Docstoc

sopc

Document Sample
sopc Powered By Docstoc
					 College of Charleston

   First Responder Unit

Standards of Patient Care
                       College of Charleston First Responder Unit
                         Standard of Care for First Responders


                                   Table of Contents

General Format
……………………………………………………………………………3

Pulseless, Non-Breathing, Unresponsive Patient (Full
Arrest)…………………………….4

Pulseless, Non-Breathing, Unresponsive Patient (Full Arrest with AED)…………..…….5

Conscious Patient in Cardiac Distress (Chest Pain and Difficulty
Breathing)….………….7

Unconscious Patient with Pulse but not Breathing (Respiratory Arrest)………………….8

Patient Unconscious for Unknown Reasons (Breathing with a
Pulse)…………………….9

Significant Visible Blood Loss or Suspected Internal Blood
Loss……………………….10

Diabetic Patient……………………………………………………………………..……11

Seizure Activity…………………………………………………………………….…….12

Burn
Patient………………………………………………………………………………13

Snake Bite………………………………………………………………………………..14

Dead on Arrival…………………………………………………………………………..15

Automobile and Vehicle
Accidents………………………………………………………16

Psychiatric
Emergencies………………………………………………………………….17

Acute Systematic Allergic Reaction
(Anaphylaxis)………………………………………18


                                           2
Gunshot…………………………………………………………………………………..19

Stabbing or Impaling
Wounds……………………………………………………………20

Childbirth…………………………………………………………………………………2
1

Heat Related Emergencies……………………………………………………………….23




                         3
                       College of Charleston First Responder Unit
                         Standard of Care for First Responders


                                       General Format

1.    Observe blood borne pathogens protocol protection at all incidents.

2.    Establish danger area, if present, and request additional help if needed.

3.    Note and apply appropriate treatment to any life threating situations; e.g.
      obstructed airway, respiratory arrest, cardiac arrest, hemorrhage, etc...

4.    Obtain vital signs, including pulse, respirations, and blood pressure.

5.    Obtain history of present events and patient’s past medical history including
      allergies. Look for medic alert tags.

6.    Examine the patient “head to toe” and note any physical findings relevant to the
      present condition.

7.    Monitor the patient closely for any change in status. Repeat vital signs every five
      minutes as indicated.

8.    Apply oxygen via mask, or nasal cannula at 3 liters/min., per standards.

9.    When EMS arrives, pass on vital information to the crew chief and assist them as
      necessary.

10.   Hand-over care of the patient ONLY to equally or more qualified personnel, and
      ONLY if they agree to CONTINUE to provide said care. Example: a SC licensed
      physician on the scene may only assume care if he agrees to transfer with the
      patient. WHEN IN DOUBT – CALL FOR ASSISTANCE FROM THE
      RESPONDING CCEMS UNIT.




         __________________________                   __________________________
                Dr. James G. Ward, Jr.                   John F. Sorrell, MD, FACEP
          College of Charleston Chief Physician           CCEMS Medical Director

                                                  4
                      College of Charleston First Responder Unit
                        Standard of Care for First Responders


                    Pulseless, Non-Breathing, Unresponsive Patient
                                  (FULL ARREST)

1.   Observe blood borne pathogens protocol protection at all incidents.

2.   Establish and maintain airway – use oral airway if necessary.

3.   Ventilate patient with bag or pocket mask – attach supplemental oxygen as soon
     as possible with 15 liter/min. flow rate.

4.   Initiate external cardiac compression after positioning patient on hard surface.

5.   Check for pulse periodically for effectiveness of compressions and for possibility
     of resuscitation, note pupil response.

6.   Monitor patient’s facial color for effectiveness of ventilations. Watch for chest to
     raise indicating adequate ventilations.

