
Administer: Nitroglycerin 0.4 mg SL prn q 5 protocol
min Contraindication:
Systolic BP >100 Impotence drug use
Only for discomfort/pain under protocol Contraindication: Impotence within 48 hours(ex.-
Systolic BP >100 drug use within 48 hours(ex.- Viagra, Levitra, Cialis)
Contraindication: Impotence drug use within Viagra, Levitra, Cialis)
48 hours(ex.-Viagra, Levitra, Cialis) See General
See General Information See General Information Information
ON-LINE ORDER REQUIRED ON-LINE ORDER REQUIRED Perform serial 12
Morphine 2-4 mg’s IV PRN leads q 10-15 min.
Heparin: Weight Based IV Bolus
If no contraindications. 5000 UI Max q 15 min If pain and/or S/S
<47 kg 47-53 kg 54-59 kg >59 kg For continued persist or worsen.
discomfort/pain Re-stratify accordingly
3500 UI 4000 UI 4500 UI 5000 UI
Minimum of 3 Nitro given
Lopressor 5mg IV q 5min Systolic BP >100 Notify Med Control of
Max 15mg total dose any major changes
If no contraindications exist Perform serial 12 leads q 10-15 min.
Morphine 2-4 mg’s IV prn q 15 min Re-stratify accordingly Transport accordingly
For continued discomfort/pain and provide continued
Minimum of 3 Nitro given Notify Heart Center or Med Control of patient reassurance
Systolic BP >100 any major changes
Perform serial 12 leads q 10-15 min.
Re-stratify accordingly Transport accordingly and provide
Notify Heart Center of any major changes continued patient reassurance
Transport accordingly and provide continued patient
reassurance
CARDIAC EMERGENCIES-ADULT VENTRICULAR
TREATMENT PROTOCOLS ECTOPY
ISSUED: 01/01/06 ______________________________________
C-03 Randall Reinhardt, MD
Laurens County EMS Medical Control Physician
PATIENT ASSESSMENT GENERAL INFORMATION
Ventricular ectopy is any rhythm containing ventricular
ectopic beats, which the patient is symptomatic and EMT/EMT Intermediates are not authorized to monitor
associated with cardiac related emergencies. patient cardiac status via cardiac monitor (ECG).
However the above personnel may respond
A patient is considered symptomatic if ALL of the following occasionally to a physician’s office or an urgent care
conditions exist: center and be informed of a patient with ventricular
ectopy and therefore should initiate this protocol.
Patient is > 30 years of Age
Patient has chest discomfort, which has not been Lidocaine administration for ventricular ectopy not
relieved with oxygen and nitroglycerin, as outlined in associated with a symptomatic cardiac related
the Chest Pain Protocol.
LAURENS COUNTY EMS
emergency requires On-Line Medical Control Order.
The discomfort is associated with multi-formed PVC’s,
ventricular couplets, > 6 PVC’s /min, and/or R on T
phenomenon.
MANAGEMENT
EMT-BASIC EMT-INTERMEDIATE EMT-PARAMEDIC
Initiate: Airway Management Continue / Initiate: Basic Continue / Initiate: Basic &
Protocol Management Intermediate Management
Initiate: Chest Pain Protocol Initiate: Intravenous Access Monitor ECG- Lead II
Protocol Consider 12 Lead
Request Paramedic Assistance Administer:
Lidocaine HCL 1 mg/kg IV
Bradycardia is not present
Repeated at 0.5 mg/kg 3-5 minutes.
Maximum dose of 3 mg/kg
Administer:
Lidocaine HCL Infusion:
Bolus 1 mg/kg = 2 mg/ min Infusion
Bolus 2 mg/kg = 3 mg/ min Infusion
Bolus 3 mg/kg = 4 mg/ min Infusion
Prior to initiation of maintenance
infusion, termination of ventricular
ectopy is required.
Transport
Contact ED with Patient Report
3
CARDIAC EMERGENCIES-ADULT VENTRICULAR FIBRILLATION
TREATMENT PROTOCOLS PULSELESS VENTRICULAR TACH
ISSUED: 01/01/06 ______________________________________
C-04 Randall Reinhardt, MD
Revised: 09/30/06 Laurens County EMS Medical Control Physician
PATIENT ASSESSMENT GENERAL INFORMATION
General Format: Drug with 2 min CPR – Defib – Drug with 2
Confirm Apenic/Pulseless
min CPR – Defib
Confirm rhythm: 30-60 ml fluid bolus after each medication administration.
1. Quick-look Paddles for unmonitored Continue CPR while defib is charging and immediately
Situations after defibrillation
2. ECG for monitored situations
Termination of V -Fib or Pulseless V - Tach:
If CPR is in progress, confirm quality of Lidocaine Infusion at 2-4 mg / minute
ventilations and compressions.
Establish Down Time
LAURENS COUNTY EMS
MANAGEMENT
EMT-BASIC EMT-INTERMEDIATE EMT-PARAMEDIC
Initiate: Cardiopulmonary Continue / Initiate: Basic Continue / Initiate: Basic & Intermediate
Resuscitation (CPR) (Until Management Management
Monitor/Defibrillator Monitor ECG-Lead II
Available). Initiate: One Defibrillation Attempt
Initiate: Intravenous ♦ (Mono) 360 Joules (Bi) 200 Joules
Request Paramedic Access Protocol
Assistance Administer: CPR for 2 min
Administer: Epinephrine 1 mg IV / IO
Initiate: Automatic External Repeat q 3-5 minutes
Administer during CPR
Defibrillator (If Available).
Check Rhythm
Continue: Defibrillate 360(M)/200(Bi) Joules
Cardiopulmonary Administer: CPR for 2 min
Resuscitation Administer: Lidocaine 1.5 mg/kg IV / IO
Repeat at .75 mg/kg q 3-5 minutes to total dose
Initiate: Airway of 3 mg/kg.
Management Protocol Administer during CPR
Check Rhythm
Defibrillate 360(M)/200(Bi) Joules
Administer: CPR for 2 min
Check Rhythm; Treat accordingly
Administer: Mag Sulfate 1-2 gm IV / IO
st
Use as 1 line for Torsades de Points
Dilute in syringe, slow IVP
Administer during CPR
Consider:
Sodium Bicarbonate 1 meq/kg
If no change and patient is properly intubated
and ventilated for >10 minutes
ON-LINE MEDICAL CONTROL ORDER
REQUIRED:
Calcium Gluconate 1gm IV
Patient receives hemodialysis and hyperklamia
is suspected
Administered over 2-5 minutes
Transport
Contact ED with Patient Report.
4
CARDIAC EMERGENCIES-ADULT ASYSTOLE
TREATMENT PROTOCOLS
ISSUED: 01/01/06 ______________________________________
C-05 Randall Reinhardt, MD
Revised: 09/30/06 Laurens County EMS Medical Control Physician
PATIENT ASSESSMENT GENERAL INFORMATION
Consider and Treat Possible Causes: 6 H’s & 5 T’s
Confirm Apenic/Pulseless
Hypovolemia Toxins
Confirm rhythm: Hypoxia Tamponade, cardiac
1. Quick-look Paddles for unmonitored Situations Hydrogen Ion Tension
2. ECG for monitored situations (acidosis) pneumothorax
Confirm and Document rhythm in Two Leads Hypo-/Hyperkalemia Thrombosis (coronary
Rhythm strips must accompany paperwork Hypoglycemia or pulmonary
Hypothermia Trauma(hypovolemia,
If rhythm is unclear and is possibly Fine Ventricular increased ICP
Fibrillation- Initiate Ventricular Fibrillation/Pulseless
Consider discontinuing resuscitation efforts if no response to
Ventricular Tachycardia Protocol
ACLS after 20 minutes and/or 3 rounds of resuscitative drugs
LAURENS COUNTY EMS
During CPR, confirm and document quality of administered. Paramedics are permitted to discontinue
ventilations and compressions without On-Line Med Control.
If DC decision made:
Establish Down Time Enroute: Transport to Laurens Hospital
Onscene: Notify Coroner and follow applicable
procedure
MANAGEMENT
EMT-BASIC EMT-INTERMEDIATE EMT-PARAMEDIC
Initiate: Cardiopulmonary Continue / Initiate: Basic Continue / Initiate: Basic &
Resuscitation (CPR) Management Intermediate Management
Monitor ECG-Lead II
Request Paramedic Initiate: Intravenous Access Consider: External Cardiac Pacing
Assistance Protocol Confirmed down time of < 10 minutes.
Rate set at 70 BPM
Initiate: Airway Management mA slowly increased until electrical and
Protocol mechanical capture occur.
Confirm mechanical capture via Femoral
Continue: Cardiopulmonary Artery
Resuscitation If Cardiac Pacing ineffective or is not
considered, continue treatment as
outlined below
Administer:
Epinephrine 1 mg IV / IO
Repeat q 3-5 minutes
Administer:
Atropine 1 mg IV / IO
Repeat q 3-5 minutes to a total of 3 mg
Administer:
CPR for 2 min
Reasses and treat accordingly
Consider:
Sodium Bicarbonate 1 meq/kg
If no change and patient is properly
intubated and ventilated for >10 minutes
ON-LINE MEDICAL CONTROL ORDER
REQUIRED:
Calcium Gluconate 1gm IV
Patient receives hemodialysis and
hyperklamia is suspected
Administered over 2-5 minutes
Transport
Contact ED with Patient Report.
5
CARDIAC EMERGENCIES-ADULT PULSELESS ELECTRICAL ACTIVITY
TREATMENT PROTOCOLS (PEA)
ISSUED: 01/01/06 ______________________________________
C-06 Randall Reinhardt, MD
Revised: 09/30/06 Laurens County EMS Medical Control Physician
PATIENT ASSESSMENT GENERAL INFORMATION
Confirm Apenic/Pulseless Consider and Treat Possible Causes: 6 H’s & 5 T’s
Confirm rhythm: Hypovolemia Toxins
1. Quick-look Paddles for unmonitored Situations Hypoxia Tamponade, cardiac
2. ECG for monitored situations Hydrogen Ion Tension
(acidosis) pneumothorax
If CPR is in progress, confirm quality of ventilations Hypo-/Hyperkalemia Thrombosis (coronary
and compressions. Hypoglycemia or pulmonary
Hypothermia Trauma(hypovolemia,
Establish Down Time increased ICP
LAURENS COUNTY EMS
MANAGEMENT
EMT-BASIC EMT-INTERMEDIATE EMT-PARAMEDIC
Initiate: Cardiopulmonary Continue / Initiate: Basic Continue / Initiate: Basic &
Resuscitation (CPR) Management Intermediate Management
Request Paramedic Initiate: Intravenous Access Monitor ECG-Lead II
Assistance Protocol
Administer:
Initiate: Airway Management
Epinephrine 1 mg IV / IO
Protocol
Repeat q 3-5 minutes
Continue: Cardiopulmonary Administer:
Resuscitation Atropine 1 mg IV / IO
If absolute or relative bradycardia
Assess for and Treat Possible Repeat q 3-5 minutes to a total of
3 mg
Causes
Administer:
CPR for 2 min
Reasses and treat accordingly
Consider:
Sodium Bicarbonate 1 meq/kg
If no change and patient is
properly intubated and ventilated
for >10 minutes
ON-LINE MEDICAL CONTROL
ORDER REQUIRED:
Calcium Gluconate 1gm IV
Patient receives hemodialysis and
hyperklamia is suspected
Administered over 2-5 minutes
Transport
Contact ED with Patient Report.
6
CARDIAC EMERGENCIES-ADULT VENTRICULAR TACHYCARDIA
TREATMENT PROTOCOLS (UNSTABLE)
ISSUED: 01/01/06 ______________________________________
C-07 Randall Reinhardt, MD
Revised: 09/30/06 Laurens County EMS Medical Control Physician
PATIENT ASSESSMENT GENERAL INFORMATION
Consider and Treat Possible Causes: 6 H’s & 5 T’s
Apenic/Pulseless follow Ventricular
Fibrillation/Pulseless Ventricular Tachycardia Protocol Hypovolemia Toxins
Hypoxia Tamponade, cardiac
Confirm rhythm Hydrogen Ion Tension
Consider Ventricular in origin if QRS > .12 sec & (acidosis) pneumothorax
regular Hypo-/Hyperkalemia Thrombosis (coronary
Hypoglycemia or pulmonary
Unstable Defined: (Must document 3 of the following Hypothermia Trauma(hypovolemia,
signs / symptoms) increased ICP
Hypotension (Systolic BP <90)
Decreased Level of Consciousness
LAURENS COUNTY EMS
Chest Pain
Dyspnea
Poor Perfusion (i.e. Diaphoresis, Cyanosis, etc.)
MANAGEMENT
EMT-BASIC EMT-INTERMEDIATE EMT-PARAMEDIC
Request Paramedic Continue / Initiate: Basic Continue / Initiate: Basic & Intermediate
Assistance Management Management
Monitor ECG-Lead II
Initiate: Airway Initiate: Intravenous
Management Protocol Access Protocol
Initiate: Synchronized Cardioversion
Consecutive shocks if no change @
♦ (M) 100 Joules (B) 75 Joules
♦ (M) 200 Joules (B) 120 Joules
♦ (M) 300 Joules (B) 150 Joules
♦ (M) 360 Joules (B) 200 Joules
ON-LINE MEDICAL CONTROL ORDER
REQUIRED:
Consider: Lorazepam 1-2 mg IV
For Sedation? / Reassess severity
Administer:
Lidocaine HCL 1-1.5 mg/kg IV / IO
Repeat Q3- 5 minutes
Maximum Dose 3 mg/kg
Cardiovert @ 360(M)/200(Bi) Joules
No Change
After each medication administration
Administer:
Mag Sulfate 1-2 gm IV / IO
st
Use as 1 line for Torsades de Points
Termination of Ventricular Tachycardia:
Lidocaine Infusion at 2-4 mg / minute
Bolus 1 mg/kg = 2 mg / min Infusion
Bolus 2 mg/kg = 3 mg / min Infusion
Bolus 3 mg/kg = 4 mg / min Infusion
Prior to initiation of maintenance infusion,
termination of ventricular tachycardia is
required.
Transport
Contact ED with Patient Report.
7
CARDIAC EMERGENCIES-ADULT VENTRICULAR TACHYCARDIA
TREATMENT PROTOCOLS (STABLE)
ISSUED: 01/01/06 ______________________________________
C-08 Randall Reinhardt, MD
Revised: 09/30/06 Laurens County EMS Medical Control Physician
PATIENT ASSESSMENT GENERAL INFORMATION
Consider and Treat Possible Causes: 6 H’s & 5 T’s
Stable Ventricular Tachycardia is defined as V-Tach Hypovolemia Toxins
that does not meet the criteria of Unstable Ventricular Hypoxia Tamponade, cardiac
Tachycardia Protocol (C-07) Hydrogen Ion Tension
(acidosis) pneumothorax
Confirm rhythm
Hypo-/Hyperkalemia Thrombosis (coronary
Consider Ventricular in origin if QRS > .12 sec &
Hypoglycemia or pulmonary
regular
Hypothermia Trauma(hypovolemia,
increased ICP
LAURENS COUNTY EMS
Procainamide
17 mg/kg in 250 ml D5W, infuse at 20 mg/min
using a 10 gtt set
MANAGEMENT
EMT-BASIC EMT-INTERMEDIATE EMT-PARAMEDIC
Request Paramedic Continue / Initiate: Basic Continue / Initiate: Basic &
Assistance Management Intermediate Management
Initiate: Airway Management Initiate: Intravenous Monitor ECG- Lead II
Protocol Access Protocol Consider 12 Lead
Administer:
Lidocaine HCL 1-1.5 mg/kg IV / IO
Repeat q 3- 5 minutes @ ½ the original
dose (0.5-0.75 mg/kg)
Maximum Dose 3 mg/kg
Administer:
Mag Sulfate 1-2 gm IV / IO
st
Use as 1 line for Torsades de
Points
Termination of Ventricular Tachycardia:
Lidocaine Infusion at 2-4 mg / minute
Bolus 1 mg/kg = 2 mg / min Infusion
Bolus 2 mg/kg = 3 mg / min Infusion
Bolus 3 mg/kg = 4 mg / min Infusion
Prior to initiation of maintenance
infusion, termination of ventricular
tachycardia is required.
