2016 EMS Protocols IOWA

8/17/2019 2016 EMS Protocols IOWA

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Iowa Department of Public HealthBUREAU OF EMERGENCY AND TRAUMA SERVICES

Statewide EMS TREATMENT PROTOCOLS

ADULT & PEDIATRIC

January 2016

LUCAS STATE OFFICE BUILDING

DES MOINES IO!A "0#1$%00"

'"1"( 2)1%0620

')00( 2)%##6

*++,-../,*/3a45.BETS.EMS

http://idph.iowa.gov/BETS/EMShttp://idph.iowa.gov/BETS/EMS


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Protocol Authorization

Iowa Administrative Code 641 - Chapter 132: Emerenc! "edical

#ervices$#ervice Proram Authorization

132.8(3) Service program operational requirements. Ambulance andnontransport service programs shall:

(. )tilize de!artment !rotocols as the standard o care. %he service !ro*rammedical director ma+ ma,e chan*es to the de!artment !rotocols !rovided

the chan*es are #ithin the $MS !rovider-s sco!e o !ractice and #ithinacce!ta(le medical !ractice. A co!+ o the chan*es shall (e led #ith thede!artment.

132.9(2) he medical director!s duties include" but need not be limited to/a. Develo!in* a!!rovin* and u!datin* !rotocols to (e used (+ service!ro*ram !ersonnel that meet or eceed the minimum standard !rotocols

develo!ed (+ the de!artment.

Purpose

%he com!leted !rotocol a!!roval !a*e allo#s or a !h+sician medical directorto im!lement the use o the 2#1$ %o&a State&ide 'S reatment rotocols or one or more service !ro*rams #here the+ serve as the !ro*ram-s medical

director.

Instructions

Print or t+!e each service-s name in the s!ace (elo# that the medicaldirector is a!!rovin* the use o the 2016 !rotocols or. et select each

service-s corres!ondin* service t+!e and level o authorization. " themedical director ma,es an+ additions su(tractions or other chan*es to the2016 !rotocols the chan*es #ill need to (e noted in the Protocol Revisionss!ace and led #ith the De!artment. %his #ould include the addition

su(traction or chan*e o an+ medication listed #ithin the 2016 !rotocols. "no chan*es are made to the 2016 !rotocols chec, the (o or no chan*es.

#cope o% Practice

%he %o&a 'mergenc* edical +are rovider Scope o, ractice documentoutlines the s,ills each level o certied $MS !rovider can !erorm. Some

s,ills #ill reuire the a!!roval o the service !ro*ram-s !h+sician medical

director as #ell as documentation o additional trainin*. "o#a $MS !rovidersma+ not !erorm s,ills outside o their identied sco!e o !ractice as

documented in the %o&a 'mergenc* edical +are rovider Scope o, ractice. %he most current version o the %o&a 'mergenc* edical +are rovider Scopeo, ractice document can (e vie#ed and do#nloaded rom the ureau-s

#e(site at/ htt!/55id!h.io#a.*ov5(ets5ems5sco!eo!ractice.

"o#a $MS %reatment Protocols 2

http://idph.iowa.gov/bets/ems/scope-of-practicehttp://idph.iowa.gov/bets/ems/scope-of-practice


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&ecommendations

"t is recommended that each service !ro*ram maintain records thatdocument the revie#5education o all sta7 mem(ers on the !ro*ram-s mostcurrent !rotocols and the most current version o the %o&a 'mergenc*edical +are rovider Scope o, ractice document.

Service8s9 ame

S e r v i c e 2 a m e





Service %+!eAm(ulance

ontrans!ort

Service-s :evel o

Authorization

$MR

$M%$M%"

A$M%

$M%P

Paramedic

Protocol "edications

Chec' All "edications Carried (! the #ervice

edication -it should contain onl* medications approved b* the service!s

edical irector

)*C "edications "edications

€ As!irin € Adenosine € :oraze!am€ Activated Charcoal € Al(uterol € Ma*nesium Sulate

€ ;lucose Paste € Amiodarone € MidazolamPatient Assisted

"edications

€ Atro!ine € Mor!hine Sulate

€ Autoin


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2/16 Protocol &evisions€ o chan*es #ere made to the 2#1$ %o&a State&ide 'S reatment

rotocols

=R:ist (elo# or attach co!ies o all chan*es made (+ the !h+sician medical

director to the 2#1$ %o&a State&ide 'S reatment rotocols

Pae Protocol 0ame Chanes "ade

Additional #'ills %or the E"& E"* AE"* E"*-I

A!!roval o these additional

s,ills must (e #ithin theService Pro*ram-s :evel oAuthorization and the "o#a

$MS Provider-s Sco!e oPractice

Mar, Bes i the s,ill isa!!roved (+ the medical

director to (e !erormed (+the identied certication level

Certication

:evel

B e s

2 o

Pulse oimetr+ $MR

;lucose monitor $M% $M%"Service carries autoin


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Adult %reatment Protocols 2016 &


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Iowa E"# *reatment Protocols

Section 2

Adult *reatment Protocols

Contents"nitial Patient Care Protocol.............................................................................. 6

A(dominal Pain................................................................................................

Acute Coronar+ S+ndrome...............................................................................E

Air#a+............................................................................................................11

Altered Mental Status.....................................................................................12

Am!utated Part..............................................................................................13

A!!arent Death.............................................................................................. 14

Asthma and C=PD..........................................................................................1&

ehavioral $mer*encies.................................................................................16

urns.............................................................................................................. 1'

Cardiac Arrh+thmias.......................................................................................20

Child(irth.......................................................................................................23

Con*estive Feart >ailure................................................................................24

>rost(ite.........................................................................................................26

Feat "llness....................................................................................................2'

F+!othermia..................................................................................................2

ausea G @omitin*.........................................................................................2E

Pain Control....................................................................................................30

Poisonin*........................................................................................................ 32

Post Resuscitation #ith Return o S!ontaneous Circulation............................33

Seizure........................................................................................................... 34

Selective S!inal "mmo(ilization......................................................................3&

Seual Assault................................................................................................ 3'Shoc,.............................................................................................................3

Stro,e.............................................................................................................43

%rauma........................................................................................................... 44

Adult %reatment Protocols 2016 6


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Initial Patient Care Protocol

REVISED 2016

1. Scene Sie !p

a" Re#iew the di$patch information b" %$ &ou approach the $cene con$ider $afet& for &our$elf and &our patient.

c" 'b$er#e uni#er$al precaution$

d" %fter determinin( the number and location of patient$) con$ider the needfor additional re$ource$

e" Determine mechani$m of in*ur& and+or nature of illne$$

f" Rea$$e$$ the $ituation often

2. Primar& Sur#e&

a" 'btain (eneral impre$$ion of patient) chief complaint) and priorit& problem$

b" Determine re$pon$i#ene$$

c" %$$e$$ airwa&

d" %$$e$$ breathin(e" %$$e$$ circulation

,. Initial Inter#ention$a" -reat airwa&+breathin( problem$

b" -reat circulation problem$

c" E$tabli$h IV+I' acce$$ if indicated

d" %ppl& cardiac monitor if indicatede" %ppl& pul$e oimetr& or Et/'2 monitor if a#ailable and indicated

f" -reat pain or nau$ea if pre$ent

(" aintain normal patient temperature

. Secondar& Sur#e&

a" Perform $econdar& a$$e$$ment after initial inter#ention$ are completed b" %ddre$$ problem$ identified in the $econdar& $ur#e& utiliin( the

appropriate protocol$"

c" 'btain #ital $i(n$.) includin( blood (luco$e if a#ailable and indicated

3. 'n(oin( %$$e$$menta" Repeated e#aluation of patient

Vital$ e#er& 3 minute$ for un$table patient$Vital$ e#er& 13 minute$ for $table patient$

b" %$$e$$ effect of inter#ention$

Adult %reatment Protocols 2016 '