7.   Determine time of arrest and obtain patient history from family or bystanders.

8.   Upon arrival of EMS, pass on all vital information to crew chief and assist them
     as necessary.




        __________________________                   __________________________
               Dr. John G. Inman                        John F. Sorrell, MD, FACEP
         College of Charleston Chief Physician           CCEMS Medical Director

                                                 5
                      College of Charleston First Responder Unit
                        Standard of Care for First Responders


                     Pulseless, Non-breathing, Unresponsive Patient
                                (Full Arrest – with AED)

1.    Observe blood borne pathogens protocols at all incidents.

2.    Determine patient unresponsiveness and provide appropriate basic life support
      (BLS-CPR).

3.    Check pulse. Notify Dispatcher of confirmed full arrest (or appropriate patient
      status) and confirm response / ETA of EMS.

4.    Initiate cardiopulmonary resuscitation if adequate manpower is available while
      semi-automatic external defibrillator (AED) is being readied and applied.

5.    Press switch to analyze cardiac rhythm if necessary, and assure all personnel are
      clear of patient contact.

6.    If shock advised, discharge AED.
      A.      If no shock advised, continue appropriate BLS-CPR for one (1) minute,
              then re-evaluate patient. Follow prompts from AED
      B.      If monitor maintains “no shock advised” status, continue appropriate BLS-
              CPR for three (3) minutes before re-evaluation. Follow prompts from
              AED

7.    Check Pulse.

8.    If no pulse, press switch to analyze cardiac rhythm if necessary, and assure all
      personnel are clear of patient contact.

9.    If shock advised, discharge AED.

10.   Check Pulse.

11.   If no pulse, press switch to analyze cardiac rhythm if necessary, and assure all
      personnel are clear of patient contact.

12.   If shock advised, discharge AED.

13.   Check pulse.



                                           6
14.   If patient is still pulseless, perform BLS-CPR for one minute, then re-evaluate.
      Discharge defibrillator up to three (3) more times.

15.   Continue CPR as appropriate and re-advise EMS dispatcher of patient status.




         __________________________               __________________________

                                           7
               Dr. John G. Inman.                       John F. Sorrell, MD, FACEP
         College of Charleston Chief Physician           CCEMS Medical Director

                      College of Charleston First Responder Unit
                        Standard of Care for First Responders


                         Conscious Patient in Cardiac Distress
                          Chest Pain and Difficulty Breathing

1.   Observe blood borne pathogens protocol protection at all incidents.

2.   Place patient at a 45 degree angle, or in the most comfortable position.

3.   Administer supplemental oxygen, via non-rebreather mask at 10 l./min. or greater,
     or nasal cannula at 3 l./min. Use higher rate and mask if no history of chronic
     lung disease and patient can tolerate.

4.   If patient has their own Nitroglycerin tablets, determine how many were taken
     prior to your arrival and allow them to take one under their tongue. They may
     repeat this dosage with five minutes between dosages for a maximum of THREE
     tablets. Discourage patient from taking any more than three tablets total.

5.   Take vital signs including pulse, blood pressure, and respirations. Note time and
     repeat every five minutes. In particular, note any irregularity in pulse. Note any
     changes in skin color, sweating, or other changes in physical status.

6.   If the patient is having chest pain with difficulty breathing and appears to be in
     severe distress, an AED may be applied, if available. If the AED has the
     capability to run an EKG strip, the strip may be run and given to the EMS Unit
     upon arrival. This should not delay the treatment above in any way. The AED is
     not to be routinely used as a cardiac monitor.

7.   Upon arrival of EMS, pass on all vital information to crew chief and assist them
     as necessary.




        __________________________                   __________________________
                                                 8
               Dr. John G. Inman                        John F. Sorrell, MD, FACEP
         College of Charleston Chief Physician           CCEMS Medical Director

                      College of Charleston First Responder Unit
                        Standard of Care for First Responders


                    Unconscious Patient with Pulse, Not Breathing
                                (Respiratory Arrest)

NOTIFY DISPATCHER YOU HAVE RESPIRATORY ARREST

1.   Observe blood borne pathogens protocol protection at all incidents.

2.   Establish and maintain airway – use oral airway if necessary.

3.   Ventilate patient with bag or pocket mask - attach supplemental oxygen as soon as
     possible with 15 liter/min. flow rate.