Consider:
Procainamide 20 mg/min IV
VT refractory to Lidocaine
Total dose 17mg/kg
Transport
Contact ED with Patient Report.
8
CARDIAC EMERGENCIES-ADULT SUPRAVENTRICULAR TACHYCARDIA
TREATMENT PROTOCOLS (UNSTABLE)
ISSUED: 01/01/06 ______________________________________
C-09 Randall Reinhardt, MD
Revised: 03/18/10 Laurens County EMS Medical Control Physician
PATIENT ASSESSMENT GENERAL INFORMATION
Supraventricular Tachycardia is defined as a regular Any Wide complex tachycardia (or if V-Tach cannot be
narrow complex rhythm (QRS < .12 sec) with a pulse ruled out) should be treated as V-Tach and follow the
rate > 150 BPM. Ventricular Tachycardia-Unstable Protocol (C-07)
Unstable Defined: (Must document 3 of the following Reset Synchronization mode after each cardioversion,
signs / symptoms) because most defibrillators default back to
Hypotension (Systolic BP <90) unsynchronized mode
Decreased Level of Consciousness Rule out Hypovolemia as underlining cause of
LAURENS COUNTY EMS
Chest Pain increased pulse rate.
Severe Dyspnea
Poor Perfusion (i.e. Diaphoresis, Cyanosis, etc.) Cardioversion is generally not needed if heart rate is
< 150 BPM
MANAGEMENT
EMT-BASIC EMT-INTERMEDIATE EMT-PARAMEDIC
Request Paramedic Continue / Initiate: Basic Continue / Initiate: Basic & Intermediate
Assistance Management Management
Initiate: Airway Initiate: Intravenous Monitor ECG- Lead II
Management Protocol Access Protocol Consider 12 Lead
Initiate: Synchronized Cardioversion
Consecutive shocks if no change @
(M) 100 Joules (B) 75 Joules
(M) 200 Joules (B) 120 Joules
(M) 300 Joules (B) 150 Joules
(M) 360 Joules (B) 200 Joules
ON-LINE MEDICAL CONTROL ORDER
REQUIRED:
Consider: Lorazepam 1-2 mg IV
For Sedation? / Reassess severity
Administer:
Adenosine 6 mg Rapid IV
Administered over 1-3 seconds
If no response in 1-2 minutes
Administer:
Adenosine 12 mg Rapid IV
Administered over 1-3 seconds
If no response in 1-2 minutes
Transport
Contact ED with Patient Report.
9
CARDIAC EMERGENCIES-ADULT SUPRAVENTRICULAR TACHYCARDIA
TREATMENT PROTOCOLS (STABLE)
ISSUED: 01/01/06 ______________________________________
C-10 Randall Reinhardt, MD
Revised: 03/18/10 Laurens County EMS Medical Control Physician
PATIENT ASSESSMENT GENERAL INFORMATION
Supraventricular Tachycardia is defined as a regular Any Wide complex tachycardia (or if V-Tach cannot be
narrow complex rhythm (QRS < .12 sec) with a pulse ruled out) should be treated as V-Tach and follow the
rate > 150 BPM. Ventricular Tachycardia-Stable Protocol (C-08)
Stable Supraventricular Tachycardia is defined as Rule out Hypovolemia as underlining cause of
Supraventricular Tachycardia that does not meet the increased pulse rate.
criteria of Unstable Supraventricular Tachycardia Vagal Maneuvers should not be attempted on patients
Protocol (C-09) with history of CVA, any type of Emboli, Carotid
LAURENS COUNTY EMS
Occlusion, or >50 years of age
MANAGEMENT
EMT-BASIC EMT-INTERMEDIATE EMT-PARAMEDIC
Request Paramedic Continue / Initiate: Basic Continue / Initiate: Basic & Intermediate
Assistance Management Management
Initiate: Airway Monitor ECG- Lead II
Initiate: Intravenous
Consider 12 Lead
Management Protocol Access Protocol
Initiate: Vagal Maneuver
1. Valsalva’s Maneuver
Instruct patient to inhale and hold breath, while
at same time bearing down as if to have a bowel
movement, and hold this position for 20-30
seconds.
Administer:
Adenosine 6 mg Rapid IV
Administered over 1-3 seconds
If no response in 1-2 minutes
Administer:
Adenosine 12 mg Rapid IV
Administered over 1-3 seconds
If no response in 1-2 minutes
Transport
Contact ED with Patient Report.
10
CARDIAC EMERGENCIES-ADULT SYMPTOMATIC
TREATMENT PROTOCOLS BRADYCARDIA
ISSUED: 01/01/06 ______________________________________
C-11 Randall Reinhardt, MD
Revised: 09/30/06 Laurens County EMS Medical Control Physician
PATIENT ASSESSMENT GENERAL INFORMATION
(Must Document)
Symptomatic Bradycardia is defined as: Consider 6 H’s & 5 T’s for possible contributing factors
Hypotension (BP <90)
Pulse Rate <60 BPM For Bradycardia associated with high degree blocks:
And One or More of the Following: Consider Pacing as first line.
Poor Perfusion
Decreased Level of Consciousness If pharmacological intervention is successful or
Severe Dyspnea rhythm develops into a high degree block,
consider placing pacer pads for emergent use
Confirm rhythm if needed.
LAURENS COUNTY EMS
MANAGEMENT
EMT-BASIC EMT-INTERMEDIATE EMT-PARAMEDIC
Request Paramedic Continue / Initiate: Basic Continue / Initiate: Basic & Intermediate
Assistance Management Management
Initiate: Airway Initiate: Intravenous Monitor ECG- Lead II
Management Protocol Access Protocol Consider 12 Lead
Initiate: External Pacing
Use as first line intervention if patient is
hemodynamically unstable and IV access is
not readily available or for high degree
blocks
Rate should be set at 20 BPM faster than the
intrinsic heart rate (minimum rate 70 BPM).
mA should be slowly increased until electrical
and mechanical capture occur.
Confirm mechanical capture via Femoral Artery
Unconscious-Increase at 20 mA increments.
Conscious- Increase at 5 mA increments
ON-LINE MEDICAL CONTROL ORDER
REQUIRED:
Consider: Lorazepam 1-2 mg IV
For Sedation or Comfort
Administer:
Atropine 0.5 – 1.0 mg IV / IO
Repeat q 3-5 minutes to a total dose of 3 mg
Consider:
Dopamine 2-10 mcg/kg/min
If pacing and Atropine are unsuccessful
Transport
Contact ED with Patient Report.
11
CARDIAC EMERGENCIES-ADULT “DO NOT RESUSCITATE”
TREATMENT PROTOCOLS DNR
ISSUED: 01/01/06 ______________________________________
C-12 Randall Reinhardt, MD
Laurens County EMS Medical Control Physician
PERFORM PATIENT ASSESSMENT
Laurens County EMS recognizes the patients’ individual right to refuse resuscitation efforts in the event of
a diagnosed terminal illness.
Laurens County EMS has established the following guidelines for “Do Not Resuscitate” orders that may be
encountered in the delivery of prehospital care. Laurens County EMS personnel will adhere to the
following protocol when a DNR order is established:
MANAGEMENT
LAURENS COUNTY EMS
• Laurens County EMS personnel will confirm the identity of the patient and the presence of a properly
completed and unaltered South Carolina EMS Do Not Resuscitate form;
• Upon finding a completed State DNR form (unaltered and intact), Laurens County EMS personnel will
then withhold or withdraw resuscitative measures to include, but not limited to the following:
CPR
Endotracheal Intubation or other Advanced Airway Procedures
Artificial Ventilation
Defibrillation
Cardiac Resuscitative Medications will be withheld, such as Epinephrine, Atropine,
Lidocaine, etc.
All cardiac related procedures will be withheld including Cardiac Monitoring, etc.
• Laurens County EMS personnel will provide palliative and supportive treatment to include, but not
limited to the following:
Airway Suctioning
IV Therapy
Oxygen Administration
Bleeding Control
Provision of pain and non-cardiac medications.
Patient Comfort
Laurens County EMS personnel will also attend to the family members to provide comfort and
support in their time of crisis.
• Laurens County EMS personnel will assure that the State DNR form accompanies the patient during
any transport, as well as transportation to the emergency department or postmortem destination, i.e.
funeral home or morgue.
• Laurens County EMS personnel may transport a copy of the State DNR form after verification of the
revised form and content has been completed by the crew. The crew will note on the back of the copy
the time and personnel verifying the Revised form. Laurens County EMS personnel will secure a copy
of the “DNR” form after any transport and attach the copy to their Patient Care Report.
• Laurens County EMS personnel may only honor the South Carolina State EMS DNR form. If the DNR
form is altered, mangled, defaced or destroyed it will be declared null and void. The patient or the
medical POA may nullify the DNR, by verbal statement, any time during the course of treatment or
transportation.
12
LAURENS COUNTY EMS
MEDICAL
EMERGENCIES
ADULT
STANDARDS OF CARE
&
TREATMENT PROTOCOLS
0
MEDICAL EMERGENCIES-ADULT GENERAL MEDICAL
TREATMENT PROTOCOLS GUIDELINES
ISSUED: 01/01/06 ______________________________________
M-01 Randall Reinhardt, MD
Revised: 09/30/06 Laurens County EMS Medical Control Physician
• Initiate patient assessment and treatment. Vital signs will be assessed and documented q 5 min for unstable
patients and q 15 min for stable patients.
• Recognize or rule-out need for additional equipment or personnel.
• Personnel shall enter every scene with the following equipment: medical bag, oxygen, and monitor. Crews
should also carry Portable suction however, may be utilized according to dispatch information.
• Airway is a top priority in all-patient contact situations. Oxygen administration is of paramount importance in the
treatment of the medical patient.
• Assure appropriate PPE is utilized on all patients.
LAURENS COUNTY EMS
• Medical patients should be stabilized on the scene.
• Ensure that a detailed ALS/BLS assessment is completed on every patient. Documentation will include LOC,
GCS, and weight in Kilograms.
• Apply cardiac monitor to all ALS medical patients who present with possible cardiac involvement.
• Ascertain and document patient information related to history, medications, allergies, and onset of present
illness with associated signs and symptoms.
• Vital Signs will include auscultated BP, pulse (rate/rhythm/quality/location), respirations (breath sounds), skin
color/capillary refill.
• Attempt to leave scene within 25 minutes. Scene times greater than 25 minutes should be explained on the
PCR.
• Assess and document relevant secondary survey information (JVD, peripheral edema, abdominal masses, etc.)
• IV’s will be established on all patients prior to receiving medications from EMS personnel, unless otherwise
directed by Medical Control.
• If attempted procedures are failing, the patient should be transported immediately.
• Notify hospital with a brief report of patient status.
• Laurens County EMS personnel caring for a patient must not leave the patient until a complete and professional
report on the patient’s condition and treatment rendered has been given to the nurse responsible for the patient
at the receiving facility.
• Emergency Transport of Medical Patients: Laurens County EMS personnel must evaluate the benefits versus
the risk for transporting a patient in an emergency mode (lights/Siren). Situations that MAY warrant emergency
transport to a medical facility:
Complicated Births
Hypotension/Shock
Medical or Cardiac Patient that appears to be decompensating
Respiratory or Cardiac Arrest
Altered Level of Consciousness not responding to treatment by EMS
Airway Obstruction not relieved by EMS
1
MEDICAL EMERGENCIES-ADULT ALTERED LEVEL OF
TREATMENT PROTOCOLS CONSCIOUSNESS
ISSUED: 06/01/06 ______________________________________
M-02 Randall Reinhardt, MD
Laurens County EMS Medical Control Physician
PATIENT ASSESSMENT GENERAL INFORMATION
Evaluate for the Following: Glucagon should only be administered if intravenous access cannot be
established.
Coma
Unknown Etiology Dextrose 50% should not be administered in absence of diabetic history, or
blood glucose level evaluation.
CVA / TIA Complete Cincinnati Pre-hospital Stroke Scale on all possible CVA/TIA
Follow Stroke Protocol M-02-A Patients.
Slurred Speech
Non-Verbal Facial Droop (Have patient show teeth or smile):
Arm Drift Normal Both sides of face move equally well
Hemipresis/Paralysis Abnormal One side does not move as well as the other
Facial Drooling Arm Drift (Patient closes eyes and holds both arms out):
Weakness Normal Both arms move the same or do not move at all
LAURENS COUNTY EMS
Hypoglycemia/Hyperglycemia Abnormal One arm does not move or one arm drifts down
Blood Glucose < 60 Speech (Have patient state “you can’t teach an old dog new tricks)
Blood Glucose > 300 Normal Patient uses correct words with no slurring
Abnormal Patient slurs words (Dysarthia) Patient uses inappropriate
Narcotic Overdose words or unable to speak (Aphasia)
MANAGEMENT
EMT-BASIC EMT-INTERMEDIATE EMT-PARAMEDIC
Request Paramedic Continue / Initiate: Basic Continue / Initiate: Basic &
Assistance Management Intermediate Management
Initiate: Airway Management Initiate: Intravenous Access Monitor ECG- Lead II
Protocol Protocol Consider 12 Lead
HYPOGLYCEMIA
HYPOGLYCEMIA HYPERGLYCEMIA
Administer:
Administer: Administer: Dextrose 50% Water 12.5-25 gms
Oral Glucose 15 gms Fluid Bolus NACL 500 ml IV (25-50 ml).
Blood Glucose < 60 Blood Glucose > 300 Blood Glucose < 60
Ensure patient can swallow and After bolus, maintain IV rate @ Obtain Blood Sample
is able to protect airway. 150 ml/hr
Administer between cheek and Administer:
gum. Thiamine 100 mg IV
Re-administer after glucose has Chronic alcohol use
dissolved, until full dose has Suspected deficiency
been delivered Administer:
Glucagon 1mg IM
Unable to establish Intravenous
access
NARCOTIC OVERDOSE
Administer:
Narcan 2 mg IV-IM-ETT
If no response:
Repeat 2 mg IV in 5 minutes.
Total maximum dose:
4 mg in field
Transport
Contact ED with Patient Report.
2
MEDICAL EMERGENCIES-ADULT Stroke Protocol
TREATMENT PROTOCOLS
ISSUED: 06/01/06 ______________________________________
M-02-A Randall Reinhardt, MD
Laurens County EMS Medical Control Physician
PATIENT ASSESSMENT Cincinnati Pre-hospital Stroke Scale:
Facial Droop (Have patient show teeth or smile)
Perform rapid and accurate assessment: Normal Both sides of face move equally well
Assessment, interventions, and transport Abnormal One side does not move as well as the other
decision within 15 min of patient contact.
Arm Drift (Patient closes eyes and holds both arms out for 10 sec)
Clearly defined time of onset: A creditable Normal Both arms move the same or do not move at all
time patient last seen without associated signs, Abnormal One arm does not move or one arm drifts down
symptoms, or neuro-deficit. Must be a reliable
witness. Document onset time and who Speech (Have patient state “you can’t teach an old dog new tricks)
reported as such. Normal Patient uses correct words with no slurring
Abnormal Patient slurs words (Dysarthia) Patient uses
Complete Cincinnati Pre-hospital Stroke inappropriate words or unable to speak (Aphasia)
Scale: on all possible CVA/TIA Patients.
Repeat and document assessment q 15 min.
Patients who present as POSSIBLE:
LAURENS COUNTY EMS
Complete LCEMS t-PA checklist: All
Inclusion criteria MUST be YES. All Exclusion t-PA Candidates: All stroke patients who are considered as possible t-PA
criteria MUST be NO. If YES to any reportable candidates will be transported to Greenville Memorial or Spartanburg
criteria notify receiving RN. Regional. (utilize closest facility)
Factors to consider for 3 hour window: Ground transfers: Notify hospital with the “stroke alert” hospital
♦ Time of onset, transport time, and arrival notification. Report as possible candidates.
to facility must be < 2 hours. Utilize air transport if needed to keep patient within the 3 hour window
♦ Allow 1 hour for hospital assessment &
patient prep for t-PA administration NOT t-PA candidates: Consider transport to Laurens Hospital. Notify
Poor quality of life at baseline: hospital with the “stroke alert” hospital notification to verify.
