Sample Medical Emergency Response Protocol

Emergency Preparedness Policies and Procedures

Practice Name: SAMPLE

Practice Address: _________________________________

_________________________________

Doctor’s Name: _________________________________

Preface for ALL STAFF:

Dear Staff Members:

Please take some time to review this manual. Periodic training will be provided on the protocols outlined in this manual. The most important aspect in any training is repetition. Our goal is to practice to perfection so that, in the event of an emergency, all we have to do is execute. By repetition, execution will be smooth and efficient.

If you have any questions at all, please feel free to approach

_____________________________ (Doctor’s Name), and I will gladly review any areas to

assure you feel competent and confident.

Emergency Preparedness Officer:

_____________________________________(Doctor’s Name)

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Sample Medical Emergency Response Protocol

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Sample Medical Emergency Response Protocol

SUMMARY LIST OF EMERGENCY DRUGS(KIT LOCATED IN CRASH CART/MEDICAL EMERGENCY KIT)

Health First SM30 Emergency Kit For Adult and Children

Nitroglycerin spray 0.4mg/spray 60 doses (x1) Epinephrine auto-injector - pediatric 0.15mg (x1) Epinephrine auto-injector - adult 0.3mg (x1) Auto-injector training unit (x1) Back-up epinephrine 1:1000 1mg/1mL, 1mL (x2) Diphenhydramine 50mg/1mL, 1mL (x2) Albuterol inhaler (x1) Ammonia inhalants (x3) Oral glucose gel (x1) Aspirin 2 - pack (x2) Naloxone HCl nasal spray (x2) Syringes 1cc with 20G x 1.5 in needle (x2) - to draw up medications and provide IM injections CPR shield (x1) Medication instructions (x1)

Additional if administering Level 1 Minimal Oral Sedation in Office

Flumazenil 0.1mg/ml, 10 ml (x1)

***Auto-Replenishment Service is arranged upon expiration date***

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Sample Medical Emergency Response Protocol

Nausea and Vomiting

Nausea may be caused by: Empty stomach Nitrous oxide Sedation medications

---------------------------------------------------------------------------RESPONSE if due to empty stomach:

1. Give pt popsicle or juice to get sugar levels up2. Re-evaluate

-----------------------------------------------------------------------------------------------RESPONSE if due to nitrous oxide:

1. Turn nitrous oxide off2. Administer 100% oxygen for 5-10 minutes3. If no improvement, give juice or popsicle to get sugar levels up

-----------------------------------------------------------------------------------------------RESPONSE if due to sedation medications:

1. Turn patient sideways2. Chin down, suction airway3. Administer 100% oxygen4. If no improvement, may be possible aspiration (see aspiration guide)

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Sample Medical Emergency Response Protocol

Acute Asthma Attack (Bronchospasm)

Signs: Shortness of Breath Wheezing Coughing Chest tightness Cyanosis Tachycardia

RESPONSE1. Sit upright or in comfortable position2. Administer oxygen3. Administer bronchodilator 4. If bronchodilator ineffective or the patient loses consciousness, activate

EMS response and administer epinephrine

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Sample Medical Emergency Response ProtocolAirway Obstruction

Signs a patient is experiencing airway obstruction: Agitation Turning blue Confusion Difficulty Breathing Wheezing Retractions Unconscious

RESPONSE

1. Place patient in supine position 2. Clear airway manually 3. Administer oxygen via Bag Valve Mask to take over breathing4. If condition doesn’t improve, activate EMS response5. Continue attempting airway rescue using appropriate airways if needed

until EMS arrives

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Sample Medical Emergency Response ProtocolChange in Intended Sedation Level

Signs a patient is beyond moderate sedation:- No response to verbal commands- Responds purposefully to tactile/painful stimulation only after

multiple repeated painful stimulation- Eyes appear to roll back- Oxygen desaturation

RESPONSE – GOOD AIRWAY IS MOST IMPORTANT

1. Turn OFF Nitrous, flush bag and fill with 100% Oxygen2. Jaw thrust and chin tilt while delivering oxygen3. Attempt painful stimulation (posterior mandible pressure)4. If pt appears to become more easily arousable, continue with Oxygen5. If pt continues to appear deeply sedated, maintain airway, administer

reversal agents, monitor recovery 2 hours after6. Ensure no objects obstructing airway7. Continue Oxygen, and add positive pressure if necessary8. If no improvement or patient stops breathing on their own, USE AMBUBAG

to administer oxygen and activate EMS Response

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Sample Medical Emergency Response Protocol

LaryngospasmLaryngospasm is when a person’s throat (larynx) goes into spasm and doesn’t allow oxygen to go to lungs. Most laryngospasms can be broken with airway positioning and positive pressure oxygen.