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In/+/a7 Pa+/8n+ Car8 Pr+;7 ';n+/nu8(

6. -ran$port+/ontact edical /ontrola" Patient$ $hould be tran$ported a$ $oon a$ fea$ible to an appropriate

medical facilit&. Immediate tran$port with treatment en route i$

recommended for patient$ with $i(nificant trauma or un$table airwa&$

b" -ier with an appropriate $er#ice if le#el of care indicate$ or a$$i$tance i$needed and can be accompli$hed in a timel& manner

c" /ontact medical direction a$ $oon a$ fea$ible in accordance with local

protocol for further order$d" 4or $eriou$l& in*ured or criticall& ill patient$) (i#e a brief initial report

from the $cene when po$$ible) with a more detailed report (i#en to

medical direction while en route

Adult %reatment Protocols 2016


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A(dominal Pain

'nn%+rau


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Acute Coronar+ S+ndrome

REVISED 2012

1. 4ollow Initial Patient /are Protocol

BASIC CARE GUIDELINES

a" Place patient in po$ition of comfort) loo$en ti(ht clothin( and pro#ide

rea$$urance. If patient i$ complainin( of $hortne$$ of breath) ha$ $i(n$ ofre$pirator& di$tre$$ and pul$e oimetr& of le$$ than 7 then titrate o&(en to

maintain a $aturation of 87

b" If capabilit& ei$t$) obtain a 128lead E95 and tran$mit to the recei#in( facilit&

and+or medical control for interpretation a$ $oon a$ po$$ible

c" If patient i$ alert and oriented and epre$$e$ no aller(& to a$pirin ha#e patient

chew nonenteric a$pirin 160 : ,23 m(

d" %n initial mana(ement (oal $hould be to identif& S-EI and tran$port the patientwith cardiac $&mptom$ to the facilit& mo$t appropriate for their need$

e" /ontact medical direction for order$

f" If the patient ha$ been pre$cribed nitro(l&cerin patient;$ nitro onl&" and $&$tolic

blood pre$$ure i$ 0 mmH( or abo#e) (i#e one do$e. If patient i$ ta


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A;u+8 Crnary Synr


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Airwa!

REVIEAED 2016



Br8a+*/n4 :,n+an8u: n /n/+/a7 a::8::


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Altered "ental #tatus

REVIEAED 2011



a" 'btain blood (luco$e

b" If con$ciou$ C able to $wallow) admini$ter (luco$e 13 (m b& mouth

ADVANCED CARE GUIDELINES

c" If blood $u(ar le$$ than 60 m(+d= admini$ter D30 12.3 8 23 (m IV

d" If no #a$cular acce$$ admini$ter (luca(on 1 m( I

e" E#aluate the need for naloone 1 m( IV. If no re$pon$e ma& repeat in ,minute$

f" E#aluate the need for intubation


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Amputated Part

REVISED 2016


2. 4ollow -rauma Protocol if indicated


a" =ocate amputated part if po$$ible

b" Arap amputated part in $aline moi$tened (aue

c" Place wrapped amputated part in empt& pla$tic ba(

d" Place the pla$tic ba( with the amputated part in a water and ice miture

e" Do not u$e ice alone or dr& ice

f" =abel with patient name) the date) and time

(" a


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Apparent .eath

REVISED 2012


%pparent death indication$ are a$ follow$> Si(n$ of trauma are conclu$i#el& incompatible with life

Ph&$ical decompo$ition of the bod&

Ri(or morti$ and+or dependent li#idit&

If apparent death i$ confirmed) continue a$ follow$>


a" -he count& edical Eaminer and law enforcement $hall be contacted

b" Ahere po$$ible) contact Iowa Donor @etwor< at ?008?,181,1. SeeProtocol %ppendi

c" %t lea$t one ES pro#ider $hould remain at the $cene until the appropriateauthorit& i$ pre$ent

d" Pro#ide p$&cholo(ical $upport for (rie#in( $ur#i#or$

e" Document the rea$on$" no re$u$citation wa$ initiated

f" Pre$er#e the crime $cene if pre$ent

(" In all other circum$tance$ ecept where @' /PR+D@RF protocol

applie$G $ee appendi %" full re$u$citation mu$t be initiated


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Asthma and C)P.

REVISED 2016



a" If patient ha$ a ph&$ician pre$cribed hand8held metered do$e inhaler>

i. %$$i$t patient in admini$terin( a $in(le do$e if the& ha#e not done

$o alread&

ii. Rea$$e$$ patient and a$$i$t with $econd do$e if nece$$ar& per

medical direction

b" E#aluate the need for /P%P) if a#ailable


c" %dmini$ter albuterol up to 3.0 m( #ia nebulier) repeat a$ needed

d" E#aluate the need for epinephrine 1>1)000 concentration 0., m( I.

e" E#aluate the need for /P%P) if a#ailable

f" E#aluate the need for intubation


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ehavioral Emerencies

REVISED 2012


2. If there i$ e#idence of immediate dan(er) protect &our$elf and other$ b&$ummonin( law enforcement to help en$ure $afet&


a" /on$ider medical or traumatic cau$e$ of beha#ior problem$

b" 9eep en#ironment calm


c" 4or $e#ere aniet&) con$ider a benodiaepine $uch a$i. Diaepam 2m( IV e#er& 3 minute$ up to 10 m( maimum

OR

ii. Diaepam 3810m( I

d" 4or ecited delirium) con$ider admini$terin( ipra$idone 5eodon" 10820

m( I) if a#ailable) or $imilar medication


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urns

REVISED 2016


2. /ontinuall& monitor the airwa& for e#idence of ob$truction

,. Do not u$e an& t&pe of ointment) lotion) or anti$eptic

. aintain normal patient temperature

3. -ran$port accordin( to the 'ut8of8Ho$pital -rauma De$tination Deci$ion Protocol

%ppendi "

T*8r


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Burn: ';n+/nu8(

C*8/n /n Ey8


a" 4lood e&e$" with lu


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Burn: ';n+/nu8(

E78;+r/;a7 Burn:


a" -reat $oft ti$$ue in*urie$ a$$ociated with the burn with dr& dre$$in(

b" -reat for $hoc< if indicated


c" Refer to Pain /ontrol protocol



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Cardiac

Arrh!thmias

@EA 201,

1. 4ollow Initial /are Protocol for

all Patient$

IF NO PULSE


a" Perform hi(h Bualit& /PR

immediatel&)

appl& %ED and follow de#ice

prompt$

ADVANCED CAREGUIDELINES

b" Perform hi(h Bualit& /PR

immediatel&)

appl& monitor and chec<

rh&thm a$ $oon a$ po$$ible



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VENTRICULAR FIBRILLATION OR VENTRICULAR TAC?YCARDIA

a" Defibrillate at manufacturer;$ $pecification) immediatel& re$ume /PR for

two minute$

b" 'r(anie therapie$ $uch a$ rh&thm and pul$e chec


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Car/a; Arry+*


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b" If $&mptomatic) admini$ter atropine 0.3 m( IV or I' e#er& ,83 minute$ a$

needed to maimum do$e of ,.0 m(

c" /on$ider tran$cutaneou$ pacin( con$ider $edation"

OR /on$ider admini$terin( dopamine 2810 mc(+


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Child(irth

REVISED 2012


Nr


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Conestive eart ,ailure

REVISED 2012



a" Place patient in po$ition of comfort) t&picall& $ittin( up) loo$en ti(ht

clothin( and rea$$ure

b" aintain o&(enation with cannula or ma$< if o&(en $aturation$ are below 7 titrate to 7 8 7

c" -ran$port immediatel& if the patient ha$ an& of the followin(> @o hi$tor& of cardiac problem$

S&$tolic blood pre$$ure of le$$ than 100.