♦ Any condition prior to onset of new Contact medical control for consult if unsure of mode of
symptoms which is considered transport, facility destination or any other needed guidance.
debilitating.
(Ex: Bedridden, unable to self feed, etc.)
Contact Med Control for consult if
unsure of poor quality of life
MANAGEMENT
EMT-BASIC EMT-INTERMEDIATE EMT-PARAMEDIC
Request Paramedic Continue / Initiate: Basic Continue / Initiate: Basic &
Assistance Management Intermediate Management
Initiate: Airway Management
Initiate: Intravenous Access Monitor ECG- Lead II
Protocol
Protocol Consider 12 Lead
Determine & Document: Time of Attempt at least 2 IV sites
Onset o For t-PA Candidates
HYPOGLYCEMIA
Complete: Cincinnate Pre-
Maintain SBP > 90
Hospital Stroke Assessment 50 ml/hr for normo-tensive MUST document BGL < 60
and LCEMS t-PA check list patients Administer:
Dextrose 50% Water 12.5-25 gms
Elevate head 30 degrees IV (25-50 ml).
unless contraindicated. Blood Glucose < 60
Administer 12.5 gms with BGL
HYPOGLYCEMIA
between 40-60 and reassess
Obtain Blood Sample
MUST document BGL < 60
Administer: Administer:
Oral Glucose 15 gms Thiamine 100 mg IV
Blood Glucose < 60 Chronic alcohol use
Ensure patient can swallow Possible deficiency
and is able to protect airway. Administer:
Administer between cheek and
Glucagon 1mg IM
gum.
Unable to establish Intravenous
Re-administer after glucose has
access
dissolved, until full dose has
been delivered
2
MEDICAL EMERGENCIES-ADULT ANAPHYLACTIC/ALLERGIC
TREATMENT PROTOCOLS REACTION
ISSUED: 01/01/06 ______________________________________
M-03 Randall Reinhardt, MD
Laurens County EMS Medical Control Physician
PATIENT ASSESSMENT GENERAL INFORMATION
Evaluate for the Following:
1. Mild Symptoms:
Rash Bradycardia Itching Rash
Hives Diaphoresis Flushed Skin Itching
Cyanosis Hypotension Dyspnea Flushed
Tachycardia Wheezing
2. Moderate Symptoms:
Dyspnea
History: Wheezing
Allergy Exposure
Foods 3. Severe Symptoms:
Shock
LAURNES COUNTY EMS
Medications
Hypotension
Insect Bites or Stings
Severe Respiratory Distress
Altered Level of Consciousness
MANAGEMENT
EMT-BASIC EMT-INTERMEDIATE EMT-PARAMEDIC
Request Paramedic Continue / Initiate: Basic Continue / Initiate: Basic &
Assistance Management Intermediate Management
Monitor ECG-Lead II
Initiate: Airway Management Initiate: Intravenous Access
Protocol Protocol MILD SYMPTOMS
Administer:
MODERATE / SEVERE SEVERE SYMPTOMS Diphenhydramine HCL 50 mg IV or
SYMPTOMS IM
Administer:
Patient Assisted Medications: Fluid Bolus NACL 500 ml MODERATE SYMPTOMS
Epinephrine 1:1,000 Maintain Systolic
Pressure >90 Administer:
Patient has prescribed
Be cautious of fluid overload Diphenhydramine HCL 50 mg IV / IM
epinephrine injector or
Anaphylactic Kit.
Administer:
Verify that the medication is Epinephrine 1:1,000 0.3 mg SQ
the patient’s own. Administer:
Solu-Medrol 125 mg IV
Verify that the medication
has not expired.
SEVERE SYMPTOMS
Patient is Alert/Oriented Administer:
Diphenhydramine HCL 50 mg IV / IM
Facilitate administration of Administer:
entire autoinjector or
Epinephrine 1:10,000 0.1-0.5 mg IV
prefilled syringe.
Patient is < 45 years of age
No Cardiac History
Administer over 5 minutes
Administer:
Solu-Medrol 125 mg IV
Transport
Contact ED with Patient Report.
3
MEDICAL EMERGENCIES-ADULT BRONCHOSPASM
TREATMENT PROTOCOLS MODERATE/SEVERE
ISSUED: 01/01/06 ______________________________________
M-04 Randall Reinhardt, MD
Laurens County EMS Medical Control Physician
PATIENT ASSESSMENT GENERAL INFORMATION
Evaluate for the Following:
Use with caution in patients with cardiac history, chest pain, or
Wheezing - (Must Document) >65 years of age.
Cyanosis
Dyspnea Albuterol is Pre-mixed
Diaphoresis
Tachycardia If unable to establish intravenous access, Albuterol may still be
Anxiety administered.
History of:
Asthma Evaluate Pulse Oximetry prior to medication administration and
Croup after treatment. Document in Patient Care Report.
LAURENS COUNTY EMS
MANAGEMENT
EMT-BASIC EMT-INTERMEDIATE EMT-PARAMEDIC
Request Paramedic Continue / Initiate: Basic Continue / Initiate: Basic &
Assistance Management Intermediate Management
Initiate: Airway Management Initiate: Intravenous Access Monitor ECG-Lead II
Protocol Protocol
Administer:
Patient Assisted Medications: Albuterol 5 mg via Nebulizer
Handheld Inhaler Nebulize with 6 LPM Oxygen
Administered over 5-10 minutes
Albuterol, Metproteranol, Re-evaluate patient, if no change
Terbutaline, Ventolin, etc.
Administer:
Patient has prescribed inhaler
for asthma or COPD Albuterol 5 mg via Nebulizer
Second Treatment
Verify that the medication is Nebulize with 6 LPM Oxygen
the patient’s own. Administered over 5-10 minutes
Re-evaluate patient, if no change
Verify that the medication has Continue treatment as severe
not expired.
Patient is Alert/Oriented
SEVERE ASTHMATIC
BRONCHOSPASMS
Facilitate administration of one
dose (one puff) of medication. Administer:
Solu-Medrol 125 mg IV
Administer:
Epinephrine 1:1,000 0.3 mg SQ
Must meet the following criteria:
Patient is < 45 years of age
Patient has no cardiac history
Transport
Contact ED with Patient Report.
4
MEDICAL EMERGENCIES-ADULT PULMONARY EDEMA
TREATMENT PROTOCOLS CONGESTIVE HEART FAILURE
ISSUED: 01/01/06 ______________________________________
M-05 Randall Reinhardt, MD
Revised: 03/18/10 Laurens County EMS Medical Control Physician
PATIENT ASSESSMENT GENERAL INFORMATION
Evaluate for the Following: Patient with fever and unilateral rales is typically indicative of
Rales pneumonia, not CHF.
Jugular Vein Distention
Chest Pain Evaluate Pulse Oximetry prior to medication administration and
Dyspnea after treatment. Document in Patient Care Report.
Diaphoresis
Nitroglycerin is absolutely contraindicated with patients that
Edema
Anxiety have used the following within 48 hours
Viagra, Cialis, or Levitra
History:
Cardiac If any question as to the administration of Lasix under standing
orders, then contact Medical Control.
LAURENS COUNTY EMS
Congestive Heart Failure
MANAGEMENT
EMT-BASIC EMT-INTERMEDIATE EMT-PARAMEDIC
Request Paramedic Continue / Initiate: Basic Continue / Initiate: Basic &
Assistance Management Intermediate Management
Initiate: Airway Management Initiate: Intravenous Access Monitor ECG- Lead II
Protocol Protocol Consider 12 Lead
Initiate CPAP immediately if Administer:
indicated per GP-1A Nitroglycerin 0.4 mg SL
Assess for Impotence Drug use!
See above general Information for
contraindication.
Systolic BP is >100
Repeat x1 (Total Dose of 2) at 5
minute intervals if systolic BP
remains >100
Administer:
Lasix 40-80 mg IV
Systolic BP >100
Maximum 80 mg under protocol
If patient prescribed Lasix:
Consider giving patients daily dose
X2 ( recommended dose range is
0.5 – 1mg/kg)
Administer:
Dopamine HCL 2-10 mcg/kg/min
Systolic BP is < 90 with signs &
symptoms of Decompensating
Shock
ON-LINE MEDICAL CONTROL
ORDER REQUIRED:
Morphine Sulfate 2-10 mg’s IV
Acute Pulmonary Edema.
Systolic BP >100
Administered in 2 mg increments.
Transport
Contact ED with Patient Report.
5
MEDICAL EMERGENCIES-ADULT MEDICAL
TREATMENT PROTOCOLS HYPOTENSION
ISSUED: 01/01/06 ______________________________________
M-06 Randall Reinhardt, MD
Laurens County EMS Medical Control Physician
PATIENT ASSESSMENT GENERAL INFORMATION
Evaluate for the Following:
Rule-out Cardiac Involvement.
Hypotension (Systolic B/P <90)
Poor Perfusion
Abdominal Aneurysm- Notify ED early. Preferably two IV lines
Dyspnea
Tachycardia initiated.
Abdominal Pain Most prevalent between the ages of 60 & 70
Back Pain
Chest Pain
Dehydration
LAURENS COUNTY EMS
History:
Cardiac
Abdominal Aneurysm
Poor Dietary Intake
MANAGEMENT
EMT-BASIC EMT-INTERMEDIATE EMT-PARAMEDIC
Request Paramedic Continue / Initiate: Basic Continue / Initiate: Basic &
Assistance Management Intermediate Management
Initiate: Airway Management Initiate: Intravenous Access Monitor ECG-Lead II
Protocol Protocol Consider 12 Lead
Administer: Rule-out Cardiac Related:
Fluid Bolus 250 ml ⇒ Symptomatic Bradycardia
Maintain systolic BP >90. Protocol (C-11)
⇒ Ventricular Tachycardia-Unstable
Be cautious of fluid overload
Protocol (C-07)
Consider no response after ⇒ Supraventricular Tachycardia-
X2 Boluses. Unstable Protocol (C-09)
If a response, maintain IV at Administer:
150 ml/hr. Dopamine HCL 2-10 mcg/kg/min
Systolic BP is < 90
No response to X2 Fluid Boluses
Transport
Contact ED with Patient Report.
6
MEDICAL EMERGENCIES-ADULT SEIZURES
TREATMENT PROTOCOLS
ISSUED: 01/01/06 ______________________________________
M-07 Randall Reinhardt, MD
Revised: 12-01-06 Laurens County EMS Medical Control Physician
PATIENT ASSESSMENT GENERAL INFORMATION
Evaluate for the Following:
Rule-out Cardiac Involvement.
Tonic/Clonic Activity
Postictal
Remember!
Altered Level of Consciousness
Hypoglycemia Most seizures are of less than 5 minutes duration and do
Hyperglycemia not require anticonvulsant medications in the field. If
Trauma unable to establish IV, consider using IM injection for
Narcotic Overdose continuous seizure. IO access will not be established
Fever solely for the administration of anticonvulsant
medications.
History:
LAURENS COUNTY EMS
Seizures
Recent Trauma
Illicit Drug Use
MANAGEMENT
EMT-BASIC EMT-INTERMEDIATE EMT-PARAMEDIC
Request Paramedic Continue / Initiate: Basic Continue / Initiate: Basic &
Assistance Management Intermediate Management
Initiate: Airway Management Initiate: Intravenous Access Monitor ECG-Lead II
Protocol Protocol
Rule–out Related Causes: Administer:
Hypoglycemia: Ativan 1-2 mg IV, IM, or IO q 10 min
Hyperglycemia: Total Dose 4 mg under protocol
Narcotic Overdose: Continuous seizure
⇒ Altered Level of
Consciousness Protocol Transport
(M-02)
Contact ED with Patient Report.
Trauma:
⇒ Appropriate Protocol
7
MEDICAL EMERGENCIES-ADULT POISONING AND
TREATMENT PROTOCOLS OVERDOSE
ISSUED: 01/01/06 ______________________________________
M-08 Randall Reinhardt, MD
Laurens County EMS Medical Control Physician
PATIENT ASSESSMENT GENERAL INFORMATION
Evaluate for the Following: Bring any containers found to the Emergency Department.
If there is evidence of external contamination:
History from family, friends, or witnesses
Protect EMS Personnel
Abnormal Breath Odor
Notify Supervisor, if appropriate, for Hazmat Team
Constricted or Dilated Pupils
Remove contaminated clothing and “Red Bag”
Altered Mental Status
If chemicals involved, identify and determine if water reactive. If not
History: flush with copious amounts of water at scene for 15 minutes. If
Suicidal Tendencies chemical residue is powder form, brush from patient prior to flushing.
Depression If there is evidence of internal ingestion and the patient is alert/oriented,
Illicit Drug Use contact On-Line Medical Control or the appropriate Poison Control Center
from the scene for advice.
LAURENS COUNTY EMS
Poison Control 1-800-222-1222
Unconscious – Initiate Altered Mental Status Protocol
MANAGEMENT
EMT-BASIC EMT-INTERMEDIATE EMT-PARAMEDIC
Request Paramedic Continue / Initiate: Basic Continue / Initiate: Basic &
Assistance Management Intermediate Management
Initiate: Airway Management Initiate: Intravenous Access Monitor ECG-Lead II
Protocol Protocol
Phenothiazine Reaction (EPR)
Administer:
Chemical or Medication
Benadryl 25-50 mg IV
Ingestion
ON-LINE MEDICAL CONTROL
Symptomatic Organophospate
ORDER REQUIRED:
Poisoning
Administer:
ON-LINE MEDICAL CONTROL
Activated Charcoal 25-50 gms
ORDER REQUIRED:
PO
Administer:
Patient is Alert/Oriented
Ingestion within 1 hour of EMS Atropine 1-2 mg IV q 5 min
arrival Total Dose 6 mg
Symptomatic Drug Overdose
Administer:
Narcan 2 mg IV-IM-ETT
If no response, Repeat 2 mg IV in 5
minutes.
Total maximum dose of 4 mg in field
Calcium Channel Blocker
Overdose
ON-LINE MEDICAL CONTROL
ORDER REQUIRED:
Administer:
Calcium Gluconate 1 gm IV
Transport
Contact ED with Patient Report
8
MEDICAL EMERGENCIES-ADULT PSYCHIATRIC
TREATMENT PROTOCOLS EMERGENCIES
ISSUED: 01/01/06 ______________________________________
M-09 Randall Reinhardt, MD
Laurens County EMS Medical Control Physician
PATIENT ASSESSMENT GENERAL INFORMATION
History: Do not assume patient’s condition is purely psychological. Rule-out
medical illnesses (diabetes, stroke, seizure, etc.). Additionally certain
Recent ingestion of toxic substances,
medical conditions (arthritis, angina, ulcers) can be exacerbated by
exposure, or seizure.
psychological stress. A patient who is treated as “helpless or crazy” will
Recent trauma or underlying illness-acute
frequently behave according to those expectations. A calm, reassuring,
or chronic, current medications.
supportive approach is best. Introduce yourself, state that you want to help
Similar behavior in the past.
and explain what you intend to do.
Alcohol or Drug Abuse
Be alert for weapons, drugs, and/or a hostile environment. Request
Pertinent Findings: assistance early (Supervisor, Law Enforcement, etc.). The need for
Suicidal Tendencies/Depression restraints exists if no one including the patient seems to be in control of the
Medic Alert card indicating medical patient’s behavior and that behavior threatens the patient or others with
LAURENS COUNTY EMS
condition harm.
Evidence of trauma or serious illness.
Evidence of medications or toxins at
scene.
Threats of hostility/harm to EMS or self.