Signs of laryngospasm: Increased effort to breathe Oxygen desaturation Possible bradycardia (decreased heart rate) Tracheal tug Inspiratory wheezing

RESPONSE1. Clear airway of debris2. Open the airway, perform mandible pull 3. Use positive pressure (BVM) oxygen (100%) to break spasm4. If no improvement, activate EMS response 5. Continue attempting airway rescue until EMS arrives

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Sample Medical Emergency Response ProtocolUrticaria (Mild Allergy)

Signs of Urticaria:- Itchy, raised skin- Hives- Swelling

RESPONSE Urticaria1. Discontinue all sources of allergens2. Diphenhydramine (Benadryl) age appropriate dose3. If no improvement, administer epinephrine OR if sedation meds on board,

MUST administer EPI as Benadryl will increase depth of sedation4. If no improvement, activate EMS response

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Sample Medical Emergency Response ProtocolAnaphylaxis

Signs of Anaphylaxis:- Flushing- Wheezing- Difficulty breathing- Bronchospasm- Laryngeal edema- Weak pulse- Low blood pressure- Unconscious

Anaphylaxis is a severe allergy and requires IMMEDIATE action, otherwise the airway may swell up, close, and impede breathing

RESPONSE Anaphylaxis1. Supine position, clear airway2. Oxygen, may be necessary to ventilate manually3. Administer epinephrine4. Administer diphenhydramine (Benadryl) IM5. Activate EMS response6. CPR if necessary until EMS arrives

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Sample Medical Emergency Response ProtocolSyncope – Fainting

AIRWAY #1 CONCERN

Signs:- Feeling warmth- Skin moist/pale- At first rapid pulse, then slow and weak- Dizziness- Hypotension- Cold extremities- Nausea- Vomiting- Unconscious

RESPONSE 1. Lay patient supine to manage airway2. Open airway for patency3. Ammonia inhalant4. Administer supplemental oxygen5. Cold towel on back of neck6. Positive pressure ventilation, if necessary 7. Assess vitals8. Elevate feet9. If no improvement, activate EMS response

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Sample Medical Emergency Response Protocol

Convulsions – Seizure

The most important thing to remember is to keep patient safe and prevent self-injury. Most seizures will not last very long.

Signs:- Warning aura- Disorientation- Blinking- Blank stare- Uncontrolled muscle movement- Dizziness/Confusion

RESPONSE 1. Maintain airway, suction after the convulsion2. Prevent patient from biting tongue, protect your hands3. If status epilepticus or lasting > 5 min, administer diazepam, call 9114. Activate EMS Response

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Sample Medical Emergency Response Protocol

Angina Pectoris (Chest Pain)Chest pain in an adult can indicate several things, but the most important/ominous is that it can be an early sign of impending myocardial infarction (heart attack).

Signs: Chest pain that is significant but not severe (can last up to 20 min) Chest fullness Burning Tightness Dyspnea diaphoresis Typically not the patient’s first time experiencing this type of pain

RESPONSE1. Stop the procedure2. Semi-reclined position, ACTIVATE EMS response3. Note time of onset4. Nitroglycerin sublingually, repeat if necessary5. Provide supplemental oxygen if necessary6. Continue to attempt to stabilize patient until EMS arrives

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Sample Medical Emergency Response ProtocolAspiration (contents in lung)

Signs of aspiration: - Coughing- Difficulty breathing- Choking

RESPONSE:1. Turn sideways, evaluate airway, suction throat2. Heimlich if actively choking3. If unable to obtain contents from airway, administer 100% oxygen4. Activate EMS Response5. If patient becomes unconscious, gently lay on floor, initiate CPR and

continue until EMS arrives

*If a dental instrument, crown, or other item is lost in oropharynx and item cannot be located, send patient to nearest medical facility with radiology capabilities for chest radiograph.

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Sample Medical Emergency Response Protocol

Hyperventilation (Panic attack)

Signs of hyperventilation: Rapid breathing, deep at first, then shallow Increased heart rate (tachycardia) Palpitations Weakness Feeling of “tight” chest Dizziness

RESPONSE1. Terminate procedure2. Position for comfort3. Calm patient, attempt to slow breathing by having them focus on a pen

light or counting breaths4. Have patient breathe in and out while cupping their hands around their

mouth.5. DO NOT administer oxygen!!!6. If no improvement, activate EMS response

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Sample Medical Emergency Response ProtocolHypertension (High Blood Pressure)

Signs of Hypertension High blood pressure

RESPONSE1. Position patient for comfort2. Monitor vital signs3. Administer oxygen4. Consider administering nitrous oxide5. If no improvement, activate EMS response