% hi$tor& of cardiac problem$) but doe$ not ha#e nitro(l&cerin

d" If capabilit& ei$t$) obtain a 128lead E95 and tran$mit it to the recei#in(

facilit& and+or medical control for interpretation prior to patient;$ arri#al

e" /ontact medical direction for order$

f" If the patient ha$ been pre$cribed nitro(l&cerin patient;$ nitro onl&" and

$&$tolic blood pre$$ure i$ 0 mmH( or abo#e) (i#e one do$e. If patient i$

ta


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Cn48:+/58 ?8ar+ Fa/7ur8 ';n+/nu8(

l" e prepared to intubate patient

m" onitor E95 and treat d&$rh&thmia$ followin( the appropriate protocol$"

n" Refer to %ppendi 4 Reperfu$ion Strate(ie$"

o" If capabilit& ei$t$) appl& /P%P

p" %dmini$ter nitro(l&cerin tab or $pra&" 0. m( $ublin(uall& if $&$tolic

blood pre$$ure 0 mmH( or abo#e

Adult %reatment Protocols 2016 2'


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,rost(ite

REVIEAED 2011



a" Remo#e the patient from the cold en#ironment

b" Protect the cold in*ured etremit& from further in*ur&

manual $tabiliation"

c" Remo#e wet or re$tricti#e clothin(

d" Do not rub or ma$$a(e

e" Do not re8epo$e to the cold

f" Remo#e *ewelr&

(" /o#er with dr& clothin( or dre$$in($


h" E$tabli$h IV acce$$ at a -9' rate. !$e warmed IV fluid if po$$ible

i" Refer to pain control protocol



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eat Illness

REVIEAED 2011



a" Remo#e from the hot en#ironment and place in a cool en#ironment

bac< of air conditioned re$pon$e #ehicle"

b" =oo$en or remo#e clothin(

c" Place in reco#er& po$ition

d" Initiall& cool patient b& fannin(

e" %dditionall& cool patient with cold pac


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!pothermia

REVIEAED 2011



a" Remo#e wet clothin(

b" If able) chec< core temperature

c" Handle patient #er& (entl&

d" /o#er patient with blan


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0ausea +omitin

REVIEAED 2011



a" 5i#e nothin( b& mouth


b" /on$ider fluid bolu$ IV+I' if e#idence of h&po#olemia and lun( $ound$are clear

c" If patient nau$eated or i$ #omitin() con$ider anti8emetic medication $uch

a$ ondan$etron Lofran" m( IV

d" /on$ider intubatin( patient$ with altered mental $tatu$ who are #omitin(

and cannot protect their airwa&



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Pain Control

REVIEAED 2012



a" 4ir$t) attempt to mana(e all painful condition$>a" Splint etremit& in*urie$

b" Place the patient in a po$ition of comfort


b" /on$ider admini$tration of pain medication$ for patient$ that ha#e$i(nificant pain) do not ha#e a decrea$ed le#el of con$ciou$ne$$) are

hemod&namicall& $table) and ha#e o&(en $aturation$ abo#e 7

medication. Eample>

a" orphine 28 m( #ia IV) repeated in 3 min

OR

b" 4entan&l 23 to 30 mc( IV e#er& 3 minute$ a$ needed to amaimum of 100 mc(

c" %dmini$ter naloone 1 m( IV for re$pirator& depre$$ion from

narcotic$. a& repeat once if needed

d" 4or $e#ere pain con$ider aniol&tic medication

a" idaolam 0.382.3 m( IV + I repeated e#er& 3 minute$ a$needed to a maimum of 3 m(

OR

b" Diaepam 283 m( IV + I repeated e#er& 3 minute$ a$needed to a maimum of 10 m(

OR

c" =oraepam 2m( IV) repeated e#er& ,0 minute$ a$ needed to a

maimum of m(. !$e for lon( tran$port$

e" onitor E/5 and '2 $aturation$



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Pa/n Cn+r7 'Cn+/nu8(

f" -he patient mu$t ha#e #ital $i(n$ ta


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Poisonin

REVIEAED 2011


2. Identif& contaminate and call Poi$on /ontrol and follow direction$ (i#en to pro#idecare> 18?00822281222

,. /ontact edical Direction a$ $oon a$ po$$ible with information (i#en b& Poi$on

/ontrol and care (i#en


In48:+8 ,/:n:

a" Identif& and e$timate amount of $ub$tance in(e$ted

In*a78 ,/:n:-a" Remo#e patient to fre$h air

b" %dmini$ter hi(h flow o&(en.

c" E$timate duration of epo$ure to inhaled poi$on

A:r8 ,/:n:a" Identif& contaminateM If it will be a haard to &ou) u$e protecti#e

clothin( and etreme caution

In8;+8 ,/:n:a" e alert for re$pirator& difficult&. aintain airwa& and

(i#e hi(h flow o&(en

b" /hec< patient for mar


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Post &esuscitation with &eturn o% #pontaneous

Circulation

Adult %reatment Protocols 2016 3&


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@EA 201,

1. 4ollow Initial Patient /are

Protocol


a" aintain

o&(en $aturation between

7 8 7

ADVANCED CARE

GUIDELINES

b" /on$ider

ad#anced airwa&

c" If a#ailable) perform

wa#eform

capno(raph&)

maintainin(

PE-/'2 ,380 mm H(

d" -reat h&poten$ion SP

N0 mm H("

i. %dmini$ter 182 = @S or =R

ii. %dmini$ter

dopamine 3810

mc(+


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f" If a#ailable) obtain 128lead E95

(" If a#ailable) obtain blood (luco$ei. If blood $u(ar le$$ than 60 m(+d= admini$ter D30 12.3 8 23 (ram$ IV

or I'

Adult %reatment Protocols 2016 3'


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#eizure

REVIEAED 2012


A;+/58 :8/ur8


a" Protect airwa&

b" /hec< blood (luco$e le#el) if a#ailable) and treat h&po(l&cemia if pre$ent


c" %dmini$ter #alium titrate 2 m( IV pu$h until $eiure $top$ or maimum

do$e of 10 m( i$ (i#en

OR

%dmini$ter loraepam 1 m( IV pu$h) titratin( 1 m( at a time until the

$eiure $top$ or until maimum do$e of 10 m( i$ (i#en

P:+ :8/ur8


a" Protect airwa&

b" /hec< blood $u(ar and treat h&po(l&cemia if pre$ent


c" /on$ider thiamine 100 m( I



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#elective #pinal Immo(ilization

Re#i$ed 2013



2. Patient Pre$entation>

a" -hi$ protocol i$ intended for patient$ who pre$ent with a traumaticmechani$m of in*ur&.

b" Immobiliation i$ contraindicated for patient$ who ha#e penetratin(

trauma who do not ha#e a neurolo(ical deficit.