MANAGEMENT
EMT-BASIC EMT-INTERMEDIATE EMT-PARAMEDIC
Request Paramedic Continue / Initiate: Basic Continue / Initiate: Basic &
Assistance Management Intermediate Management
Introduce yourself and be
supportive Consider: Intravenous Access Consider: Monitor ECG-Lead II
Initiate: Airway Management Protocol
Protocol
ON-LINE MEDICAL CONTROL
Complete appropriate patient ORDER REQUIRED:
assessment and rule out the Ativan 2 mg IV / IM q 10 min
following:
Total Dose 4 mg
Hypoglycemia: Severe Acute Anxiety States
Hyperglycemia: Extremely Combative Patients
⇒ Altered Level of
Consciousness Protocol Transport
(M-02)
Drug Overdose Contact ED with Patient Report
⇒ Poisoning/Overdose
Protocol (M-08)
Hypoxia
⇒ Airway Management
Protocol (GP-1)
Attempt Verbal Control
Request adequate manpower to
mitigate the incident (If needed):
Supervisor
Law Enforcement
Additional Unit
Apply Necessary Restraints (If
needed):
Soft Restraints
Scoop Stretcher
9
MEDICAL EMERGENCIES-ADULT OBSTETRICAL
TREATMENT PROTOCOLS EMERGENCIES
ISSUED: 01/01/06 ______________________________________
M-10 Randall Reinhardt, MD
Laurens County EMS Medical Control Physician
PATIENT ASSESSMENT GENERAL INFORMATION
Evaluate the Following: Preterm Labor = < 38 weeks gestation
Term Labor = > 38 weeks gestation
Due Date/Estimate Gestational Age
Abortion = < 20 weeks gestation
Possibility of complicated delivery
Ectopic Pregnancy = < 20 weeks gestation
Foul smelling or discolored amniotic fluid
Third Trimester Bleeding = Abruptio Placenta or Placenta Previa, until
How many pregnancy’s (Gravida)?
otherwise proven.
How many deliveries (Para)?
How many miscarriages or abortions Prolapsed Cord: Place patient prone in knee-chest position. Manually
(AB)? reduce pressure on cord with two gloved fingers. High Flow O2
Length of contractions? Limb Presentation: Place patient prone in knee-chest position. Avoid
Has water broken? touching presenting part. High Flow O2
LAURENS COUNTY EMS
Left Lateral Recumbent Position: Third trimester patients should be
transported in a left Lateral Recumbent position, If:
Delivery is not imminent
Bleeding and/or contraindications are not present
MANAGEMENT
EMT-BASIC EMT-INTERMEDIATE EMT-PARAMEDIC
Request Paramedic Continue / Initiate: Basic Continue / Initiate: Basic &
Assistance Management Intermediate Management
Initiate: Airway Management Initiate: Intravenous Access Consider: Monitor ECG-Lead II
Protocol Protocol
Transport
Hypotensive
Imminent Delivery:
Heavy Vaginal Bleeding Contact ED with Patient Report-
Prepare for Delivery
Request additional assistance Severe Abdominal Pain Advise to notify Labor & Delivery.
Aid Delivery Delivery is Imminent
Suction Infant Complicated Delivery
Cut Cord Abruptio Placenta
Dry and Warm Infant Placenta Previa
Initiate tactile stimulation Abortion or Miscarriage
Position Infant
Ectopic Pregnancy
Complete APGAR Score (1 min)
Repeat APGAR Score (5 min)
Initiate Neonatal Resuscitation
Protocol, if needed. (P-03)
10
MEDICAL EMERGENCIES-ADULT HYPERTHERMIA
TREATMENT PROTOCOLS
ISSUED: 01/01/06 ______________________________________
M-11 Randall Reinhardt, MD
Laurens County EMS Medical Control Physician
PATIENT ASSESSMENT GENERAL INFORMATION
Evaluate for the Following: Minor Conditions- Require only supportive care, monitoring and
History of low-fluid intake movement from environment- Salt / fluid replacement accomplished via
Decreased Urine Output PO route.
Positive Orthostatic Vital Signs or Heat Cramps: Tends to occur after exercise, when the patient has stopped
Hypotension work and is at rest. Generally a result of salt loss.
Tachycardia/Bradycardia Heat Edema: Characterized by swollen feet and ankles, and sometimes
Nausea & Vomiting swollen hands. This is a result of peripheral vasodilation.
Heat Syncope: The elderly seem to have a special susceptibility for this
Dizziness & Transient Syncope
disorder with vasodilation and peripheral pooling without the ability to
Headache/Confusion/Disorientation maintain their blood pressure in an upright position.
Muscle Cramps
Diarrhea Major Conditions- Require aggressive treatment to lower body
LAURENS COUNTY EMS
Coma/Seizures temperature (below 104) and replace fluid through intravenous access.
Heat Exposure Heat Exhaustion: Characterized by weakness, fatigue, low-grade frontal
headache, impaired judgment, vertigo, nausea, vomiting, and occasionally
muscle cramps.
Heat Stroke: a syndrome, which occurs when homeostatic
thermoregulatory mechanisms are unable to meet the demands of heat
stress. Defined as hyperpyrexia with neurological symptoms.
TRUE MEDICAL EMERGENCY!
Patients with heat stroke may still sweat, manifested by sudden loss of
consciousness with little or no prodrome; however, prior to this
irritability, bizarre behavior, combativeness, hallucinations, or coma
may occur.
MANAGEMENT
EMT-BASIC EMT-INTERMEDIATE EMT-PARAMEDIC
Request Paramedic Continue / Initiate: Basic Continue / Initiate: Basic &
Assistance Management Intermediate Management
Initiate: Airway Management Initiate: Intravenous Access Consider: Monitor ECG-Lead II
Protocol Protocol
Initiate: Cooling Procedures: Administer: Transport
Fluid Bolus NACL 500 ml x 1
Move to cool environment Maintain systolic pressure >90 Contact ED with Patient Report
(out of sun, in ambulance or Maintain IV at 150 ml/hr after
initial bolus.
air-conditioned environment)
Disrobe patient
Wet patient with tap water or
normal saline (Evaporation
process).
Ice packs should be applied
to axilla, neck, and groin
regions (If available).
11
MEDICAL EMERGENCIES-ADULT HYPOTHERMIA
TREATMENT PROTOCOLS
ISSUED: 01/01/06 ______________________________________
M-12 Randall Reinhardt, MD
Revised: 12/01/06 Laurens County EMS Medical Control Physician
PATIENT ASSESSMENT GENERAL INFORMATION
Evaluate for the Following: Mild Hypothermia: Core temperature 32-35° C (90-95° F)- is common and
Shivering is not life threatening by itself. The typical patient with mild hypothermia
Altered Mental Status may be slightly confused and uncoordinated, often with intense shivering.
Muscle Rigidity Treatment consists of removal to a warm environment, removal of wet
Ataxia clothing, and wrapping in blankets. Attention must be paid to underlying
Confusion/Stupor medical conditions.
Cold Exposure Severe Hypothermia: Core temperature is < 32° C (90° F)- is life
Skin Cold to Touch threatening and requires treatment beyond the scope of prehospital care.
Hypotension This protocol outlines the treatment for patients with severe hypothermia
Slow or Absent Pulse and/or hypothermic cardiac arrest
Dilated Pupils
LAURENS COUNTY EMS
Present of “J” Waves (ECG) Attempts shall be made to obtain a complete history and assessment, to
ensure that underlying and potentially treatable medical conditions are not
Special Note: contributing to the hypothermia.
Respirations should be assessed for 1 Active attempts to re-warm patient shall not be attempted in the field. The
minute. patient should be protected from any further heat loss by removing wet
Pulse should be assessed for 1-2 clothing, wrapping in blankets and rapid transport.
minutes
MANAGEMENT
EMT-BASIC EMT-INTERMEDIATE EMT-PARAMEDIC
Initiate: Cardiopulmonary Continue / Initiate: Basic Continue / Initiate: Basic &
Resuscitation (CPR) (Until Management Intermediate Management
Monitor/Defibrillator Available).
If Apneic / Pulseless Initiate: Intravenous Access Initiate: Defibrillation X 1, if V-Fib or
Protocol Pulseless V-Tach is present:
Request Paramedic Ensure IV Fluids are warm ♦ (Mono) 360 Joules (Bi) 200 Joules
Assistance Enroute to ED
Monitor ECG-Lead II
Remove wet Clothing and
Cover with Blankets: Defibrillation & Pharmacological
No heat packs or active re- Intervention:
warming to be attempted in the Core Temp < 30° C (86° F)
field. Withhold further defib attempts & all
pharmacological intervention in the
Initiate: Automatic External field
Core Temp > 30° C (86° F)
Defibrillator (If Available).
Continue normal defib protocol.
Administer pharmacological
intervention as indicated at longer
Continue: Cardiopulmonary intervals
Resuscitation
Transport and Continue CPR
Initiate: Airway Management
Protocol Contact ED with Patient Report
(Early contact, if possible)
Attempt to minimize physical
manipulation.
12
MEDICAL EMERGENCIES-ADULT ACUTE
TREATMENT PROTOCOLS ABDOMEN
ISSUED: 01/01/06 ______________________________________
M-13 Randall Reinhardt, MD
Laurens County EMS Medical Control Physician
PATIENT ASSESSMENT GENERAL INFORMATION
Evaluate for the Following: Acute abdomen refers to the relatively sudden onset of abdominal pain.
Pain Most cases of abdominal pain arise from problems within the abdomen
Nausea/Vomiting itself. However, 10-15% result from pathology elsewhere in the body.
Abdominal tenderness
Guarding The prehospital care provider’s primary responsibility in dealing with a
Rigidity patient suffering an abdominal emergency consists of detection and
Hematuria stabilization. The patient with an acute abdomen can deteriorate rapidly.
Hematemesis Continuous reassessment and management is of paramount importance.
Melanotic Diarrhea
LAURENS COUNTY EMS
Abdominal Distention The differential diagnosis of acute abdominal pain is not pertinent in the
Pulsating Masses prehospital environment. The standard of treatment remains the same
Orthostatic Vital Sign Changes regardless of underlying cause.
MANAGEMENT
EMT-BASIC EMT-INTERMEDIATE EMT-PARAMEDIC
Request Paramedic Continue / Initiate: Basic Continue / Initiate: Basic &
Assistance Management Intermediate Management
Maintain: Position of comfort Initiate: Intravenous Access Monitor ECG-Lead II
If shock is not present Protocol
Initiate two IV lines, if Transport
Initiate: Airway Management hypotensive.
Protocol Maintain systolic pressure Contact ED with Patient Report
>90
Maintain NPO Status
13
MEDICAL EMERGENCIES-ADULT Nausea and Vomiting
TREATMENT PROTOCOLS
ISSUED: 06/01/08 ______________________________________
M-14 Randall Reinhardt, MD
Laurens County EMS Medical Control Physician
PATIENT ASSESSMENT GENERAL INFORMATION
Evaluate for the Following: Rule out any of the following before administering anti-emetics
Perform patient assessment o alcohol intoxication
o Onset of vomiting ? o drug overdose
o Blood in emesis ? o poisoning or toxic ingestion
o hyperglycemia (BGL>300)
o Previous similar episodes ?
Evaluate for dehydration Use caution
o Tachycardia o Patient with impaired liver function
o Poor skin signs o Patient with impaired kidney function
LAURENS COUNTY EMS
o Hypotension
o Orthostatic V/S This protocol is to be used in conjunction with other applicable LCEMS
protocols.
MANAGEMENT
EMT-BASIC EMT-INTERMEDIATE EMT-PARAMEDIC
Continue / Initiate: Basic Continue / Initiate: Basic &
Request Paramedic Management Intermediate Management
Assistance
Initiate: Intravenous Access Monitor ECG-Lead II
Initiate: Airway management Protocol
protocol Consider: Zofran 4-8 mg IV
Transport For repeated episodes of
Maintain: Position of comfort vomiting
Contact ED with Patient Report
Transport
Contact ED with Patient Report
13
LAURENS COUNTY EMS
PEDIATRIC
EMERGENCIES
STANDARDS OF CARE
&
TREATMENT PROTOCOLS
PEDIATRIC EMERGENCIES GENERAL
TREATMENT PROTOCOLS GUIDELINES
ISSUED: 01/01/06 ______________________________________
P-01 Randall Reinhardt, MD
Laurens County EMS Medical Control Physician
• All items outlined in the Adult General Medical Guidelines Protocol and the General Trauma Guidelines
Protocol shall also apply to the Pediatric Guidelines Protocol, when appropriate and with the addition of
the following:
• Age Ranges:
Neonate: Time of Birth.
Newborn: Day 1 to 2 months.
Pediatric: 2 months to 12 years.
•
LAURENS COUNTY EMS
Consent: A patient of sound mind is legally able to make decisions about his or her medical care, if any
of the following apply:
The patient is 16 years old or older.
The patient is legally married.
The patient is living on his / her own.
• If condition of the patient is deemed life or limb threatening, medical care should be rendered under
the auspices of implied consent.
• When condition is NOT limb or life threatening, every reasonable effort shall be made to contact the
legal guardian for medical decisions.
• Drug dosages are based on patient weight.
Activated Charcoal 1 gm/kg P.O.
Albuterol 0.15 mg/kg (max. dose 2.5 mg)
Atropine 0.02 mg/kg (min dose 0.1mg)
Benadryl 1.0 mg/kg
Dextrose 25% (< 2 y/o) 2 cc/kg (dilute 1:1 with Normal Saline = D25W)
Dextrose 50% (> 2 y/o) 0.1 mg/kg (0.1 ml/kg)
Epinephrine 1:10,000 0.01 mg/kg (0.1 ml/kg)
Lasix 1.0 mg/kg
Lidocaine 1.0 mg/kg
Lorazepam 0.05 - 0.1 mg/kg
Narcan 0.1 mg/kg (dilute 1:1 with Normal Saline)
Sodium Bicarbonate 1 mEq/kg (dilute 1:1 with Normal Saline = 4.8%)
Solu-Medrol 1-2 mg/kg
Syrup of Ipecac 15 cc P.O.
Zofran 0.15mg/kg (dilute 1:1 with normal saline)
• Defibrillation - 2 joules / kg initially, 4 joules / kg subsequently.
1
PEDIATRIC EMERGENCIES PEDIATRIC TABLE
TREATMENT PROTOCOLS
ISSUED: 01/01/06 ______________________________________
P-02 Randall Reinhardt, MD
Revised: 09/30/06 Laurens County EMS Medical Control Physician
PEDIATRIC VITAL SIGNS - CHART
Age Heart SBP Respirations Weight (kg)
Rate
Newborn 100-160 50-70 30-60 3
1-6 weeks 100-160 70-95 30-60 4
6 months 90-120 80-100 25-40 7
1 year 90-120 80-100 20-30 10
3 years 80-120 80-110 20-30 15
6 years 70-100 80-110 18-25 20
LAURENS COUNTY EMS
10 years 60-90 90-120 15-20 30
Lower limits of systolic blood pressure 1-10 y/o (5th percentile)
70 + (childs age in years x 2) = SBP mm hg
PEDIATRIC EQUIPMENT - CHART
Age OPA Blade Size ET Tube Suction Cath NG/OG
Newborn 00 0-1 2.5-3.5 5-6 10
6 months 1 0-1 3.5 6-8 10
1 year 2 1-2 4.0 8 12
2-3 years 2 1-2 4.0-4.5 10 12
4-5 years 3 2 4.5-5.0 10 12-14
6-7 years 4 2 5.0-6.0 10 14
8-10 years 4-5 2-3 6.0-6.5 10-12 16
PEDIATRIC MODIFIED GLASGOW COMA SCALE
SCORE INFANTS CHILDREN
EYE OPENING
4 Spontaneous Spontaneous
3 To speech To verbal stimuli
2 To pain To pain
1 No response No response
MOTOR RESPONSE
6 Normal spontaneous movement Follows commands
5 Withdraws to touch Localizes pain
4 Withdraws to pain Withdraws to pain
3 Abnormal flexion Abnormal flexion to pain
2 Abnormal extension Abnormal extension
1 No response No response
VERBAL RESPONSE
5 Coos and babbles Oriented
4 Irritable cries Confused
3 Cries to pain Inappropriate word
2 Moans to pain Non-specific sounds
1 No response No response
2
PEDIATRIC EMERGENCIES NEONATAL (NEWBORN)
TREATMENT PROTOCOLS RESUSCITATION
ISSUED: 01-01-06 ______________________________________
P-03 Randall Reinhardt, MD
Revised: 09/30/06 Laurens County EMS Medical Control Physician
PATIENT ASSESSMENT GENERAL INFORMATION
Evaluate the Following: The vast majority newborns (80%) require no resuscitation beyond
suctioning, mild stimulation, and maintenance of body temperature.