4.   Suction fluids from upper airway as necessary.

5.   Take vital signs including pulse, blood pressure, and respirations. Note the time
     and repeat every five minutes.

6.   Monitor patient’s facial color. Watch for chest to rise indicating adequate
     ventilation. Watch for the possibility of patient beginning to breathe on their own
     and assist as necessary.

7.   Monitor patient closely and watch for possible full arrest.

8.   Determine time of respiratory arrest and obtain patient history from family or
     bystanders.

9.   Upon arrival of EMS, pass on all vital information to crew chief and assist them
     as necessary.




        __________________________                   __________________________
                                                 9
               Dr. John G. Inman                         John F. Sorrell, MD, FACEP
         College of Charleston Chief Physician            CCEMS Medical Director

                      College of Charleston First Responder Unit
                        Standard of Care for First Responders


        Unconscious Patient for Unknown Reason with Pulse and Breathing

1.   Observe blood borne pathogens protocol protection at all incidents.

2.   Establish and maintain airway. Protect spine. The patient may have a neck or
     back injury.

3.   Administer supplemental oxygen, via mask at 12 liters/min. or nasal cannula at 3
     liters/min. (Use higher rate if no history of Chronic Lung Disease).

4.   Take vital signs including pulse, blood pressure, and respirations. Note pupil
     response. Note the time and repeat every five minutes.

5.   Check patient for obvious injuries, especially head injuries. Note breath odor for
     fruity odor or alcohol.

6.   Upon arrival of EMS, pass on all vital information to crew chief and assist them
     as necessary.




        __________________________                    __________________________
                                                 10
               Dr. John G. Inman                         John F. Sorrell, MD, FACEP
         College of Charleston Chief Physician            CCEMS Medical Director

                      College of Charleston First Responder Unit
                        Standard of Care for First Responders


          Significant Visible Blood Loss or Suspected Internal Blood Loss

1.   Observe blood borne pathogens protocol protection at all incidents.

2.   Control bleeding by appropriate means.

3.   Administer supplemental oxygen, via mask or nasal cannula at 3 liters/min. (Use
     higher rate if no history of Chronic Lung Disease).

4.   Maintain body warmth and take vital signs including pulse, blood pressure, and
     respirations. Note pupil response. Note time and repeat every five minutes.

5.   If blood pressure (systolic) is less than 90 and if patient can be moved without
     further injury, lay him down and elevate the feet and legs (shock position). If long
     spine board is available, foot end may be elevated 6” to 12”.

6.   Dress and bandage open wounds. Note: EMS may remove dressing to examine
     wounds, they must describe them to doctor.

7.   Upon arrival of EMS, pass on all vital information to crew chief and assist them
     as necessary.




        __________________________                    __________________________
                                                 11
               Dr. John G. Inman                         John F. Sorrell, MD, FACEP
         College of Charleston Chief Physician            CCEMS Medical Director

                      College of Charleston First Responder Unit
                        Standard of Care for First Responders


                                      Diabetic Patient

1.   Observe blood borne pathogens protocol protection at all incidents.

2.   Obtain patient history:

        A. Determine if patient has eaten recently.

        B. Determine patient’s medications, including last dose.

3.   Take vital signs including pulse, blood pressure, and respirations. Note time.

4.   If insulin shock is suspected and patient is conscious and alert, you may give the
     patient glucose gel or a drink of 3 to 4 ounces of orange juice with a tablespoon of
     sugar mixed into the drink. If the patient is unconscious or stuporous, maintain an
     airway and note pupil response. Give nothing by mouth until EMS arrives.

5.   Upon arrival of EMS, pass on all vital information to crew chief and assist them
     as necessary.




        __________________________                    __________________________
                                                 12
               Dr. John G. Inman                         John F. Sorrell, MD, FACEP
         College of Charleston Chief Physician            CCEMS Medical Director

                      College of Charleston First Responder Unit
                        Standard of Care for First Responders


                                      Seizure Activity

1.   Observe blood borne pathogens protocol protection at all incidents.

2.   Establish and maintain airway. Protect spine. The patient may have a neck or
     back injury. Obtain history from family or bystanders. Do not attempt to restrain
     patient, or put anything hard in the patient’s mouth. Protect patient from further
     injury.