,. Patient ana(ement>

a" %$$e$$ment>

i. %$$e$$ for mental $tatu$) neurolo(ical deficit$) $pinal pain)tenderne$$) an& e#idence of intoication) or other $e#ere in*urie$.

ii. Ahile maintainin( $pinal ali(nment) eamine the $pine for

tenderne$$ on palpation or deformitie$.

b" -reatment and Inter#ention$>

i. %ppl& cer#ical re$triction if there i$ an& of the followin(>

1. Patient complain$ of nec< pain.

2. %n& nec< tenderne$$ of palpation.

,. %n& abnormal mental $tatu$) includin( etreme a(itation)

or neurolo(ical deficit.

. %n& e#idence of alcohol or dru( intoication

3. -here are other $e#ere or painful in*urie$ pre$ent.

6. %n& communication barrier that pre#ent$ accurate

a$$e$$ment.

Adult %reatment Protocols 2016 3E


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#e5ual Assault

REVIEAED 2011



a" Identif& &our$elf to the patient) a$$ure patient that the& are $afe and in no

further dan(er

b" Do not burden patient with Bue$tion$ about the detail$ of the crimeG &ouare there to pro#ide emer(enc& medical care

c" e alert to immediate $cene and document what &ou $ee. -ouch onl& what&ou need to touch at the $cene

d" Do not di$turb an& e#idence unle$$ nece$$ar& for treatment of patient. If

nece$$ar& to di$turb e#idence) document wh& and how it wa$ di$turbed."

e" Pre$er#e e#idenceG $uch a$ clothin( &ou ma& ha#e had to remo#e for

treatment) and ma


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#hoc'

REVISED 2016

1 . 4ollow Initial /are Protocol for all Patient$

2. aintain o&(en $aturation between 7 8 7

?y,578+8rna7 B788/n4


a" %#oid further heat lo$$

b" Splint etremitie$ a$ needed

c" 4ollow Hemorrha(e /ontrol Protocol

i. /ontrol

bleedin( with direct pre$$ure. =ar(e (apin( wound$ ma& need

application of a bul


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d" E$tabli$h IV+I' acce$$e" If radial pul$e i$ ab$ent or $&$tolic blood pre$$ure i$ le$$ than 0 mmH()

admini$ter 20ml+


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S*;@ ';n+/nu8(


b" -he (oal $hould be to minimie $cene time with time critical in*urie$)includin( e$tabli$hin( IV acce$$ en route.

c" %dmini$ter 20 ml+


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S*;@ ';n+/nu8(


c" %dmini$ter 20 ml+

a. admini$terin( atropine 0.3 m( e#er& 3 minute$) up to , m(

'R

b. tran$cutaneou$ pacin(

D/:+r/u+/58 S*;@- Ana,*y7a;+/;


a" If the patient ha$ a ph&$ician pre$cribed %uto8In*ect Epinephrine a$$i$t

with admini$terin( it for $i(n$ of anaph&lai$


b" %dmini$ter epinephrine 1>1)000 concentration 0.01 m(+10)000 concentration 0., m( 8 0.3 m( IV+I' $lowl& o#er ,83 minute$.

D/:+r/u+/58 S*;@- S8,+/; S*;@


a" aintain o&(en $aturation between 7 8 7 b" Place patient in $upine po$ition

c" If temperature i$ o#er 102o4+,?.o/) cool patient i.e. cool $pon(e$"

Adult %reatment Protocols 2016 4&


47/104

S*;@ ';n+/nu8(


a" %dmini$ter 20 ml+


48/104

#tro'e

REVISED 2012

,. 4ollow Initial Patient /are Protocol


a" Perform a 4%S-F /incinnati Preho$pital Stro


49/104

*rauma

REVISED 2016

1. 4ollow Initial Patient Protocol for all patient$

2. 4ollow the 'ut8of8Ho$pital -rauma -ria(e De$tination Deci$ion Protocol for the

identification of time8critical in*urie$) method of tran$port and de$tination

deci$ion for treatment of tho$e in*urie$

,. -he (oal $hould be to minimie $cene time with time critical in*urie$) includin(e$tabli$hin( IV$ en route.

?8


50/104

c" -a


51/104

(" If patient i$ intubated or ha$ an airwa& $uch a$ /ombitube) 9in() =%

PE-/'2 le#el$ $hould be continuall& monitored and maintained at ,, : ,

mmH( if a#ailable

Adult %reatment Protocols 2016 &0


52/104

Trau


53/104

IOWA EMS TREATMENT PROTOCOLS

Section 3

Pediatric *reatment Protocols

Pediatric "nitial Care Protocol..........................................................................4

Pediatric Air#a+.............................................................................................&0

Pediatric Aller*ic Reaction.............................................................................. &2

Pediatric Altered Mental Status......................................................................&3

Pediatric A!!arent Death............................................................................... &4

Pediatric Asthma............................................................................................ &&

Pediatric urns............................................................................................... &6

Pediatric Cardiac Arrh+thmia..........................................................................&EPediatric ausea G @omitin*.......................................................................... 62

Pediatric ear Dro#nin*.................................................................................63

e#(orn Resuscitation G Care.......................................................................6&

Pediatric Pain Control..................................................................................... 6

Pediatric Poisonin*......................................................................................... 6E

Pediatric Seizure.............................................................................................'0

Pediatric Selective S!inal "mmo(ilization.......................................................'1

Pediatric Shoc,...............................................................................................'3Sus!ected Child A(use...................................................................................'4

Pediatric %rauma............................................................................................ '&

Pediatric -reatment Protocol$ 2016 &2


54/104

Pediatric Initial Care Protocol

REVISED 2016

1. Scene Sie !p

a" Re#iew the di$patch information b" %$ &ou approach the $cene) be $ure to con$ider $afet& for &our$elf and

&our patient

c" 'b$er#e uni#er$al precaution$d" %fter determinin( the number and location of patient$) con$ider the

need for additional re$ource$

e" Determine mechani$m of in*ur& and+or nature of illne$$f" Rea$$e$$ the $ituation often

2. Primar& Sur#e&a" 'btain (eneral impre$$ion of patient) chief complaint) and priorit&

problem$ b" Determine re$pon$i#ene$$

c" %$$e$$ airwa&d" %$$e$$ breathin(

e" %$$e$$ circulation

f" aintain cer#ical $tabiliation+immobiliation if indicated(" !tilie len(th+wei(ht ba$ed tape to determine appropriate medication$

and eBuipment

,. Initial Inter#ention$

a" -reat airwa&+breathin( problem$

b" -reat circulation problem$c" E$tabli$h IV+I' acce$$ if indicatedd" -reat pain or nau$ea

e" %ppl& cardiac monitor

f" aintain normal patient temperature

. Secondar& Sur#e&

a" Perform $econdar& a$$e$$ment after initial inter#ention$ are completed b" %ddre$$ problem$ identified in the $econdar& $ur#e& utiliin( the

appropriate protocol$"c9 'btain #ital $i(n$) includin( blood (luco$e if a#ailable and indicated

d" %$$e$$ pain

3. 'n(oin( %$$e$$ment

a" Repeated e#aluation of patient Vital$ e#er& 3 minute$ for un$table patient

Vital$ e#er& 13 minute$ for $table patient$

b" %$$e$$ effect of inter#ention$



55/104

P8/a+r/; In/+/a7 Car8 Pr+;7 ';n+/nu8(

6. -ran$port+/ontact edical /ontrol

a" Patient$ $hould be tran$ported a$ $oon a$ fea$ible to an appropriate

medical facilit&. Immediate tran$port with treatment enroute i$recommended for patient$ with $i(nificant trauma or un$table airwa&$

b" -ier with an appropriate $er#ice if le#el of care indicate$ or a$$i$tance i$needed and can be accompli$hed in a timel& manner

c" /ontact medical direction a$ $oon a$ fea$ible in accordance with local

protocol for further order$d9 4or $eriou$l& in*ured or criticall& ill patient$) (i#e a brief initial report

from the $cene when po$$ible) with a more detailed report (i#en to

medical direction while en route



56/104

Pediatric Airwa!