APGAR Score (1 MINUTE)
Neonatal Resuscitation is typically responsive to Basic Life Support
APGAR Score (5 MINUTES)
Treatment.
Do not delay treatment to complete APGAR Score.
MANAGEMENT
EMT-BASIC EMT-INTERMEDIATE EMT-PARAMEDIC
Request Paramedic Continue / Initiate: Basic Continue / Initiate: Basic &
Assistance Management Intermediate Management
LAURENS COUNTY EMS
Time of Delivery: Time of Delivery: Administer:
Asses for Meconium Asses for Meconium Epinephrine 0.01 mg/kg of 1:10,000
Remove from airway prior Remove from airway prior to IV or IO
to stimulation stimulation Repeat q 3-5 min
Limited to upper airway Perform direct tracheal suction May utilize ETT dose as last resort if
suctioning only with meconium aspirator IV/IO unobtainable or procedure fails
Initiate: Airway Management Initiate: Intravenous Access 0.1 mg/kg 1:1,000 followed by 5 cc
Protocol fluid and 5 ventilations
Protocol
Symptomatic Bradycardia: Administer:
Heart Rate <100 D25W 2 ml/kg IV or IO
Persistent Cyanosis Blood Glucose Level <60
Position Infant
(Trendlenburg)
Transport
Suction Airway Contact ED with Patient Report-
Dry Infant
Stimulate Infant
Advise to notify Labor & Delivery.
Warm Infant (Maintain )
No Improvement; Administer:
100% Oxygen via Blow-By
Method
No Improvement; Administer:
Bag Valve Mask
Ventilations with 100% O2.
Ventilate @ 40 BPM for one
minute
Re-assess
No Improvement in initial
status or heart rate <60
Administer:
Chest Compressions @
>100 per min for 1 min.
Bag Valve Mask
Ventilations with 100 O2.
Ventilate @ 40 BPM for 1
min
Re-assess – No
Improvement;
Continue CPR and Bag
Valve Mask Ventilations.
3
PEDIATRIC EMERGENCIES ASYSTOLE &
TREATMENT PROTOCOLS PULSELESS ELECTRICAL ACTIVITY
ISSUED: 01/01/06 ______________________________________
P-04 Randall Reinhardt, MD
Revised: 09/30/06 Laurens County EMS Medical Control Physician
PATIENT ASSESSMENT GENERAL INFORMATION
Confirm Apenic/Pulseless Consider and Treat Possible Causes: 6 H’s & 5 T’s
Confirm rhythm: Hypovolemia Toxins
1. Quick-look Paddles for unmonitored Situations Hypoxia Tamponade, cardiac
2. ECG for monitored situations Hydrogen Ion Tension
(acidosis) pneumothorax
Confirm and Document rhythm in Two Leads Hypo-/Hyperkalemia Thrombosis (coronary
If rhythm is unclear and is possibly Fine Ventricular Hypoglycemia or pulmonary
Fibrillation- Initiate Ventricular Fibrillation/Pulseless Hypothermia Trauma(hypovolemia,
Ventricular Tachycardia Protocol increased ICP
LAURENS COUNTY EMS
If CPR is in progress, confirm quality of ventilations Pediatric Asystole may not be terminated in the
and compressions. field. All pediatric arrests shall be transported to the ED
Establish Down Time with ACLS in process if initiated.
MANAGEMENT
EMT-BASIC EMT-INTERMEDIATE EMT-PARAMEDIC
Initiate: Cardiopulmonary Continue / Initiate: Basic Continue / Initiate: Basic &
Resuscitation (CPR) Management Intermediate Management
Request Paramedic Initiate: Intravenous Access Monitor ECG-Lead II
Assistance Protocol
Initiate: Airway Management Administer: Administer:
Protocol Fluid Challenge 20 ml/kg Epinephrine 1:10,000 0.01 mg/kg
Assess lung fields IV/IO
Continue: Cardiopulmonary Repeat q 3-5 minutes
Resuscitation May utilize ETT dose as last resort if
IV/IO unobtainable or procedure fails
0.1 mg/kg 1:1,000 followed by 5 cc
fluid and 5 ventilations
Administer:
Sodium Bicarbonate 1 meq/kg
Patient is properly ventilated for >10
minutes
Dilute 1:1 with NS (4.2%)
Flush IV line before & after
administration
Transport
Contact ED with Patient Report.
4
PEDIATRIC EMERGENCIES VENTRICULAR FIBRILLATION
TREATMENT PROTOCOLS PULSELESS VENTRICULAR TACH
ISSUED: 01/01/06 ______________________________________
P-05 Randall Reinhardt, MD
Revised: 09/30/06 Laurens County EMS Medical Control Physician
PATIENT ASSESSMENT GENERAL INFORMATION
Confirm Apenic/Pulseless General Format: Drug with 2 min CPR-Defib-Drug with 2 min CPR -Defib
Confirm rhythm: 20-40 ml fluid bolus after each medication administration.
1. Quick-look Paddles for unmonitored
Situations Termination of Ventricular Fibrillation or Pulseless Ventricular
Tachycardia:
2. ECG for monitored situations Lidocaine Bolus 0.5 mg/ kg, If initial dose not given or if >10
minutes of initial dose and maximum dose has not been achieved
If CPR is in progress, confirm quality of
ventilations and compressions. Lidocaine Infusion at 1 ml/kg/hr (20ug/kg/min)
Lidocaine Drip: Add 300 mg Lidocaine to 250 ml D5W = 1200 ug/ml
Establish Down Time
Use 60 gtt set (1 gtt/min/kg = 20uq/kg/min with a 1200uq/ml
LAURENS COUNTY EMS
concentration)
MANAGEMENT
EMT-BASIC EMT-INTERMEDIATE EMT-PARAMEDIC
Initiate: Cardiopulmonary Continue / Initiate: Basic Continue / Initiate: Basic & Intermediate
Resuscitation (CPR) Management Management
Initiate: Defibrillation
Request Paramedic Initiate: Intravenous
Defibrillate 2 Joules/kg
Assistance Access Protocol
♦ No Change
Initiate: Airway Management Monitor ECG-Lead II
Protocol Administer: CPR for 2 min
Administer:
Continue: Cardiopulmonary Epinephrine 1:10,000 0.01 mg/kg IV/IO
Resuscitation Repeat q 3-5 minutes
Administer during CPR
May utilize ETT dose as last resort if IV/IO
unobtainable or procedure fails
0.1 mg/kg 1:1,000 followed by 5 cc fluid
and 5 ventilations
Check Rhythm
Defibrillate 4 Joules/kg
Administer: CPR for 2 min
Administer:
Lidocaine HCL 1 mg/kg IV / IO
Repeat at 0.5 mg/kg q3-5 minutes to total
dose of 3 mg/kg.
Administer during CPR
Check Rhythm
Defibrillate 4 Joules/kg
Administer: CPR for 2 min
Administer:
Magnesium Sulfate 25-50 mg/kg
Use as first line for Torsades de Points
Max of 2 gm
Consider:
Sodium Bicarbonate 1 meq/kg
Patient is properly ventilated for >10
minutes
Dilute 1:1 with NS (4.2%)
Flush IV line before & after administration
Transport
Contact ED with Patient Report.
5
PEDIATRIC EMERGENCIES SYMPTOMATIC
TREATMENT PROTOCOLS BRADYCARDIA
ISSUED: 01/01/06 ______________________________________
P-06 Randall Reinhardt, MD
Revised: 09/30/06 Laurens County EMS Medical Control Physician
PATIENT ASSESSMENT GENERAL INFORMATION
Evaluate for the Following: Chest Compressions should be initiated if heart rate is < 60 BPM
Must document (2) two of the following: and bradycardia is causing severe cardiorespiratory compromise
Poor Perfusion
Decreased Level of Consciousness Bradycardia in children is usually due to Respiratory causes or
Hypotension Acidosis. Establish aggressive oxygenation and ventilation.
Respiratory Difficulty
Rule out specific causes if condition persists despite adequate
ventilation and oxygenation (i.e., hypoglycemia, severe acidosis,
hypothermia, etc.) 6 H’s & 5 T’s
LAURENS COUNTY EMS
MANAGEMENT
EMT-BASIC EMT-INTERMEDIATE EMT-PARAMEDIC
Request Paramedic Continue / Initiate: Basic Continue / Initiate: Basic &
Assistance Management Intermediate Management
Initiate: Airway Management Initiate: Intravenous Access Monitor ECG-Lead II
Protocol Protocol
Administer:
Initiate: Cardiopulmonary Consider: Epinephrine 1:10,000 0.01 mg/kg
Resuscitation (CPR), if despite Fluid Challenge 20 ml/kg IV/IO
oxygenation and ventilation: Repeat q 3-5 minutes
May repeat fluid challenge X 1
May utilize ETT dose as last resort
Heart Rate <60 BPM (infant or
if IV/IO unobtainable or procedure
child)
fails
Severe cardiorespiratory
0.1 mg/kg 1:1,000 followed by 5
compromise
cc fluid and 5 ventilations
Administer:
Atropine Sulfate 0.02 mg/kg IV/IO
Consider as first line drug for:
increased vagal tone or primary
A/V heart block
Minimum Dose = 0.1 mg
Child -Maximum single dose
0.5 mg
Adolescent - Maximum single dose
1.0 mg
May repeat X 1 in 5 minutes
Consider: Cardiac Pacing
Refractory bradycardia with severe
cardiorespiratory compromise
Set rate at 100
Transport
Contact ED with Patient Report.
6
PEDIATRIC EMERGENCIES HYPOTENSION
TREATMENT PROTOCOLS
ISSUED: 06/2003 ______________________________________
P-07 Randall Reinhardt, MD
Laurens County EMS Medical Control Physician
PATIENT ASSESSMENT GENERAL INFORMATION
Evaluate for the Following: Hypotension in a pediatric patient is defined as the following:
Infant (< 1 year of age) Systolic BP < 70
Poor Perfusion
Decreased Level of Consciousness Pediatric (> 1- < 5 years of age) Systolic BP < 80
Hypotension
Respiratory Difficulty Child (> 5 - < 12 years of age) Systolic BP < 90
Diaphoresis Hypotension in the pediatric patient is usually a result of
Cyanosis hypovolemia.
Dehydration
Trauma Rule out specific causes if condition persists despite adequate
Abdominal Pain ventilation/oxygenation and fluid infusion (i.e., blood loss, severe
LAURENS COUNTY EMS
acidosis, hypothermia, sepsis, anaphylactic, etc.)
13 years of age or older, follow Adult Trauma or Medical
Hypotension Protocol
MANAGEMENT
EMT-BASIC EMT-INTERMEDIATE EMT-PARAMEDIC
Request Paramedic Continue / Initiate: Basic Continue / Initiate: Basic &
Assistance Management Intermediate Management
Initiate: Spinal Immobilization Initiate: Intravenous Access Monitor ECG-Lead II
If Suspected Trauma Protocol
Transport
Initiate: Airway Management Administer:
Protocol Fluid Challenge 20 ml/kg Contact ED with Patient Report.
Follow Medical or Trauma
Control Bleeding Standards of Care
Repeat fluid bolus as needed to
maintain systolic BP
Use Pediatric Vital Sign Table as
reference
7
PEDIATRIC EMERGENCIES SEIZURES
TREATMENT PROTOCOLS
ISSUED: 01/01/06 ______________________________________
P-08 Randall Reinhardt, MD
Revised: 12-01-06 Laurens County EMS Medical Control Physician
PATIENT ASSESSMENT GENERAL INFORMATION
Evaluate for the Following:
Most seizures are of less than 5 minutes duration and do not
Tonic / Clonic Activity require anticonvulsant medications in the field. If unable to
Postictal
establish IV, consider using IM injection for continuous seizure.
Altered Level of Consciousness
Hypoglycemia IO access will not be established solely for the administration
Hyperglycemia of anticonvulsant medications.
Trauma
Infection Most pediatric seizures that involve EMS are most often
Toxic Ingestion/Exposure Febrile Seizures. Most commonly febrile seizures occur
Hypoxia between the ages of 6 months and 6 years. Febrile seizures
LAURENS COUNTY EMS
Fever should be suspected if the temperature is above 103° F.
History: Febrile seizures typically require no treatment other than
Seizures monitoring and supportive treatment. Diagnosis of febrile
Recent Trauma seizures should not be made in the field.
MANAGEMENT
EMT-BASIC EMT-INTERMEDIATE EMT-PARAMEDIC
Request Paramedic Continue / Initiate: Basic Continue / Initiate: Basic &
Assistance Management Intermediate Management
Initiate: Airway Management Initiate: Intravenous Access Monitor ECG-Lead II
Protocol Protocol
Rule–out Related Causes: ON-LINE MEDICAL CONTROL ORDER
REQUIRED:
Hypoglycemia: Ativan 0.05-0.1 mg/kg IV, IM, or IO
Hyperglycemia: Continuous Seizure or No Regain of
⇒ Altered Level of Consciousness
Consciousness Maximum dose 2 mg.
Protocol (P-09) Administer IV slow over 2-5
Toxic Ingestion/Exposure: minutes.
⇒ Pediatric Poisoning/
Ingestion Protocol Transport
(P-11)
Trauma: Contact ED with Patient Report.
⇒ Appropriate Protocol
8
PEDIATRIC EMERGENCIES ALTERED LEVEL OF
TREATMENT PROTOCOLS CONSCIOUSNESS
ISSUED: 01/01/06 ______________________________________
P-09 Randall Reinhardt, MD
Laurens County EMS Medical Control Physician
PATIENT ASSESSMENT GENERAL INFORMATION
Evaluate for the Following: Dextrose 50% should not be administered in absence of diabetic history, or
blood glucose level evaluation.
• A- Alcohol
• E- Encephalitis/Meningitis Dextrose should be administered if Blood Glucose Level is < 60 and in
• I - Insulin/Hypoglycemia accordance to the following:
• O- Opiates/Other Ingestants D25W < 2 years of age
• U- Uremia/Hypoxia/Hyper-Hypothermia D50W > 2 years of age
• T- Trauma Pediatric patients that present with fever, nausea/vomiting, severe
LAURENS COUNTY EMS
• I- Infection/Sepsis/Fever headache, stiff neck and recent ear or respiratory infections should alert
• P- Psychiatric (Adolescent) personnel to a high awareness of infection control procedures (i.e., mask,
goggles, gloves, etc.).
• S- Seizures
MANAGEMENT
EMT-BASIC EMT-INTERMEDIATE EMT-PARAMEDIC
Request Paramedic Continue / Initiate: Basic Continue / Initiate: Basic &
Assistance Management Intermediate Management
Initiate: Airway Management Initiate: Intravenous Access Monitor ECG-Lead II
Protocol Protocol
HYPOGLYCEMIA HYPERGLYCEMIA HYPOGLYCEMIA
Administer: Administer: Administer:
Oral Glucose 15 gms Fluid Bolus NACL 20 ml/kg Dextrose (D25W or D50W)
Blood Glucose < 60 Blood Glucose > 200 2 ml/kg IV/ IO
Ensure patient can swallow and After bolus, maintain IV rate @ Blood Glucose < 60
is able to protect airway. 1 ml/kg/hr Obtain Blood Sample
Administer between cheek and
gum. Administer:
Re-administer after glucose has Glucagon 0.1 mg/kg IM
dissolved, until full dose has Unable to establish Intravenous
been delivered access
Max Dose 1.0 mg
NARCOTIC OVERDOSE
Administer:
Narcan IV-IM-ETT-IO
0.1 mg/kg up to 5 years old
2.0 mg over 5 years old
Repeat once in 5 min
Transport
Contact ED with Patient Report.
9
PEDIATRIC EMERGENCIES ASTHMA/RESTRICTIVE AIRWAY
TREATMENT PROTOCOLS DISEASE
ISSUED: 01/01/06 ______________________________________
P-10 Randall Reinhardt, MD
Laurens County EMS Medical Control Physician
PATIENT ASSESSMENT GENERAL INFORMATION
Evaluate for the Following:
Children with croup, epiglottitis, or laryngeal edema usually have
Wheezing (Must Document) respiratory arrest due to exhaustion or spasm. Use extreme caution;
Cyanosis never attempt to visualize the oropharynx. Attempt ventilation with Bag
Dyspnea Valve Mask instead of intubation. Transport without delay. Invasive
Diaphoresis or upsetting procedures should only be performed on children with the
above conditions in extreme emergencies, as unnecessary agitation
Tachycardia
may cause the patient to develop complete airway obstruction.