3.   Administer supplemental oxygen, via mask at 12 liters/min. or nasal cannula at 3
     liters/min. (Use higher rate if no history of Chronic Lung Disease). Suction
     airway as necessary.

4.   Take vital signs including pulse, blood pressure, and respirations. Note pupil
     response. Note time and repeat every five minutes.

5.   Check patient for obvious injuries, especially head injuries.

6.   Upon arrival of EMS, pass on all vital information to crew chief and assist them
     as necessary.




        __________________________                    __________________________
                                                 13
               Dr. John G. Inman                         John F. Sorrell, MD, FACEP
         College of Charleston Chief Physician            CCEMS Medical Director

                      College of Charleston First Responder Unit
                        Standard of Care for First Responders


                                        Burn Patient

1.   Observe blood borne pathogens protocol protection at all incidents.

2.   Establish and maintain airway - Watch for breathing difficulties especially if face
     is burned. Cut away charred clothing. Note percentage of body burned.

3.   Cool area with clean tap or sterile water immediately, apply nothing else to skin.
     Cover burned area with sterile dressing. Maintain body temperature.

4.   Take vital signs including pulse, respirations, and blood pressure (blood pressure
     if possible). Repeat every 5 minutes as patient status dictates.

5.   Check patient for other injuries and monitor condition for further complications.

6.   Upon arrival of EMS, pass on all vital information to crew chief and assist them
     as necessary.




        __________________________                    __________________________
                                                 14
               Dr. John G. Inman                         John F. Sorrell, MD, FACEP
         College of Charleston Chief Physician            CCEMS Medical Director

                      College of Charleston First Responder Unit
                        Standard of Care for First Responders


                                         Snake Bite

1.   Observe blood borne pathogens protocol protection at all incidents.

2.   Get patient away from snake. Try to identify the type of snake. This is important,
     but DON’T GET YOURSELF OR ANYONE ELSE BITTEN!

3.   Do not use a tourniquet. Do not apply ice! Place the patient supine and keep him
     still and quiet. Keep the affected extremity in a dependant position or neutral
     position (dependant is better) and immobilized.

4.   Take vital signs, including pulse, blood pressure, and respirations. Note pupil
     response. Note time and repeat every five minutes.

5.   Monitor patient closely and expedite transportation. If patient develops
     hypotension (systolic less than 90), elevate unaffected lower extremities and apply
     oxygen via mask at 12 liters/min.

6.   Upon arrival of EMS, pass on all vital information to the crew chief and assist
     them as needed.




        __________________________                    __________________________
                                                 15
                Dr. John G. Inman                         John F. Sorrell, MD, FACEP
          College of Charleston Chief Physician            CCEMS Medical Director

                       College of Charleston First Responder Unit
                         Standard of Care for First Responders


                                       Dead on Arrival

1.   Observe blood borne pathogens protocol protection at all incidents.

2.   When given a patient with no pulse or respiration, resuscitation is generally not
     indicated when:

     A.      The presence of obvious rigor or liver mortis (body stiffness or pooling of
             blood).

     B.      Injuries are obviously incompatible with life (i.e., decapitation, gross
             mutilation).

     C.      In chronic terminally ill patients where it is agreed with immediate family
             and, where applicable, the patient’s physician that resuscitation is
             inappropriate and there is a signed “DHEC EMS DO NOT
             RESUSCIATE” form.

3.   Contact the EMS dispatcher immediately and apprise them of the situation.




          __________________________                   __________________________
                                                  16
                Dr. John G. Inman                         John F. Sorrell, MD, FACEP
          College of Charleston Chief Physician            CCEMS Medical Director

                       College of Charleston First Responder Unit
                         Standard of Care for First Responders


                            Automobile and Vehicle Accidents

1.   Observe blood borne pathogens protocol protection at all incidents.

2.   Upon arrival, determine the possibility of hazards, including:

     A.      Fire, explosion, or electrical line hazards.

     B.      Hazardous materials especially in large trucks.

     C.      The need for rescue operations and extrication of victims.

3.   Initiate proper patient care according to appropriate Standard of Care.

4.   If patients are trapped or cannot be readily moved due to injuries, always provide
     for fire protection (1 ½” or 1 ¾” charged hand line). Do not hesitate to pull more
     than lines or set up foam if necessary to protect yourselves or the patient(s) from
     the threat of fire or explosion.