REVIEAED 2016


Br8a+*/n4 :,n+an8u: n /n/+/a7 a::8::


57/104

P8/a+r/; A/r3ay ';n+/nu8(

I9 :+ru;+/n n+ ;78ar8


a" %ttempt endotracheal intubation and tr& to #entilate the patient

b" If endotracheal intubation i$ not $ucce$$ful) perform needlecricoth&rotom& and needle in$ufflation



58/104

Pediatric Alleric &eaction

REVISED 2012



a" %$$e$$ airwa& #ia %irwa& Protocol

b" If the patient ha$ a ph&$ician pre$cribed auto8in*ectable epinephrine a$$i$t

with admini$tration and monitor for $i(n$ of anaph&lai$


c" %dmini$ter epinephrine 1>1)000 concentration 0.01 m(+


59/104

Pediatric Altered "ental #tatus

REVISED 2012



a" 4ollow %irwa& Protocol to en$ure adeBuate #entilation

b" 'btain blood (luco$e

c" Patient con$ciou$8 (i#e oral 5luco$e for children o#er 2 &ear$ of a(e.


d" E$tabli$h IV + I' acce$$

I9 ?y,47y;8


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Pediatric Apparent .eath

REVISED 2012



%pparent death indication$ are a$ follow$>

Si(n$ of trauma are conclu$i#el& incompatible with life

Ph&$ical decompo$ition of the bod&

Ri(or morti$ and+or dependent li#idit&

If apparent death i$ confirmed) continue a$ follow$>

a" -he count& edical Eaminer and law enforcement $hall be contacted

b" Ahere po$$ible contact Iowa Donor @etwor< at ?008?,181,1

See protocol appendi

c" %t lea$t one ES pro#ider $hould remain at the $cene until the appropriateauthorit& i$ pre$ent

d" Pro#ide p$&cholo(ical $upport for (rie#in( $ur#i#or$

e" Document rea$on no re$u$citation wa$ initiated

f" Pre$er#e the crime $cene if pre$ent

(" In all other circum$tance$ ecept where @' /PR+D@RF protocolapplie$" full re$u$citation mu$t be initiated

Pediatric -reatment Protocol$ 2016 &E


61/104

Pediatric Asthma

REVISED 2016



a" !$e %irwa& Protocol to e#aluate the airwa& and adeBuac& of #entilation

b" If patient ha$ a ph&$ician pre$cribed) hand8held metered do$e inhaler)

a$$i$t with admini$tration

c" Rea$$e$$ patient and repeat $econd do$e if nece$$ar& per medical direction


d" %dmini$ter albuterol 2.3.m( #ia @ebulier

e" E#aluate the need for epinephrine 1>1)000 concentration accordin( tolen(th+wei(ht ba$ed tape. Do$a(e ma& be repeated once after 3 minute$.

f" E#aluate the need for intubation.

Pediatric -reatment Protocol$ 2016 60


62/104

Pediatric urns

REVISED 2016


2. /ontinuall& monitor the airwa& for e#idence of ob$truction

,. Do not u$e an& t&pe of ointment) lotion) or anti$eptic

. aintain normal patient temperature

3. -ran$port accordin( to the 'ut8of8Ho$pital -rauma De$tination Deci$ion Protocol

%ppendi "

T*8r


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P8/a+r/; Burn: ';n+/nu8(

C*8


64/104

P8/a+r/; Burn: ';n+/nu8(

E78;+r/;a7 urn:


a" -reat $oft ti$$ue in*urie$ a$$ociated with the burn with dr& dre$$in(

b" -reat for $hoc< if indicated

c9 -ran$port accordin( to the 'ut8of8Ho$pital De$tination Deci$ion Protocol%ppendi "

d" E$timate percent of bod& $urface area in*ured and e$timate the depth of

burn a$ $uperficial) partial thic


65/104

Pediatric Cardiac

Arrh!thmia

@EA 201,

1. 4ollow Initial

/are Protocol for Pediatric

Patient$

IF NO PULSE


a" Perform hi(hBualit& /PR

immediatel&)

appl& %ED and follow

de#ice prompt$

ADVANCED CARE

GUIDELINES

b" Perform hi(hBualit& /PR

immediatel&)

appl& monitor and

chec< rh&thm a$ $oon

a$ po$$ible

Pediatric -reatment Protocol$ 2016 64


66/104

VENTRICULAR FIBRILLATION OR VENTRICULAR

TAC?YCARDIA

a" Defibrillate at 2+


67/104

P8/a+r/; Car/a;

Arr*y+*


68/104

BRADYCARDIA !IT? SIGNS OF POOR PERFUSION DESPITE

OYGENTATION AND VENILATION


a" Start /PR if pul$e i$ le$$ than 60 and altered mental $tatu$


b" %dmini$ter epinephrine 1>10)000 accordin( to len(th+wei(ht ba$ed

tape e#er& ,83 minute$

c" /on$ider admini$tration of atropine accordin( to len(th+wei(ht ba$ed

tape

Pediatric -reatment Protocol$ 2016 6'


69/104

P8/a+r/; Car/a;

Arr*y+*


70/104

Pediatric 0ausea +omitin

REVIEAED 2011



a" Initiate IV acce$$

b" /on$ider fluid bolu$ if e#idence of h&po#olemia

c" If patient nau$eated or i$ #omitin( admini$ter anti8emetic medication $ucha$ ondan$etron Lofran" 0.1 m(+


71/104

Pediatric 0ear .rownin

REVISED 2012



a" E$tabli$h patient re$pon$i#ene$$

b" If cer#ical $pine trauma i$ $u$pected) manuall& $tabilie the $pine

c" %$$e$$ airwa& for patenc&) protecti#e reflee$ and the po$$ible need forad#anced airwa& mana(ement. =oo< for $i(n$ of airwa& ob$truction

d" 'pen the airwa& u$in( head tilt+chin lift if no $pinal trauma i$ $u$pected)or modified *aw thru$t if $pinal trauma i$ $u$pected

e" Suction a$ nece$$ar&

f" /on$ider placin( an orophar&n(eal or na$ophar&n(eal airwa& ad*unct ifthe airwa& cannot be maintained with po$itionin( and the patient i$

uncon$ciou$

(" %$$e$$ breathin(. 'btain pul$e oimeter readin(

h" If breathin( i$ inadeBuate) a$$i$t #entilation u$in( an appropriate ad*unct

with hi(h8flow) 1007 concentration o&(en

i" %$$e$$ circulation and perfu$ion

*" If breathin( i$ adeBuate) place the child in a po$ition of comfort and

maintain o&(enation with cannula) ma$< or blow8b& if o&(en $aturation$

are below 7 titrate to 7 8 7


72/104

P8/a+r/; N8ar Dr3n/n4 ';n+/nu8(

o" If the child;$ condition i$ $table) perform focu$ed hi$tor& and detailed ph&$ical eamination on the $cene) then initiate tran$port


p" If abdominal di$tention ari$e$) con$ider placin( a (a$tric tube todecompre$$ the $tomach if a#ailable