Anxiety
History of: If unable to establish intravenous access, Nebulization may still be
Asthma administered.
LAURENS COUNTY EMS
Croup
Evaluate Pulse Oximetry prior to medication administration and after
treatment. Document in Patient Care Report.
MANAGEMENT
EMT-BASIC EMT-INTERMEDIATE EMT-PARAMEDIC
Request Paramedic Continue / Initiate: Basic & Continue / Initiate: Basic &
Assistance Intermediate Management Intermediate Management
Initiate: Airway Management Initiate: Intravenous Access Monitor ECG-Lead II
Protocol Protocol
ASTHMA
Patient Assisted Medications:
Handheld Inhaler Administer:
Albuterol 5 mg via Nebulizer
Albuterol, Metproteranol,
Nebulize with 6 LPM Oxygen
Terbutaline, Ventolin, etc.
Patient has prescribed inhaler
for asthma or COPD CROUP
Verify that the medication is the
patient’s own. Administer:
Verify that the medication has Inhalation (Racemic)
not expired. Epinephrine 0.5 mg via Nebulizer
Patient is Alert/Oriented Nebulize with 6 LPM Oxygen
Facilitate administration of one Dilute 0.5 ml of Epinephrine
dose (one puff) of medication. 1:1,000 in 3 ml normal saline
SEVERE ASTHMATIC
BRONCHOSPASMS
Administer:
Epinephrine 1:1,000 0.01 mg/kg
Sub-Q
Maximum 0.3 mg
Administer:
Solu-Medrol 1-2 mg/kg IV
Transport
Contact ED with Patient Report.
10
PEDIATRIC EMERGENCIES PEDIATRIC
TREATMENT PROTOCOLS POISONING/INGESTION
ISSUED: 01-01-06 ______________________________________
P-11 Randall Reinhardt, MD
Laurens County EMS Medical Control Physician
PATIENT ASSESSMENT GENERAL INFORMATION
Evaluate for the Following: Bring any containers found to the Emergency Department.
History from family, friends, or witnesses If there is evidence of external contamination:
Abnormal Breath Odor Protect EMS Personnel
Constricted or Dilated Pupils Notify Hazmat Team, if appropriate
Altered Mental Status Remove contaminated clothing and “Red Bag”
Open Containers/Bottles If chemicals involved, identify and determine if water reactive. If not
flush with copious amounts of water at scene for 15 minutes. If
chemical residue is powder form, brush from patient prior to flushing.
Contact On-Line Medical Control or the appropriate Poison Control Center
from the scene for advice.
Poison Control 1-800-222-1222
LAURENS COUNTY EMS
Unconscious – Initiate Altered Mental Status Protocol
MANAGEMENT
EMT-BASIC EMT-INTERMEDIATE EMT-PARAMEDIC
Request Paramedic Continue / Initiate: Basic Continue / Initiate: Basic &
Assistance Management Intermediate Management
Monitor ECG-Lead II
Initiate: Airway Management Initiate: Intravenous Access
Protocol Protocol
Phenothiazine Reaction (EPR)
Chemical or Medication Administer: Benadryl 1 mg/kg
Ingestion IV/IM/IO
ON-LINE MEDICAL CONTROL Symptomatic Organophospate
ORDER REQUIRED: Poisoning
Administer: Activated Charcoal ON-LINE MEDICAL CONTROL
1 gm/kg PO ORDER REQUIRED:
Patient is Alert/Oriented
Administer: Atropine
Ingestion within 45 minutes of
EMS arrival .05 – 0.1 mg/kg IV/IO/ETT
Adolescence: 2 mg
Repeat q 10 min up to 3 total doses
Drug Overdose
Administer: Narcan IV/IM/ETT/IO
0.1 mg/kg up to 5 years old
2.0 mg over 5 years old
Repeat once in 5 min
Calcium Channel Blocker
Overdose
ON-LINE MEDICAL CONTROL
ORDER REQUIRED:
Administer: Calcium Gluconate
5 mg/kg IV
Transport
Contact ED with Patient Report
11
PEDIATRIC EMERGENCIES ANAPHYLACTIC/ALLERGIC
TREATMENT PROTOCOLS REACTION
ISSUED: 01-01-06 ______________________________________
P-12 Randall Reinhardt, MD
Laurens County EMS Medical Control Physician
PATIENT ASSESSMENT GENERAL INFORMATION
Evaluate for the Following: 1. Mild Symptoms:
Rash Bradycardia Itching Rash
Itching
Hives Diaphoresis Flushed Skin
Flushed
Cyanosis Hypotension Dyspnea
Tachycardia Wheezing 2. Moderate Symptoms:
Dyspnea
History: Altered Level of Consciousness
Allergy Exposure Wheezing
Foods 3. Severe Symptoms:
Medications Shock
Insect Bites or Stings Hypotension
LAURENS COUNTY EMS
Severe Respiratory Distress
MANAGEMENT
EMT-BASIC EMT-INTERMEDIATE EMT-PARAMEDIC
Request Paramedic Continue / Initiate: Basic Continue / Initiate: Basic &
Assistance Management Intermediate Management
Monitor ECG-Lead II
Initiate: Airway Management Initiate: Intravenous Access
Protocol Protocol MILD SYMPTOMS
Administer:
MODERATE / SEVERE SEVERE SYMPTOMS Diphenhydramine HCL 1 mg/kg IV /
SYMPTOMS IM
Administer:
Patient Assisted Medications: Fluid Bolus NACL 20 ml/kg MODERATE SYMPTOMS
Epinephrine 1:1,000 Maintain Systolic
Pressure in accordance with Administer:
Patient has prescribed
Pediatric Table Diphenhydramine HCL 1 mg/kg IV /
epinephrine injector or
Anaphylactic Kit. IM
Verify that the medication Administer:
is the patient’s own. Epinephrine 1:1,000 0.01 mg/kg SQ
Max Dose 0.3 mg
Verify that the medication Administer:
has not expired.
Solu-Medrol 1-2 mg/kg IV
Patient is Alert/Oriented SEVERE SYMPTOMS
Facilitate administration of Administer:
entire autoinjector or Diphenhydramine HCL 1 mg/kg IV /
prefilled syringe. IM
Administer:
Epinephrine 1:10,000 0.01 mg/kg IV
Max Dose 0.5 mg
Administer over 5 minutes
Administer:
Solu-Medrol 1-2 mg/kg IV
Transport
Contact ED with Patient Report.
12
LAURENS COUNTY EMS
TRAUMA
MANAGEMENT
STANDARDS OF CARE
&
TREATMENT PROTOCOLS
TRAUMA MANAGEMENT GENERAL TRAUMA
TREATMENT PROTOCOLS GUIDELINES
ISSUED: 01/01/06 ______________________________________
T-01 Randall Reinhardt, MD
Revised: 09/30/06 Laurens County EMS Medical Control Physician
• Paramedics, EMT-I’s, and EMT’s must remember that traumatically injured patients need immediate
surgical intervention.
• It is imperative to make a quick assessment of the scene for hazards and assess the patient for
airway, breathing, and/or circulatory problems.
• Recognize or rule - out the need for additional equipment or personnel.
• Correct life threatening problems immediately and administer oxygen / airway maintenance as soon
as possible. Immobilize patients.
• Notify the emergency department, and began rapid transport to the nearest trauma center.
LAURENS COUNTY EMS
• All IV lines will be established enroute to the hospital on critical trauma patients, unless the patient is
trapped and/or the IV will not delay transport.
• Reassessment of the primary survey, vitals, and neurological status is important and should be done
frequently while treating the patient. Vital signs will be assessed and documented q 5 min for unstable
patients and q 15 min for stable patients.
• All head trauma patients with decreased level of consciousness should receive proper airway
management and should be ventilated with 100% oxygen to decrease intracranial pressure.
• All Patients complaining of neck/back pain, or patients with a significant mechanism of injury will
receive full spinal immobilization.
• All patients found in a seated position complaining of neck/back pain or significant mechanism of
injury will be extricated and/or packaged using the following equipment as available; c-collar
KED/short backboard and LSB. Patients that are too obese for such equipment may be exempt from
this standard.
• Rapid extrication shall only be performed in the presence of load and go criteria:
Respiratory Distress.
Altered Mental Status.
Shock.
Unsafe Scene.
• All suspected femur fractures shall have a traction splint applied, unless the patient meets the load
and go criteria and time is of the essence. Minor splinting and bandaging will not delay transport in
the load and go patient.
• Inverted KED or Scoop stretcher may be utilized for suspected fracture hips if full spinal
immobilization is not required.
• Crews should attempt to leave the scene within 10 minutes with all critical trauma patients and 20
minutes with all stable trauma patients.
• Laurens County EMS personnel may not leave a patient until they have given a complete,
professional report on the patient’s condition, mechanism of injury, and treatment rendered to the
responsible nurse or physician receiving the patient.
1
TRAUMA MANAGEMENT TRAUMA TRANSPORT
TREATMENT PROTOCOLS PROTOCOL
ISSUED: 01/01/06 ______________________________________
T-02 Randall Reinhardt, MD
REVISED: 06/30/08 Laurens County EMS Medical Control Physician
THE FOLLOWING GUIDELINES SHAL BE CONSIDERED WHEN DETERMINING
THE MOST APPROPRIATE RECEIVING FACILITY AND MODE OF TRANSPORT
FOR TRAUMA PATIENTS.
Patients who meet any (1) of the following criteria shall be transported to a Level I Trauma Center
RTS < 12
Age appropriate hypotension
Respiratory rate < 10 or > 29 per minute (< 20 in infant less than 1 year)
Penetrating injuries to the head, neck, torso or extremity to elbow and knee
LAURENS COUNTY EMS
Flail chest
Two or more proximal long bone fractures
Crush, de-gloved, or mangled extremity
Amputation proximal to wrist or ankle
Clinically apparent pelvic fracture
Paralysis
Severe burns with other traumatic injuries
Isolated severe burns (if available, triage to nearest burn center)
Greenville Memorial Hospital or Spartanburg Regional Hospital
Consider Air Transport if ground transport will exceed 25-30 minutes
Patients who do not meet the above criteria, shall be evaluated for mechanism of injury. Patients
who meet any of the following shall be transported to the closest Level 1 or 3 Trauma Center.
Fall > 20 feet
Fall greater than 2-3 times the height of a child
Intrusion > 12 inches occupant side
Intrusion > 18 inches on ANY side
Ejection (partial or complete) from automobile
Death in same passenger compartment
Pedestrian struck by vehicle, thrown, run over, or with impact > 20 MPH
Bicyclist thrown, run over, or with impact > 20 MPH
Motorcycle crash > 20 MPH
Greenville Memorial Hospital, Spartanburg Regional Hospital or Self Memorial
These patients rarely need Air Transport, and will usually be transported by ground to the
closest of the above facilities
If you are in doubt as to the best destination or mode of transport contact on-line medical
control Physician for guidance.
2
TRAUMA MANAGEMENT MULTIPLE TRAUMA
TREATMENT PROTOCOLS HYPOVOLEMIC SHOCK
ISSUED: 01/01/06 ______________________________________
T-03 Randall Reinhardt, MD
Laurens County EMS Medical Control Physician
PATIENT ASSESSMENT GENERAL INFORMATION
Evaluate the Following: Altered Level of Consciousness, Respiratory Distress, and Shock are “Load
& Go” criteria. Patients should be transported within 10 minutes after scene
Weakness
arrival, unless extenuating circumstances exist.
Tachycardia
Diaphoresis Bilateral Femurs Fractures, Pelvic Instability, Abdominal Rigidity/Guarding
Poor Perfusion are secondary “Load & Go” conditions. Upon recognizing these conditions
Diminished Peripheral Pulses the patient should be immediately transported.
Hypotension
Altered Sensorium Intravenous Access is initiated ENROUTE to the medical facility, unless
Pale/Ashen Skin extrication is required.
Mechanism of Injury
DCAPBTLS A brief report should be given to the receiving facility as soon as possible
LAURENS COUNTY EMS
Tension Pneumothorax encompassing the following:
Rigid Guarded Abdomen
Age/Level of Consciousness
Specific Injury
Respiratory Rate
Circulatory Status
Revised Trauma Score
MANAGEMENT
EMT-BASIC EMT-INTERMEDIATE EMT-PARAMEDIC
Request Paramedic Continue / Initiate: Basic Continue / Initiate: Basic &
Assistance Management Intermediate Management
Initiate: Spinal Immobilization Initiate: Intravenous Access Initiate: Tension Pneumothorax/
Protocol (ENROUTE) Pleural Decompression Protocol
Rapid Extrication
Technique If indicated (T-05)
Attempt to establish 2 Lines
Largest gauge possible
Initiate: Airway Management Transport (Load & Go)
Infuse at a rate to maintain
Protocol
systolic BP > 90
Monitor ECG-Lead II
Control Bleeding
Contact ED with Patient Report
Splint Fractures
MAST may be utilized to splint:
Pelvis
Femur Fractures
Lower Extremity Fractures
3
TRAUMA MANAGEMENT TRAUMATIC ARREST
TREATMENT PROTOCOLS
ISSUED: 01/01/06 ______________________________________
T-04 Randall Reinhardt, MD
Laurens County EMS Medical Control Physician
PATIENT ASSESSMENT GENERAL INFORMATION
Evaluate the Following: Rapid transport is the most definitive care for the traumatic arrest. Request
additional personnel early to assist.
Airway Problems
Obstructions Do not just rely on Cardiac Emergencies Protocols for treatment. Attempt
Respiratory Distress to identify the underlying cause of the arrest and treat during transport.
Breathing Problems Intravenous Access is initiated ENROUTE to the medical facility, unless
Sucking Chest Wound extrication is required. Treatment on the scene of a traumatic arrest is
Flail Chest limited to initial defibrillation, airway maintenance, spinal immobilization,
Smoke Inhalation and hemorrhage control. Further treatment should be attempted during
LAURENS COUNTY EMS
Pneumothorax transport.
Circulatory Problems Attempt to leave scene within 5 minutes.
Tension Pneumothorax
A brief report should be given to the receiving facility as soon as possible
Hemorrhagic Shock
MANAGEMENT
EMT-BASIC EMT-INTERMEDIATE EMT-PARAMEDIC
‘
Initiate: Spinal Immobilization Continue / Initiate: Basic Continue / Initiate: Basic &
Rapid Extrication Management Intermediate Management
Technique
Initiate: Cardiopulmonary Initiate: Intravenous Access Monitor ECG-Lead II:
Resuscitation (CPR) (Until Protocol (ENROUTE) V-Fib: Initiate Ventricular Fibrillation
Monitor/Defibrillator Available). Protocol (C-04) - Rapid Transport
Attempt to establish 2 Lines Asystole / EMD: Initiate Asystole or
PEA Protocol (C-05/06) -Rapid
Request Paramedic Transport
Assistance
Initiate: Tension Pneumothorax/
Initiate: Automatic External Pleural Decompression Protocol
Defibrillator (If Available). If indicated (T-05)
Continue: Cardiopulmonary Transport ( Load & Go)
Resuscitation
Initiate: Cardiac Emergencies
Initiate: Airway Management Protocols in conjunction with
Protocol Trauma Management Protocols
Control Bleeding Contact ED with Patient Report
4
TRAUMA MANAGEMENT TENSION PNEUMOTHORAX
TREATMENT PROTOCOLS PLEURAL DECOMPRESSION
ISSUED: 01/01/06 ______________________________________
T-05 Randall Reinhardt, MD
Laurens County EMS Medical Control Physician
PATIENT ASSESSMENT GENERAL INFORMATION
Evaluate and document the following: Use aseptic Technique.
Absent or Decreased Breath Sounds
Perform Pleural Decompression:
Mechanism of Injury
Respiratory Distress 14 or 16 gauge catheter
⇒ Option 1: Midclavicular 2nd or 3rd Intercostal Space or;
ALL OF THE ABOVE SIGNS AND ⇒ Option 2: Midaxillary 5 or 6 Intercostal Space.
th th
SYMPTOMS MUST BE PRESENT !