5.   Keep people away from the wreckage until law enforcement arrives to handle
     crowd control.

6.   Upon arrival of EMS, notify crew chief of any potential hazards. Pass on all vital
     information to and assist them as necessary.




          __________________________                   __________________________
                                                  17
               Dr. John G. Inman                         John F. Sorrell, MD, FACEP
         College of Charleston Chief Physician            CCEMS Medical Director

                      College of Charleston First Responder Unit
                        Standard of Care for First Responders


                                 Psychiatric Emergencies

1.   Observe blood borne pathogens protocol protection at all incidents.

2.   As much as possible, obtain history from family and/or bystanders and determine
     specific events which precipitated call for EMS.

3.   Obtain history and question patient for any illness, injuries, drug, or alcohol
     involvement hallucinations, delusions, illusions, suicidal or homicidal thoughts.

4.   Maintain calm but purposeful affect.

5.   Have law enforcement intervene when physical danger is present. You should
     restrain only if law enforcement is not present and there is imminent danger of
     injury to the patient or others.

6.   Monitor vital signs and assess pupillary response, particularly when restraint is
     necessary.

7.   The patient may not be legally transported against their will unless intervention is
     obtained prior to transportation. Make sure an important family member stays
     with the patient to provide history.




        __________________________                    __________________________
                                                 18
               Dr. John G. Inman                       John F. Sorrell, MD, FACEP
         College of Charleston Chief Physician          CCEMS Medical Director

                      College of Charleston First Responder Unit
                        Standard of Care for First Responders


                            Acute Systemic Allergic Reaction

1.   Observe blood borne pathogens protocol protection at all incidents.

2.   Establish and maintain airway and ventilate as necessary.

3.   If the patient is breathing, administer supplemental oxygen, via mask at 12
     liters/min., or nasal cannula 3 liters/min. (use higher rate if no history of Chronic
     Lung Disease).

4.   If reaction is due to an insect bite or sting on extremity, apply loose constriction
     band 3 to 4 inches above the wound.

5.   Obtain vital signs, including pulse, respiration, and blood pressure. If systolic
     blood pressure is less than 90, elevate feet and legs (shock position).

6.   Monitor patient closely. Repeat vital signs at least every 5 minutes and be
     prepared to do CPR as necessary. Look for medic alert tags.

7.   Upon arrival of EMS, pass on all vital information to crew chief and assist them
     as necessary.




         __________________________                __________________________
                                   19
                Dr. John G. Inman                         John F. Sorrell, MD, FACEP
          College of Charleston Chief Physician            CCEMS Medical Director

                       College of Charleston First Responder Unit
                         Standard of Care for First Responders


                                       Gunshot Wound

1.    Observe blood borne pathogens protocol protection at all incidents.

2.    Establish and maintain airway.

3.    Control bleeding by appropriate means.

4.    Dress and bandage open wounds. Use Occlusive Dressing if treating an open
      chest or back wound. Tape on three sides only. Note: EMS may remove dressing
      to examine wounds, they must describe them to the hospital. Determine type of
      weapon used, if possible.

5.    Listen for air movement in lungs.

6.    Administer supplemental oxygen, via mask at 12 liters/min. or nasal cannula at 3
      liters/min. (Use higher rate if no history of Chronic Lung Disease).

7.    Maintain body warmth and take vital signs. If wounds involve extremity,
      determine presence/quality of the distal pulses, skin color, and temperature.