B" If the airwa& cannot be maintained b& other mean$) includin( attempt$ ata$$i$ted #entilation) or if prolon(ed a$$i$ted #entilation i$ anticipated

r" Perform $edati#e$ and paral&tic a(ent$) to aid with intubation a$ permitted

b& medical direction. /onfirm placement of endotracheal tube u$in(

clinical a$$e$$ment and end8tidal /'2 monitorin( a$ per medical direction

$" Initiate cardiac monitorin( and determine rh&thm. /on$ult the appropriate

protocol for treatment of $pecific d&$rh&thmia$. Refer to %H% (uideline$

t" 'btain #a$cular acce$$. %dmini$ter normal $aline at a maintenance rateaccordin( to wei(ht

u" If the child;$ condition i$ critical or un$table) initiate tran$port a$ Buic


73/104

0ew(orn &esuscitation Care

REVISED 2012



a" Suction the airwa& u$in( a bulb $&rin(e a$ $oon a$ the head i$ deli#eredand before deli#er& of the bod&. Suction the mouth fir$t) then the no$e

b" 'nce the bod& i$ full& deli#ered) dr& the bab&) replace wet towel$ with dr&

one$) and wrap the bab& in a thermal blan

e(in che$t compre$$ion$ at a combined rate of 120+minute three

compre$$ion$ to each #entilation"

Pediatric -reatment Protocol$ 2016 '2


74/104

N83rn R8:u:;/+a+/n & Car8 ';n+/nu8(


i" If there i$ no impro#ement in heart rate after ,0 $econd$. Performendotracheal intubation

*" If there i$ no impro#ement in heart rate after intubation and #entilation)

admini$teri. epinephrine 1>1000 concentration at 0.1 m(+


75/104

N83rn R8:u:;/+a+/n & Car8 ';n+/nu8(

I9 +*/;@


76/104

Pediatric Pain

Control

R$@"$H$D 2011


2. 4ir$t attempt to mana(e all painful condition$ with ba$ic care


a" Splint etremit& in*urie$

b" Place the patient in a po$ition of comfort


c" /on$ider admini$tration of pain medication$ for patient$ that ha#e

$i(nificant pain) do not ha#e a decrea$ed le#el of con$ciou$ne$$) arehemod&namicall& $table) and ha#e o&(en $aturation$ abo#e 7

medication

Eample$>

• orphine 0.1 m(+


77/104

Pediatric Poisonin

REVIEAED 2011


2. Identif& contaminate and call Poi$on /ontrol and follow direction$ (i#en to

pro#ide care> 18?00822281222

,. /ontact edical Direction a$ $oon a$ po$$ible with information (i#en b& Poi$on

/ontrol and care (i#en


In48:+8 P/:n:

a" Identif& and e$timate amount of $ub$tance in(e$ted

In*a78 P/:n:-

a" Remo#e patient to fre$h air

b" %dmini$ter hi(h flow o&(en

c" E$timate duration of epo$ure to inhaled poi$on

A:r8 P/:n:

a" If it will be a haard to &ou) u$e protecti#e clothin( and etreme caution

In8;+8 P/:n:

a" e alert for re$pirator& difficult&. aintain airwa& and (i#e hi(h flow

o&(en

b" /hec< patient for mar


78/104

Pediatric #eizure

REVIEAED 201


A;+/58 S8/ur8


a" %$$e$$ airwa& #ia %irwa& Protocol

b" /hec< blood (luco$e) if a#ailable


c" E$tabli$h IV acce$$

d" %dmini$ter enodiaepine) do$a(e accordin( to len(th+wei(ht ba$ed

de#ice) to $top $eiure. a& repeat do$e in 3 minute$ if $till $eiin(

e" If blood (luco$e le$$ than 60 m(+d= (i#e (luco$e IV+I') or (luca(on I if

no IV acce$$) do$a(e accordin( to len(th+wei(ht ba$ed de#ice.

P:+ S8/ur8


a" Protect airwa&

b" /hec< blood (luco$e) if a#ailable


c" E$tabli$h IV

d" If blood (luco$e le$$ than 60 m(+d= (i#e (luco$e IV+I') do$a(e accordin(to len(th+wei(ht ba$ed de#ice.

Pediatric -reatment Protocol$ 2016 ''


79/104

Pediatric #elective #pinal Immo(ilization

REVISED 2013



2. Patient Pre$entation>

a" -hi$ protocol i$ intended for patient$ who pre$ent with a traumatic

mechani$m of in*ur&.

b" Immobiliation i$ contraindicated for patient$ who ha#e penetratin( trauma who do not ha#e a neurolo(ical deficit.

. Patient ana(ement>

a" %$$e$$ment>

i. %$$e$$ for mental $tatu$) neurolo(ical deficit$) $pinal pain)

tenderne$$) an& e#idence of intoication) or other $e#ere in*urie$.

ii. Ahile maintainin( $pinal ali(nment) eamine the $pine for

tenderne$$ on palpation or deformitie$.

b" -reatment and Inter#ention$>

i. %ppl& cer#ical re$triction if there i$ an& of the followin(>

1. Patient complain$ of nec< pain.

2. %n& nec< tenderne$$ of palpation.

,. %n& abnormal mental $tatu$) includin( etreme a(itation)

or neurolo(ical deficit.

. %n& e#idence of alcohol or dru( intoication

3. -here are other $e#ere or painful in*urie$ pre$ent.

6. %n& communication barrier that pre#ent$ accurate

a$$e$$ment.

Pediatric -reatment Protocol$ 2016 '


80/104

P8/a+r/; S878;+/58 S,/na7 I


81/104


82/104

#uspected Child A(use

REVIEAED 2011



a" %pproach child $lowl& to e$tabli$h rapport ecept in life8threatenin($ituation$") then perform eam

b" -reat ob#iou$ in*urie$ accordin( to appropriate protocol

c" 5enital eam onl& if indicated in the pre$ence of blood)


83/104

Pediatric *rauma

REVISED 2016


2. 4ollow the 'ut8of8Ho$pital -rauma -ria(e De$tination Deci$ion Protocol for the

identification of time critical in*urie$) method of tran$port and trauma facilit&

re$ource$ nece$$ar& for treatment of tho$e in*urie$

,. -he (oal $hould be to minimie $cene time with time critical in*urie$) includin(

e$tabli$hin( IV$ en route.


a" 4ollow Shoc< Protocol if $hoc< i$ pre$ent

?8


84/104

P8/a+r/; Trau


85/104

IOWA EMS TREATMENT PROTOCOLS

Section 4

Appendices

$MS =ut=Fos!ital DootResuscitate Protocol..........................................'

Adult =ut = Fos!ital %rauma %ria*e Destination Decision Protocol...............'E

Pediatric =ut = Fos!ital %rauma %ria*e Destination Decision Protocol..........0

Ph+sician =n Scene........................................................................................ 1

Air Medical %rans!ort......................................................................................2

Discontinuation = Resuscitation....................................................................3

Re!erusion %hera!+ Screenin* ot :imited %o Paramedic :evel...................4

Strate*ies or Re!erusion %hera!+/ Acute Stro,e..........................................6S % A R %.........................................................................................................