Listen for Air Release/ Document on PCR
Additional signs that may be present: Attach Flutter Valve
LAURENS COUNTY EMS
Tracheal Deviation Secure Catheter to Patient
Distended Neck Veins
Hypotension Attempt to leave scene within 10 minutes.
Sucking Chest Wounds should be sealed with occlusive
dressing and the dressing should be secured on three sides.
If tension pneumothorax develops, lift corner of dressing to
release air.
A brief report should be given to the receiving facility as soon
as possible
MANAGEMENT
EMT-BASIC EMT-INTERMEDIATE EMT-PARAMEDIC
Request Paramedic Continue / Initiate: Basic Continue / Initiate: Basic &
Assistance Management Intermediate Management
Initiate: Spinal Immobilization Initiate: Intravenous Access Initiate: Pleural Decompression
Rapid Extrication Protocol (ENROUTE)
Technique if applicable
Attempt to establish 2 Lines Transport (Load & Go)
Infuse at a rate to maintain
Initiate: Airway Management systolic BP > 90
Protocol. Monitor ECG-Lead II
Contact ED with Patient Report
5
TRAUMA MANAGEMENT BURNS/THERMAL INJURIES
TREATMENT PROTOCOLS
ISSUED: 01/01/06 ______________________________________
T-06 Randall Reinhardt, MD
Laurens County EMS Medical Control Physician
PATIENT ASSESSMENT GENERAL INFORMATION
Evaluate the Following: Move patient away from heat or source and into a well-ventilated area.
Burns of the face/Singed Eyebrows/Burns Determine extent of burn utilizing “Rule of Nines”.
in the mouth/Sooty Sputum Remove clothing and all restrictive articles (rings, watches, bracelets, etc.)
Stridor (80% airway occlusion) Cool burn area with any source of water available for a period of one
Confined in a Closed Space minute
Entrance/Exit Wounds (Electrical Burns) Ice absolutely contraindicated
Pre-existing Medical Disorders Following brief period of cooling, manage burn by use of dry
Presence of other injuries dressings, sheets, and blankets. Patient should not be
transported wet.
Minor Burns: Prevent Hypothermia.
Superficial < 50% BSA (sunburn) Any patient involved with an electrical current injury, regardless of how
LAURENS COUNTY EMS
Partial Thickness < 15% BSA stable he/she looks, should have immediate evaluation of cardiac status
Full Thickness < 10% BSA and continuous cardiac monitoring (ECG). Manage cardiac dysrhythmias in
Moderate Burns: accordance with Cardiac Emergencies Protocols.
Superficial > 50% BSA Injuries that may benefit from a burn center:
Partial Thickness < 30% BSA Partial Thickness > 15% BSA
Full Thickness > 2% BSA Full Thickness > 5% BSA
Significant burns to the face, feet, hands, or genitalia
Severe Burns: High-voltage electrical burns
Partial Thickness > 30% BSA Inhalation injuries
Full Thickness > 10% BSA Chemical burns causing progressive tissue destruction
Inhalation injury Associated significant injuries
nd rd
2 / 3 degree to hands, feet, or genitalia
MANAGEMENT
EMT-BASIC EMT-INTERMEDIATE EMT-PARAMEDIC
Request Paramedic Continue / Initiate: Basic Continue / Initiate: Basic &
Assistance Management Intermediate Management
Initiate: Spinal Immobilization Initiate: Intravenous Access Monitor ECG-Lead II
Mechanism of Injury Protocol
Attempt to establish 2 Lines Initiate: Pain Management
Initiate: Airway Management Infuse at a rate to maintain systolic
Protocol ON-LINE MEDICAL CONTROL
BP > 90- initiate second line KVO
For moderate to severe burns, use ORDER REQUIRED:
the Parkland Formula below: Morphine Sulfate 2-10 mg’s IV
Control Bleeding
Systolic BP >100
Administered in 2 mg increments.
Initiate: Cooling Procedures
Parkland Burn Formula
and/or Decontamination of Contact ED with Patient Report
Affected Area
4ml X Kg X BSA = Amount of
Dry Chemicals should be Total Fluid
brushed away, prior to flushing Give half in the first 8 hours
with water.
Chemical Burns of the Eye-
Flush for a minimum of 15 ½ Total Fluid / 8 hours = ml/hr
minutes
6
TRAUMA MANAGEMENT HEAD TRAUMA
TREATMENT PROTOCOLS
ISSUED: 01/01/06 ______________________________________
T-07 Randall Reinhardt, MD
Laurens County EMS Medical Control Physician
PATIENT ASSESSMENT GENERAL INFORMATION
Evaluate and Document the Following: Ventilation with 100% Oxygen via Bag Valve Mask (ETT) at a rate
Mechanism of Injury of 16-20 breaths per minute is the primary treatment for Increased
ICP in a head injury patient.
Level of Consciousness:
Head Injury Patient’s with Altered Mental Status meet the “Load &
A= Alert Go” Criteria.
V= Responds to verbal stimuli
P= Responds to painful stimuli All prehospital care with the exception of airway maintenance and
♦ Decerebrate --- Extensor spinal immobilization should be performed during transport.
Response
♦ Decorticate --- Flexor
LAURENS COUNTY EMS
Response
U= Unresponsive
Glasgow Coma Score
Pupillary Response
Rhinorrehea, Otorrehea, Battle Sign,
and/or Raccoons Eyes.
MANAGEMENT
EMT-BASIC EMT-INTERMEDIATE EMT-PARAMEDIC
Request Paramedic Continue / Initiate: Basic Continue / Initiate: Basic &
Assistance Management Intermediate Management
Initiate: Spinal Immobilization Initiate: Intravenous Access Transport
Protocol Consider: (Load & Go)
Initiate: Airway Management
Infuse at a rate to maintain systolic
Protocol BP > 90 Monitor ECG-Lead II
Control Bleeding Contact ED with Patient Report
7
TRAUMA MANAGEMENT NEAR DROWNING
TREATMENT PROTOCOLS
ISSUED: 01/01/06 ______________________________________
T-08 Randall Reinhardt, MD
Laurens County EMS Medical Control Physician
PATIENT ASSESSMENT GENERAL INFORMATION
Evaluate for the Following: Victims with a documented submersion time of less than One (1) hour in
water 70° or > and not hypothermic, shall receive full Advanced Cardiac
Level of Consciousness
Life Support resuscitation in accordance with the American Heart
Stable versus Unstable Association Guidelines for ACLS and the Laurens County EMS Protocols.
Estimated Down Time
Confirm rhythm: Victims with a documented submersion time of less than One (1) hour and
Thirty (30) minutes in water < 70° and documented severe hypothermia
1. Quick-look Paddles / AED for (Body Temperature < 88°) shall receive treatment in accordance to the
Apnea/Pulseless Situations Laurens County EMS Hypothermia Protocol.
2. ECG for stable situations
If CPR is in progress, confirm quality of A significant number of drownings involve spinal injuries due to diving
ventilations and compressions. accidents. Therefore, spinal immobilization should be initiated in all
LAURENS COUNTY EMS
Length of Submersion drownings where there is a possible mechanism of injury.
Trauma All victims of significant submersion accidents should be transported for in-
Medical Conditions hospital evaluation, regardless of their initial presentation.
MANAGEMENT
EMT-BASIC EMT-INTERMEDIATE EMT-PARAMEDIC
Request Paramedic Continue / Initiate: Basic Continue / Initiate: Basic &
Assistance Management Intermediate Management
Initiate: Spinal Immobilization Initiate: Intravenous Access Monitor ECG-Lead II
Protocol
Initiate: Airway Management Transport
Protocol
Contact ED with Patient Report
Remove Wet Clothing and
Wrap patient in blankets
Initiate: Appropriate Cardiac
Emergencies Protocol, if
patient is non-hypothermic
Initiate: Hypothermia Protocol,
if patient is hypothermic (M-12)
8
TRAUMA MANAGEMENT SNAKEBITES/ENVENOMATION
TREATMENT PROTOCOLS
ISSUED: 01/01/06 ______________________________________
T-09 Randall Reinhardt, MD
Laurens County EMS Medical Control Physician
PATIENT ASSESSMENT GENERAL INFORMATION
Evaluate for the Following: Pit Vipers (Rattlesnake, Cotton Mouth, & Copperhead): Venom contains
destructive proteins, polypeptides, and hydrolytic enzymes that are capable
Fang Marks of destroying cell membranes, protein and most other tissue components.
Swelling/Pain/Oozing at Wound Site The toxic venom fractions may produce destruction of the red blood cells
Weakness/Dizziness/Faintness/Ataxia and affect the body’s blood clotting system within the blood vessels.
Minty/Metallic/ or Rubber Taste in Mouth Deaths from pit viper bites typically result from hypovolemia.
and/or Lips
Sweating/Chills Coral Snake:” red touch yellow, kill a fellow; red touch black, venom lack”
Thirst Venom of the coral snake contains some of the enzymes found in pit vipers.
Nausea/Vomiting However, because of the presence of neurotoxin, coral snake venom
Diarrhea primarily affects nervous tissue. The classic, severe coral snake bite
Tachycardia/Hypotension results in respiratory and skeletal muscle paralysis. Laurens County
Hospital does not have this antivenom.
LAURENS COUNTY EMS
Ecchymosis
Necrosis Less than 40% of poisonous snakebites to human’s result in envenomation
Numbness and Tingling around face and (60% Dry Bites). Death from poisonous snake bites range from 12-36
head (Classic) hours after envenomation. Not every snakebite is poisonous! Attempt to
identify the snake if at all possible
DO NOT: Allow Patient to Ambulate, Apply Ice, Any Type of Suction, or
Make Incisions over the Bite.
MANAGEMENT
EMT-BASIC EMT-INTERMEDIATE EMT-PARAMEDIC
Request Paramedic Continue / Initiate: Basic Continue / Initiate: Basic &
Assistance Management Intermediate Management
Initiate: Airway Management Initiate: Intravenous Access Monitor ECG-Lead II
Protocol Protocol
Attempt to establish X 2 Lines Initiate Pain Management
Immobilize Extremity Maintain systolic BP > 90 ON-LINE MEDICAL CONTROL
Avoid injured extremity ORDER REQUIRED:
Morphine Sulfate 2-10 mg’s IV
Control Bleeding Severe Pain
Systolic BP >100
Administer in 2 mg increments.
Transport- Contact ED with Patient
Report
9
TRAUMA MANAGEMENT EXTREMITY TRAUMA
TREATMENT PROTOCOLS AMPUTATION
ISSUED: 01/01/06 ______________________________________
T-10 Randall Reinhardt, MD
Laurens County EMS Medical Control Physician
PATIENT ASSESSMENT GENERAL INFORMATION
Evaluate the Following: Isolated extremity trauma is rarely Life Threatening.
All fractures will have pulse, sensory and motor function assessed and
Mechanism of Injury
documented prior to application of splint and after application.
Pain
Movement Splint injured extremities in the position found, unless precluded by
Deformity extrication considerations and/or patient comfort.
Ecchymosis If extremity is pulseless, attempt gentle manipulation to place in normal
Hemorrhage anatomic position to restore circulation. If initial manipulation does not
Crepitation restore circulation do not manipulate any further.
Swelling Amputation: if not completely severed, treat as fracture. If severed, place
Tenderness part in dry, sterile dressing, place in sealed plastic bag, and cover with ice (if
Diaphoresis available).
LAURENS COUNTY EMS
Hypotension
Bilateral Femurs, Pelvic Instability or any fracture resulting in shock is
Open or Closed Fracture
considered a “Load & Go” situation. Do not delay scene time to splint
Pulse/Sensory/Motor Function
fracture with any patient meeting the “Load & Go” criteria. Fractures should
External/Internal Rotation
be managed by best method possible (i.e., Long Spineboard, MAST, etc.)
MANAGEMENT
EMT-BASIC EMT-INTERMEDIATE EMT-PARAMEDIC
Request Paramedic Assistance Continue / Initiate: Basic Continue / Initiate: Basic &
Management Intermediate Management
Initiate: Airway Management Initiate: Intravenous Access Consider: Monitor ECG-Lead II
Protocol Protocol
Maintain systolic BP > 90 Initiate Pain Management
Control Bleeding
Avoid injured extremity ON-LINE MEDICAL CONTROL
Immobilize Fracture: ORDER REQUIRED:
⌦ Pelvis: Morphine Sulfate 2-10 mg’s IV
KED/MAST/LSB (Load & Go) Severe Pain
Systolic BP >100
⌦ Hip: Administer in 2 mg increments.
KED/LSB-Pillows
⌦ Femur: Transport- Contact ED with
Traction Splint Patient Report
(Bilateral Femur Fractures-
Load & Go. MAST/LSB)
⌦ Knee/Elbow:
Position of comfort
⌦ Tibia/Fibula:
Board Splint/Frac-Pak/ Pillow
⌦ Shoulder/Humerus/Clavicle:
Sling & Swath
⌦ Forearm/Wrist/Hand:
Board Splint/Frac-Pak
10
LAURENS COUNTY EMS
APPENDECIES
Laurens County EMS Approved Abbreviations
Abbreviation Meaning Abbreviation Meaning
Abd Abdomen DO Doctor of Osteopathy
ABG Arterial Blood Gas DOA Dead on arrival
A Fib Atrial Fibrillation DOB Date of birth
AMI Acute Myocardial D5W 5% Dextrose in Water
Infarction Dx Diagnosis
Ant. Anterior ENT Ears, Nose and Throat
Approx Approximate EKG Electrocardiogram
ASAP As soon as possible EMS Emergency Medical
Ausc Auscultation Services
Admin Administer ER Emergency Room
B Black ETA Estimated time of
BBB Bundle Branch Block arrival
BID Twice a day ETT Endotracheal tube
BM Bowel movement ETOH Ethyl Alcohol
BP Blood Pressure Exam Examination
BS Blood Sugar F Female
C With FD Fire Department
CA Cancer Fx Fracture
CAT Computerized Axial Gal Gallon
Tomography GI Gastrointestinal
Cath Catheter Gm Gram
Cc Cubic Centimeter GMH Greenville Memorial
CCU Coronary Care Unit Hospital
C/C Chief Complaint Gr Gram
C-collar Cervical collar GSW Gunshot wound
CHF Congestive Heart gtt Drops
Failure Gyn Gynecology
H Hispanic
Cm Centimeter Ha Headache
CNS Central Nervous Hgb Hemoglobin
System HH Hillcrest Hospital
CO2 Carbon dioxide HPI History of Present
C/O Complaining of Illness
CP Chest Pain HR Heart Rate
C-spine Cervical Spine Hx History
CPR Cardio-pulmonary ICP Intracranial Pressure
Resuscitation ICU Intensive Care Unit
C-section Cesarean Section IM Intramuscular
CSF Cerebrospinal Fluid Info Information
CTA Clear to auscultation INT Saline Lock
CVA Cerebrovascular IUD Intra Uterine Device
Accident IV Intravenous
D/C Discontinue JVD Jugular Vein
DNR Do not resuscitate Distention
Laurens County EMS Approved Abbreviations
Abbreviation Meaning Abbreviation Meaning
K Potassium NTG Nitroglycerin
KED Kendrick Extrication N/V Nausea / Vomiting
Device O2 Oxygen
Kg Kilogram OB Obstetrics
KVO Keep vein open OB-GYN Obstetrics and
L Left Gynecology
Lat Lateral OJ Out of jurisdiction
Lb Pound OPA Oropharyngeal
LCH Laurens County Airway
Hospital OR Operating Room
LLQ Left lower quadrant Ortho Orthopedics
LMP Last menstrual period oz Ounce
LOC Loss of consciousness P Pulse
LR Lactated Ringer’s P.A. Physician’s Assistant
Solution PAC Premature Atrial
L/S Lung sounds Complex
LSB Long spine board PAP Smear Papanicolaou Smear
LUQ Left upper quadrant PAT Paroxysmal Atrial
M Male Tachycardia
MCA Motorcycle accident PEEP Positive End
Mcg Microgram Expiratory Pressure
MD Medical Doctor PERL Pupils equal and
Meq Milliequivalent reactive to light
Mg Magnesium Ph Hydrogen Ion
mg Milligram Concentration
MI Myocardial Infarction PID Pelvic Inflammatory
Ml Milliliter Disease
Mm Millimeter PJC Premature Junctional
MVA Motor vehicle accident Complex
Na Sodium PMH Past Medical History
N/A Not applicable p.o. By mouth
NaCl Sodium Chloride Post Posterior
NC Nasal Cannula Prn As necessary
NCMH Newberry County Pt. Patient
Memorial Hospital PVC Premature Ventricular
Neuro Neurological Complex
N/K Not known q Every
NKDA No known drug allergy qd Every day
NKA No known allergy qh Every hour
NPA Nasopharyngeal qid Four times a day
Airway R Right
NS Normal Saline RBC Red Blood Cell
NSR Normal Sinus Rhythm Reg Regular
NT Nasotracheal RLQ Right Lower Quadrant
Laurens County EMS Approved Abbreviations
Abbreviation Meaning
Rx Prescription
S Without
SAA Same as above
SL Sublingual
SQ Subcutaneous
SR Sinus Rhythm
SRH Self Regional Hospital
SRMC Spartanburg Regional
Medical Center
ST Sinus Tachycardia
Stat At once
STD Sexually Transmitted
Disease
Sx Symptoms
Tach Tachycardia
Tbsp Tablespoon
Temp Temperature
TIA Transient Ischemic
Attack
tid Three times a day
Tsp Teaspoon
VA Veteran’s
Administration
VD Venereal Disease
Vfib Ventricular
Fibrillation
V/S Vital signs
Vtach Ventricular
Tachycardia
W White
WBC White Blood Cell
> Greater than
< Less than
= Equal
+ Positive
- Negative
↑ Increase or superior to
↓ Decrease or inferior to
♂ Male
♀ Female
Laurens County EMS 12 Lead Informational Appendix 1-1-06
• Place Leads in this order
• V-1 4th intercostal space to the right of the
sternum
• V-2 4th intercostal space to the left of the
sternum
• V-4 5th intercostal space in the mid-clavicular
line
• V-3 between V2 and V4
• V-6 5th intercostal space in the mid-axillary line
• V-5 between V4 and V6
Aquire 12 leads on all possible Acute Coronary Syndrome Patients. Utilize limb leads at distal points
Limit motion while analyzing, supine if patient condition warrants
QRS Width in V1
> 0.12: can not use ST elevation as MI indicator, however, may be new onset BBB.