8.    Examine for exit wound.

9.    If patient can be moved without further injury, lay them down and elevate their
      feet (shock position).

10.   Upon arrival of EMS, pass on all vital information to crew chief and assist them
      as necessary.




         __________________________                    __________________________
                                                  20
               Dr. John G. Inman                         John F. Sorrell, MD, FACEP
         College of Charleston Chief Physician            CCEMS Medical Director

                      College of Charleston First Responder Unit
                        Standard of Care for First Responders


                               Stabbing or Impaled Object

1.   Observe blood borne pathogens protocol protection at all incidents

2.   Same care as with Standard Care for Gunshot.

3.   If the knife or impaling object is still in place, DO NOT REMOVE unless it is
     obstructing airway. Immobilize knife or impaling object in place to be transported
     with patient.




        __________________________                    __________________________
                                                 21
                Dr. John G. Inman                      John F. Sorrell, MD, FACEP
          College of Charleston Chief Physician         CCEMS Medical Director

                       College of Charleston First Responder Unit
                         Standard of Care for First Responders


                                          Childbirth

***   Observe blood borne pathogens protocol protection at all incidents.

ACTIVE LABOR

1.    Determine time of onset and intervals between contractions.

2.    Obtain history including due date and examine for crowning.

3.    Monitor vital signs.

4.    Administer supplemental oxygen via nasal cannula at a flow rate of 3 liters/min.

OBSTETRICAL DELIVERY

1.    Position supine.

2.    Control delivery of head to prevent an “explosive” delivery (if time allows,
      suction nose and mouth with bulb syringe before delivering shoulders.

3.    Gently guide head down for delivery of anterior shoulder, then up for delivery of
      posterior shoulder (note time).

4.    Avoid tension on cord after delivery.

POST PATRUM CARE

1.    Suction infant’s nostrils and airway with bulb syringe.

2.    Rapidly dry head, then body, and preserve body warmth. Note the infant’s color,
      respirations, heart rate, muscle tone, and response to stimulation.

3.    DO NOT cut umbilical cord if EMS arrival is imminent. If cord must be cut,
      place first tie or clamp six inches from infant and second tie or clamp three inches
      from the first. Cut with sterile instrument between clamps.

4.    Allow the placenta to deliver itself - DO NOT pull on cord (note time).

                                                  22
5.   If vaginal bleeding is heavy, massage the mother’s abdomen. Place infant to
     breast. Elevate mothers feet (shock position).

6.   Upon arrival of EMS, pass on all vital information to crew chief and assist them
     as necessary.




        __________________________              __________________________

                                         23
                Dr. John G. Inman                         John F. Sorrell, MD, FACEP
          College of Charleston Chief Physician            CCEMS Medical Director

                       College of Charleston First Responder Unit
                         Standard of Care for First Responders


                             Heat Related Emergencies
***   Observe blood borne pathogen protocol protection at all incidents.

HEAT CRAMPS
1.   Establish and maintain airway.

2.    Get patient to a cool or shady area.

3.    If the patient is conscious and alert, encourage patient to drink a salt drink (a
      teaspoon of salt in a quart of water or lemonade) or diluted Gatorade. You
      should be able to note improvement in condition within a few minutes.

HEAT EXHAUSTION
1.   Follow procedures for heat cramps.

2.    Remove as much of patients clothing as the situation will allow and cool him off
      by bathing in or spraying with cool water followed by fanning, if possible.

HEAT STROKE
1.   Establish and maintain airway.

2.    Administer supplemental oxygen, via face mask at 12 liters/min. or nasal cannula
      at 3 liters/min. (Use higher flow if no history of Chronic Lung Disease).

3.    Remove as much of the patient’s clothing as situation will allow and start cooling
      him off. Reducing body temperature is critical. The best method is to spray or
      bathe the patient with cool (NOT ice) water and fan (if possible). The idea is to
      cool through evaporation and NOT induce shivering.

4.    Upon arrival of EMS, pass on all vital information to crew chief and assist them
as    necessary.




         __________________________                    __________________________
                                                  24
      Dr. John G. Inman                      John F. Sorrell, MD, FACEP
College of Charleston Chief Physician         CCEMS Medical Director




                                        25