Pediatric Ium!S%AR%......................................................................................E

;uidelines or $MS Provider "nitiatin* =r*an G %issue Donation....................E0

;uidelines or $MS Providers res!ondin* to a !atient #ith s!ecial needs......E1

$MS A!!roved A((reviations.........................................................................E2

;uidelines >or e# Protocol Develo!ment.....................................................E3

4


86/104

A,,8n/> A

E"# )ut-o%-ospital .o-0ot-&esuscitate Protocol

Pur,:8- -hi$ protocol i$ intended to a#oid unwarranted re$u$citation b& emer(enc& care pro#ider$ in

the out8of8ho$pital $ettin( for a Bualified patient.i -here mu$t be a #alid 'ut8'f8Ho$pital Do8@ot8

Re$u$citate ''H D@R" order $i(ned b& the Bualified patient;$ attendin( ph&$ician or the pre$ence of the

''H D@R identifier indicatin( the ei$tence of a #alid ''H D@R order.N r8:u:;/+a+/n- ean$ withholdin( an& medical inter#ention that utilie$ mechanical or artificial

mean$ to $u$tain) re$tore) or $upplant a $pontaneou$ #ital function) includin( but not limited to>

1. /he$t compre$$ion$)

2. Defibrillation)

,. E$opha(eal+tracheal+double8lumen airwa&G endotracheal intubation) or

. Emer(enc& dru($ to alter cardiac or re$pirator& function or otherwi$e $u$tain life.

Pa+/8n+ ;r/+8r/a- -he followin( patient$ are reco(nied a$ Bualified patient$ to recei#e no re$u$citation>

1. -he pre$ence of the uniform ''H D@R order or uniform ''H D@R identifier) or 2. -he pre$ence of the attendin( ph&$ician to pro#ide direct #erbal order$ for care of the patient.

-he pre$ence of a $i(ned ph&$ician order on a form other than the uniform ''H D@R order formappro#ed b& the department ma& be honored if appro#ed b& the $er#ice pro(ram ES medical

director. Howe#er) the immunitie$ pro#ided b& law appl& onl& in the pre$ence of the uniform ''H

D@R order or uniform ''H D@R identifier. Ahen the uniform ''H D@R order or uniform ''H

D@R identifier i$ not pre$ent contact mu$t be made with on8line medical control and on8line medical

control mu$t concur that no re$u$citation i$ appropriate.

R85;a+/n> %n ''H D@R order i$ deemed re#o


87/104

A,,8n/> B

R85/:8 201

Adult )ut )% ospital *rauma *riae .estination .ecision Protocol

%he ollo#in* criteria shall (e utilized to assist the $MS !rovider in the identication o time critical in


88/104

A,,8n/> B

R85/:8 201o Patients #ith head inacilit+ need not (e the hi*hest level trauma care acilit+.I% none o% the criteria in the a(ove 4 steps are met %ollow local protocol %or patient disposition8 9hen indou(t transport to nearest trauma care %acilit! %or evaluation8

,or all *ransported *rauma Patients:1. Patient re!ort to include/ M=" "nacilit+ is less than 30 minutes trans!ort to thenearest Resource 8:evel "9 or Re*ional 8:evel ""9 %rauma Care >acilit+. " *reater than 30 minutes *round trans!ort time to Resource8:evel "9 or Re*ional 8:evel ""9 %rauma Care >acilit+ trans!ort to the nearest a!!ro!riate %rauma Care >acilit+. " time can (e saved orlevel o care needs eist tier #ith *round or air A:S service !ro*ram

If step 1 does not apply, move on to step 2

#tep 2 - Assess %or Anatom! o% an Inur!• All !enetratin* inacilit+ is less than 30 minutes trans!ort to thenearest Resource 8:evel "9 or Re*ional 8:evel ""9 %rauma Care >acilit+. " *reater than 30 minutes *round trans!ort time to Resource8:evel "9 or Re*ional 8:evel ""9 %rauma Care >acilit+ trans!ort to the nearest a!!ro!riate %rauma Care >acilit+. " time can (e saved or

level o care needs eist tier #ith *round or air A:S service !ro*ramIf step 2 does not apply, move on to step 3

Step 3 / +onsider echanism o, %n0ur* igh 'nerg* rans,er

• >alls 10 eet or t#o times the hei*ht o thechild

• Fi*hris, auto crash

N "nterior com!artment intrusion includin*roo/ L12 inches occu!ant siteO

N L1 inches an+ siteN $


89/104

A,,8n/> B

R85/:8 201• Auto vs. !edestrian5(ic+clist thro#n run over

or #ith si*nicant 8L20 m!h9 im!act• Motorc+cle crash L20 m!h

%rans!ort to the nearest a!!ro!riate %rauma Care >acilit+ need not (e the hi*hest level trauma care acilit+.

If step 3 does not apply, move on to step 4

#tep 4 - Consider ris' %actors:

• Pre*nanc+ L 20 #ee,s• Anticoa*ulants and (leedin* disorders

QPatients #ith head in


90/104

A,,8n/> C

Ph!sician )n #cene

our offer of a$$i$tance i$ appreciated. Howe#er) thi$ ES $er#ice) under law and in accordance with

nationall& reco(nied $tandard$ of care in Emer(enc& edicine) operate$ under the direct authorit& of aPh&$ician edical Director. 'ur edical Director and ph&$ician de$i(nee$ ha#e alread& e$tabli$hed a ph&$ician8patient relation$hip with thi$ patient. -o en$ure the be$t po$$ible patient care) and to pre#ent

inad#ertent patient abandonment or interference with an e$tabli$hed ph&$ician8patient relation$hip) plea$e

compl& with our e$tabli$hed protocol$.

P78a:8 r85/83 +*8 9773/n4 /9 yu 3/:* + a::u


91/104

A,,8n/> D

Air "edical *ransport

U+/7/a+/n Gu/87/n8: 9r S;8n8 R8:,n:8

-he$e (uideline$ ha#e been de#eloped to a$$i$t with the deci$ion ma


92/104

A,,8n/> E

.I#C)0*I0A*I)0 ), &E##CI*A*I)0

INDICATIONS TO CONSIDER TERMINATION OF RESUSCITATION-

1. Patient i$ in full arre$t with no $i(n$ of life pre$ent.2. Patient i$ con$idered an adult.

,. 4ull %/=S ha$ been in$tituted Paramedic le#el" to include rh&thm anal&$i$ and defibrillation if

indicated) ad#anced airwa& mana(ement) and dru($ (i#en per protocol.

. @o return of circulation or $hoc


93/104

&eper%usion *herap! #creenin 0ot 7imited *o Paramedic

7evel

-hi$ form $hould be completed for patient$ $ufferin( from %cute /oronar& S&ndrome$. -hi$ tool will be u$edto tria(e patient$ to the appropriate recei#in( facilit&) and pro#ide a template for pa$$in( information on to therecei#in( facilit&. 4ibrinol&tic $creenin( ma& be done at the E-8 le#elG howe#er the deci$ion to b&pa$$ a

local ho$pital to tran$port to a Percutaneou$ /oronar& Inter#ention P/I" capable facilit& i$ re$er#ed for the PS

and Paramedic le#el$.

1. If a#ailable) obtain 128=ead E95 and tran$mit to recei#in( facilit&

2. E- le#el : -ran$port patient to clo$e$t appropriate facilit&. /ontact medical control for

deci$ion on completin( thrombol&tic chec

1. /omplete fibrinol&tic therap& chec %uthoried b& #oice contact with medical control) and

-he PS+Paramedic ha$ recei#ed trainin( and ha$ the appro#al of their ph&$ician

medical director

In all in$tance$ tho$e patient$ reBuirin( immediate hemod&namic or airwa& $tabiliation $hould be tran$ported

to the clo$e$t appropriate facilit&.