< 0.12: assess for ST elevation >1mm in two or more contiguous leads. Use the reference chart below.
Remember patterns that mimic STEMI (LBBB, LVH, Pericarditis, & Benign Early Repolarization)
LEAD I V-1 V-4
AVR
Lateral Septum Anterior
LEAD II AVL V-2 V-5
Inferior Lateral Septum Lateral
LEAD III AVF V-3 V-6
Inferior Inferior Anterior Lateral
Normal Axis
0 to 90
Physiological
Left Axis
0 to -40
Pathological
Anterior
Left Axis
Hemiblock
-40 to -90
Right Axis Posterior
90 to 180 Hemiblock
Extreme
Ventricular in
Right Axis
origin
“no mans land”
Laurens County EMS 12 Lead Informational Appendix 1-1-06
Conditions that mask or mimic the criteria for EKG categorization of injury
patterns
A. Left Bundle Branch Block (LBBB)
LBBB can produce ST elevation in leads V1, V2, and V3. It will also display a
QRS of abnormal duration. (>120 sec) and a QS complex or negative terminal
force in V1.
Electrophysiology:
LBBB alters depolarization (affects QRS), which alters
repolarization (affects ST-T wave). Therefore, LBBB can produce
changes in the QRS-ST-T waves that are identical to those
produced by injury.
A BBB widens the QRS (120 sec or more). This widening is due to
the fact that the ventricles are forced to contract sequentially, thus
requiring more time. Therefore, when a QRS of 120 sec or more is
produced by a supraventricular rhythm, think BBB. This rule applies
in all leads.
Differentiation of LBBB from RBBB comes from evaluation of lead
V1 on the 12-lead ECG. The “classic” pattern of LBBB in V1 is a
QS complex or negative terminal force.
Laurens County EMS 12 Lead Informational Appendix 1-1-06
B. Left Ventricular Hypertrophy (LVH)
LVH can produce ST elevation in leads V1, V2, and V3. The formula to use to
look for LVH is as follows:
1. Compare V1 and V2 and determine which lead has the deepest S
wave. Then determine the depth of the deepest S wave.
2. Compare V5 and V6 and determine which lead has the tallest R wave.
Then determine the depth of the R wave.
3. Add the height of the R wave and the depth of the S wave. If the
number is > 35mm suspect LVH (each box = 1 mm).
Electrophysiology:
There are many causes of LVH. Most are the result of either the left
ventricle working harder over a long period of time or the result of
chronic overfilling. For ACS management, it is NOT critical to
determine the cause of the LVH. Simply suspecting the presence of
LVH is sufficient.
LVH can mimic “injury” patterns on the 12-Lead ECG. Unlike BBB,
LVH does NOT usually widen the QRS to 120 sec or more. Instead
of abnormally widening the QRS, LVH increases amplitude. LVH
can produce ST segment elevation in early V leads.
Laurens County EMS 12 Lead Informational Appendix 1-1-06
C. Pericarditis
There are numerous causes of pericarditis. These patients often complain
of chest pain, which is an indication for a 12-Lead ECG. Pericarditis is
capable of producing diffuse ST segment elevation across the ECG. The
ST segment elevation of pericarditis is caused by inflammation of the
epicardium secondary to inflammation of the pericardium. This process is
not related to coronary artery disease and, therefore, ST segment
changes do not tend to follow anatomical groups typically seen with AMI.
Pericarditis may produce notching of the J-point and a “fish hook” shaped
ST and J-Point.
The “classic” pericarditis presentation has some distinguishing features.
Listed below are the differentiating characteristics of AMI vs. Pericarditis.
The purpose is not to rule out AMI, but help the care provider suspect the
possibility of pericarditis.
MI Pericarditus
Chest Pain - Quality Pressure Stabbing / Sharp
Chest Pain - Radiation Left Arm, Shoulder, Neck
Jaw
Chest Pain - Non-Postural Postural
Provocation
ST Elevation Anatomical Contiguous Diffuse across EKG
Leads
PR Depression Uncommon Common
J Point Normal Notching
Laurens County EMS 12 Lead Informational Appendix 1-1-06
D. Benign Early Repolarization
Can produce ST elevation in the anterior or anteriolateral leads and tall T waves.
In some respects it closely resembles pericarditis on the 12 lead ECG with
notching of the J point.
Electrophysiology:
It has been theorized that the cause of Benign Early Repolarization
is due to one region of myocardium repolarizing early. This
produces a difference in electrical potential, and thus causes ST
and T wave changes. Changes can occur in any lead. But are more
common in the lateral and anterior chest leads.
Benign Early Repolarization, like pericarditis, may produce notching
of the J-point and a “fish hook” shaped ST and J-Point. Patients
with Benign Early Repolarization often meet the voltage criteria for
LVH. However, no true hypertrophy may exist.
Anyone, male or female, of any ethnic background can have this
pattern on his or her ECG. However, this pattern
SOAP
DOCUMENTATION FORMAT
EXAMPLE
ISSUED: 01/01/06 FORMAT
Patient Care Reports Should:
• Be printed or written legibly
• Contain only medically acceptable symbols, abbreviations, and terms
• Accurately depict the assessment and treatment rendered to the patient
• Completed utilizing black ink ball point pen
• Appropriate blocks (boxes) will be completely filled in (no “X’s or check marks)
(S) SUBJECTIVE: “Chief Complaint” :
LAURENS COUNTY EMS
S-Symptoms
O- Onset
Q- Quality
R- Radiation
S- Severity
T- Time
A- Allergies
M- Medications
P- Past Medical History
L- Last Oral Intake
E- Events
(O) OBJECTIVE: Vital Signs and Assessment: Neurological/Mental Status-Cardiovascular-
Pulmonary-Gastrointestinal-Genitourinary-Neurovascular- Muscular
Skeletal/Integumentry:
1. GENERAL IMPRESSION: Health Status
2. HEENT: Head/Eyes/Ears/Nose/Throat
3. SKIN: Temperature/Texture/Color/Tugor
4. NEURO: LOC/GCS/Arm Lift/Facial Droop/Weakness-Extremity Strength-Grip-
ROM
5. PULM: Respiratory Status/Chest Assess/Breath Sounds/O2 Sat/DIB Scale
6. CARD: Heart Sounds/Distal Pulses/Cap Refill/BP/EKG/CP Scale
7. GI: Abdominal Assessment/Nausea-Vomiting/Emesis
8. GU: Incontinence/Urine Output/Stools/Pain
9. MS: Muscular skeletal Assessment (DCAPBTLS)
D- Deformities
C- Contusions
A- Abrasions
P- Punctures
B- Burns
T- Tenderness
L- Lacerations
S- Swelling
(A) ANALYSIS OF ASSESSMENT/ PROTOCOL
(P) PLAN: Chronological Listing of Treatment and Response to Treatment.
CHART
DOCUMENTATION FORMAT
EXAMPLE
ISSUED: 01/01/06 FORMAT
Patient Care Reports Should:
• Be printed or written legibly
• Contain only medically acceptable symbols, abbreviations, and terms
• Accurately depict the assessment and treatment rendered to the patient
• Completed utilizing black ink ball point pen
• Appropriate blocks (boxes) will be completely filled in (no “X’s or check marks)
(C) Chief Complaint:
(H) History:
LAURENS COUNTY EMS
S- Symptoms A- Allergies
O- Onset M- Medications
P- Provocation P- Past Medical History
Q- Quality L- Last Oral Intake
R- Radiation E- Events Leading to Injury/Illness
S- Severity
T- Time
(A) Assessment: Vital Signs and Assessment: Neurological/Mental Status-
Cardiovascular Pulmonary-Gastrointestinal-Genitourinary-
Neurovascular-Muscular Skeletal/Integumentry:
1. GENERAL IMPRESSION: Health Status
2. HEENT: Head/Eyes/Ears/Nose/Throat
3. SKIN: Temperature/Texture/Color/Tugor
4. NEURO: LOC/GCS/Arm Lift/Facial Droop/Weakness-Extremity Strength-Grip-
ROM
5. PULM: Respiratory Status/Chest Assess/Breath Sounds/O2 Sat/DIB Scale
6. CARD: Heart Sounds/Distal Pulses/Cap Refill/BP/EKG/CP Scale
7. GI: Abdominal Assessment/Nausea-Vomiting/Emesis
8. GU: Incontinence/Urine Output/Stools/Pain
9. MS: Muscular skeletal Assessment (DCAPBTLS)
D- Deformities
C- Contusions
A- Abrasions
P- Punctures
B- Burns
T- Tenderness
L- Lacerations
S- Swelling
10. Analysis of Assessment/Protocol
(R) Treatment: Chronological Listing of Treatment and Response to Treatment.
(T) Transport and Transfer: Significant events during Transport/ To whom
Patient care was Transferred/ Patient Status
Update.
Laurens County EMS
Pre-Hospital T-PA Checklist for
Acute Stroke
Version 060106
Patient Name: ___________________________________Date: ____________
EMS Crew: ___________________/____________________Medic # _______
Inclusion criteria: (All of these must be YES)
Yes No
1. Patient is > 18 years old
2. Acute stroke of clearly defined onset
3. Measurable neurological deficit
4. Onset will be <3 hours before administration of tPA
3 hour window is from clearly defined time of onset
to actual t-PA administration. (LCEMS protocol # M-2-A)
Time of onset to arrival at hospital must be < 2 hours
Exclusion criteria: Historical (All of these must be NO)
Yes No
1. Incapacitating history at baseline (poor quality of life)
2. Stroke or serious head trauma within previous 3 months
3. Major surgery within previous 14 days
(Transfer to facility where surgery was performed)
4. Seizure at onset of stroke
5. Rapidly improving symptoms
Reportable criteria: Historical (Not considered an exclusion for
pre-hospital assessment. Notify RN if any is YES)
Yes No
1. MI within previous 3 months
1. GI/GU bleeding within previous 21 days
2. Arterial puncture within 7 days
3. Hypertension: Systolic > 185, Diastolic > 110
4. Current Coumadin therapy (Warfarin)
Laurens County EMS
Stroke Alert Notification
Version 060106
Hospital ,LC Medic____: Stroke Alert Notification
On Scene En route
Age Sex
NEUROLOGICAL ASSESSMENT
LOC: GCS: Pupils:
SPEECH:
Aphasia Dysarthia Normal
Unable or not Slurred
Appropriate
FACIAL
WEAKNESS L deficit R deficit Normal
MOTOR
STRENGTH: L weak R weak Normal
Other:
Last time seen w/o symptoms:
Pertinent History:
Possible
T-PA Candidate Yes No Report reason why excluded
Trauma
History: Yes No
Seizure at
onset: Yes No
Initial
BP______ Pulse______ Resp______ BGL______
Vitals:
Repeat if significant change:
TREATMENT
O2- IV- ECG-
Other
ETA:
Request air transport for possible TPA candidates if time window will be
in excess for ground transfer to Greenville Memorial or Spartanburg
Regional. Time of onset to arrival at hospital must be < 2 hours.
Facility__________________________ Mode___________________
Laurens County EMS
STEMI Alert Notification
Version 061608
Greenville Memorial Spartanburg Regional Self Regional
864-455-7705 864-560-5427 864-725-5738
Hospital ,LC Medic____: Requesting Doctor consult for coronary patient
On Scene En route Age M F “State stratification ▲”Pt. ETA
C/C:
Onset:
Pert. Hist/Meds:
RR- B/P- P- ECG Lead II-
▲STEMI ALERT QRS <120ms in V-1 & ST Seg ⇑ >2mm in two or more cont. leads
▲Possible STEMI QRS <120ms in V-1 & ST Seg ⇑ <2mm in two or more cont. leads
▲Possible New L R BBB QRS >120ms in V-1
__mm⇑ Inferior Right Side Involvement
II III AVF (check V4R)
Recip ∆’s I AVL
V4R !Caution with Nitro & Morphine
__mm⇑ Septal __mm⇑ Anterior __mm⇑ Lateral __mm⇑ Posterior
V-5 V-6 I AVL
V-1 & V-2 V-3 & V-4 V-8 & V-9
Recip ∆’s II III AVF
TREATMENT O2- sats- % IV-
ASA_____mg Nitro x’s ___ Fibrinolytic Candidate Yes No
Weight______kg
If Indicated Request:
Heparin
<47 kg 47-53 kg 54-59 kg > 59 kg
Requested Granted
3500 UI 4000 UI 4500 UI 5000 UI(MAX)
Denied List
pertinent changes:
Lopressor
Requested Granted Denied List pertinent changes:
Morphine: 2-4 mg prn q 15 min
Requested Granted Denied
Air Transport requested? Yes No EMT-P____________________
Facility__________________________ Mode_______________________
Laurens County EMS
Pre-Hospital Fibrinolytic Checklist for
STEMI
Version 070107
Patient Name: _____________________Call #_________Date: ____________
EMS Crew: ___________________/____________________Medic # _______
Inclusion criteria: (Must be YES)
Yes No
1. ST-segment elevation > 1-2 mm in two or more contiguous
leads and S/S consistent with an acute MI
Exclusion criteria: Historical (All of these must be NO)
(☼ Heparin Contraindications ☼)
Yes No
1. ☼ Active bleeding ☼
2. ☼ Thrombocytopenia or other known bleeding disorders ☼
3. Intracranial, intraspinal, or major surgery within previous 14 days
4. History of CVA
5. Intracranial or intraspinal tumor, aneurysm, or arteriovenous
malformation
Reportable criteria: Historical (Not considered an absolute
exclusion for pre-hospital assessment. Notify RN/MD upon
arrival if any are YES)
Yes No
1. History of GI / GU bleeding within 1 month
2. History of head/facial trauma within previous 3 months
3. Hypertension: Systolic > 185, Diastolic > 110
4. Current Coumadin therapy (Warfarin)
5. Impaired renal or liver disease
6. Pregnancy
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