If S-EI i$ not pre$ent) tran$port patient to clo$e$t appropriate facilit&.

N+8- S88 F/r/n7y+/; C*8;@7/:+ n +*8 9773/n4 ,a48

E2


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#trateies %or &eper%usion *herap!: Acute #tro'e

8$H 20129

Re!erusion %hera!+ Screenin* ot :imited to Paramedic :evel

-hi$ appendi $hould be u$ed for $u$pected acute $tro


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Fibrinolytic Checklist

%n& YES findin($ will be rela&ed to medical control. A:7u+8 Cn+ra/n/;a+/n: preclude the u$e of

fibrinol&tic$. R87a+/58 Cn+ra/n/;a+/n: reBuire con$ultation with medical control.

DATE: PATIENT AGE: MALE FEMALE INCIDENT/EC!D ": #ES N!

A$S!L%TE C!NTAINDICATI!NS

Any known intracranial hemorrhage?

Known structural cerebral vascular lesion?

Ischemic stroke within 3 months EXCEPT acute ischemic stroke within 3 hours?

Susecte! aortic !issection?

Active blee!ing or blee!ing !iathesis "e#clu!ing menses$?

Signi%icant close! hea! trauma or %acial trauma within 3 months?

ELATI&E C!NTAINDICATI!NS

&istory o% chronic' severe' oorly controlle! hyertension?

Severe' uncontrolle! hyertension on resentation "S ()*+mm&g or ,())+mm&g$

&istory o% rior ischemic stroke (3 months' !ementia' or known intracranial athology?

Traumatic or rolonge! "()+ min$ CP- or ma.or surgery "/3 weeks$

0on1comressible vascular unctures?

Pregnancy?

Active etic ulcer?

Current use o% anticoagulants?

EMS Pro'()er Pr(nt Name: S(*nature:

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#imple *riae and &apid *reatment

# * A & *

The %ollowing are gui!elines %or initial tactical triage using the STA-T metho!2 STA-T is most use%ul in initially clearingthe !isaster one where there are numerous casualties2 It fo+uses on resp(rat(on rate, perfus(on, an) menta statusan) ta.es un)er one m(nute to +ompete 4nce the atient moves towar! a higher level o% care "evacuation$' a more!etaile! aroach to triage may be nee!e!2

R8:,/ra+/n:

P8r9u:/n

M8n+a7 S+a+u:

Gr88n M/nr.A


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#imple *riae and &apid *reatment

E'


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Pediatric >ump#*A&*

E


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?uidelines %or E"# Provider Initiatin )ran *issue

.onation

%t the Scene of the Decea$ed

1. %ll appropriate patient care protocol$ will be enacted to a$$ure patient care i$ pro#ided

accordin( to pre#ailin( $tandard$.

2. If re$u$citation effort$ are un$ucce$$ful or if upon arri#al the patient i$ decea$ed and without

indication$ to initiate re$u$citation) then on8line medical direction will be contacted to confirm

that no further medical care i$ to be (i#en.

,. %$ per Iowa /ode 12/.O a medical eaminer or a medical eaminer;$ de$i(nee) peace

officer) fire fi(hter) or emer(enc& medical care pro#ider ma& relea$e an indi#idual;$information to an or(an procurement or(aniation) donor re(i$tr&) or ban< or $tora(e

or(aniation to determine if the indi#idual i$ a donor.

. %$ per Iowa /ode 12/.O an& information re(ardin( a patient) includin( the patient;$ identit&)

howe#er) con$titute$ confidential medical information and under an& other circum$tance$ i$

prohibited from di$clo$ure without the written con$ent of the patient or the patient;$ le(alrepre$entati#e.

3. %t lea$t one ES pro#ider $hould remain at the $cene until the appropriate authorit& medicaleaminer) funeral home) public $afet&) etc." i$ pre$ent.

6. /ontact I'A% D'@'R @E-A'R9 at ?008?,181,1

EE


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Appendi5 @

?uidelines %or E"# Providers respondin to a patient

with special needs

'T*/: Pr+;7 /: n+ /n+8n8 9r /n+8r9a;/7/+y +ran:98r:(

-he$e (uideline$ $hould be u$ed when an ES pro#ider) re$pondin( to a call) i$ confronted with a patient

u$in( $pecialied medical eBuipment that the ES pro#ider ha$ not been trained to u$e) and the operationof that eBuipment i$ out$ide of the ES pro#ider;$ $cope of practice. -he ES pro#ider ma& treat and

tran$port the patient) a$ lon( a$ the ES pro#ider doe$n;t monitor or operate the eBuipment in an& wa&

while pro#idin( care.

Ahen pro#idin( care to patient$ with $pecial need$) ES per$onnel $hould pro#ide the le#el of care

nece$$ar&) within their le#el of trainin( and certification. Ahen po$$ible) the ES pro#ider $hould

con$ider utiliin( a famil& member or care(i#er who ha$ been u$in( thi$ eBuipment to help withmonitorin( and operatin( the $pecial medical eBuipment if nece$$ar& durin( tran$port.

Some eample$ of $pecial medical de#ice$>

• P/% patient controlled anal(e$ic"

• /he$t -ube

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Appendi5 7

E"# APP&)+E. A&E+IA*I)0# (eoreAC air#a+ (reathin*

circulation

A:S advanced liesu!!ortAM" acute m+ocardial

inarctionam!s am!ulesASA as!irinA% atrial tach+cardiaA@ atrioventricular(icar( sodium(icar(onate"D t#ice a da+:S (asic lie su!!ortP (lood !ressure

S (lood su*ar

#ith

CAD coronar+ arter+disease

CC chie com!laintcc cu(ic centimeterCC) coronar+ care unitCF com!lete heart(loc,CF> con*estive heart

ailurecm centimeter

CS central nervouss+stemc5o com!lains o C= car(on monoideC02

car(on dioideC=PD chronic

o(structive!ulmonar+disease

CPR cardio!ulmonar+resuscitation

CS> cere(ral s!inal

uidC@A cere(ral vascular

accidentD5C discontinueD=A dead on arrivalD&H &? detrose in#aterD dia*noses

$D emer*enc+de!artment

$T;5$C; electrocardio*ram

$!i e!ine!hrine$R emer*enc+ room$% endotracheal$%=F alcohol( (rillation uid racture;" *astrointestinal*m *ram*r *rain*t8t9 dro!8s9hhr hourh histor+

"C) intensive care unit"M intramuscular"@ intravenousT* ,ilo*ramT@= ,ee! vein o!en: liter:=C level oconsciousness:R lactated rin*ers*tt microdri!MD medical doctorm$ millieuivalentsm* milli*ramM" m+ocardialinarctionmin minuteml millilitermm millimeterMS mor!hine sulateaC" sodium chlorideaFC=3 sodium(icar(onate;5; naso*astricnitro nitro*l+cerineP= nothin* (+ mouthS normal salineSR normal sinusrh+thm%; nitro*l+cerine02 o+*en= o(stetrics=D overdose=R o!eratin* roomP !ulse! ater

PAC !remature atrialcontraction

PA% !aro+smal atrial

tach+cardiaPCR !atient carerecordP$ !h+sical eam

!ulmonar+ edema!edi !ediatric

P$R: !u!ilseual reactive toli*ht

PIC !remature


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Appendi5 7

?uidelines %or 0ew Protocol .evelopment

A rational decision making process*Can also be sed to evalate e!isting protocols

a


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2016 EMS Protocols IOWA

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