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Sample Medical Emergency Response Protocol

Hypotension (Low Blood Pressure)Signs of hypotension

Fatigue Dizziness Lightheaded Nausea Clamor Blurry vision Unconscious

RESPONSE1. Lay supine to manage airway2. Open airway – keep patent3. Administer supplemental O24. Positive pressure ventilation, if necessary5. Assess blood pressure and pulse6. Elevate feet7. If no improvement, activate EMS response8. BLS protocols until EMS arrival

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Sample Medical Emergency Response Protocol

Hypoglycemia (Low Blood Sugar)Signs of hypoglycemia:

Excess sweating Hunger Lightheaded Feels faint Shaky Slurs speech Unconscious (passing out)

RESPONSE – Conscious patient1. Administer glucose tablets, one tube of glucose gel or juice/soda 2. Evaluate response3. If unimproved, activate EMS response

RESPONSE – Unconscious patient1. Activate EMS response immediately2. DO NOT GIVE INSTAGLUCOSE – it can clog airway3. BLS protocols until EMS arrival

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Sample Medical Emergency Response ProtocolSudden Cardiac Arrest (Stopped

Breathing)Signs:

Unconscious and without a pulse

RESPONSE1. Activate EMS response immediately2. Initiate rapid defibrillation of the heart using an AED3. Early BLS protocols

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Sample Medical Emergency Response Protocol

Myocardial Infarction (Heart Attack)Signs of Hypertension

- Radiating pain down left side of body- Pain in upper chest- Pain between shoulder blades- Pain in back- Pain in jaw (mandible)- Pain in arm- Impending sense of doom

RESPONSE – INITIATE BLS/ACLS protocol1. Medical assistance, call 9112. Note time of onset3. Record vitals4. Chewable aspirin 4x81 mg 5. Be prepared for CPR

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Sample Medical Emergency Response Protocol

EMS RESPONSE

1. In event of ANY emergency, get Doctor’s attention immediately.2. STAY CALM3. Doctor will ASSIGN ROLES – very important to follow role

assigned.

ROLES & Duties

EMS activator Calls 911, serves as communication liaison

Drugs Retriever Retrieves and draws medications as doctor instructs

Airway Manager Assures that patient’s airway is patent

AED Retriever Gets AED, clears field, and preps patient’s chest for AED

Recorder Records time based record of sequence of events, drugs administered, and vital signs

EMS Liaison Clear hallways and rooms for EMS access

4. Once Doctor has assigned roles, proceed to follow duties assigned to that role

5. After airway management and drug options have been exhausted, CPR may need to be initiated.

6. If patient progresses past CPR sequence, then chest compressions initiated, and Doctor + Airway manager will switch off compression roles

*ALWAYS USE CLINICAL JUDGMENT: IF DR NOT IN IMMEDIATE VICINITY AND YOU RECOGNIZE AN EMERGENCY, PROCEED WITH RESCUE PROTOCOL.

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Sample Medical Emergency Response Protocol

CPR Tips

IF you identify a patient in distresso Yell for HELP, check pulse while attempting to engage

patiento If no pulse, initiate CPR

IF EVER respiratory rate or heart rate = ½ resting rates, BEGIN CPR with airway/BVM and chest compressions

Head tilt-chin lift to open airway unless cervical spine injury suspected – CAUTION against hyperextending infant necks

Cardiac arrest with agonal gasps BEGIN CPR

Adult with chest pain – CALL 911

Proper technique: Good rate, depth, and full chest recoil

No pulse CHEST COMPRESSIONS immediately

Earlier defibrillation = Higher survival rate

If choking victim becomes unresponsive lay on floor, initiate CPR, check for object between breathso NO MORE HEIMLICH once unconsciouso NO BLIND FINGER SWEEPS

Minimize interruptions between compressions

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Sample Medical Emergency Response ProtocolCALLING 911

REMAIN CALM

Give location (office address)

Give phone number (identify land line or cell phone)

Inform operator of medical emergency

Inform whether patient is conscious or unconscious

Details of incident

Explain current intervention

Inform operator who the assigned EMS liaison is and best route into facility

Ask how long for EMS to arrive

Stay on phone until instructed otherwise

Inform Doctor of any pertinent updates

MEET EMS personnel at designated entrance with EMERGENCY TREATMENT

RECORD and convey all pertinent information

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Sample Medical Emergency Response Protocol

Compression to Ventilation Ratios

Age Single Rescuer

Two Rescuer

Hand Placement

Compression Depth

Adult 30:2 30:2 2 Hands Lower ½ of breastbone (sternum)

At least 2 in (5 cm)

Child (1-8) 30:2 15:2 2 hands or 1 on lower ½ of breastbone

At least 1/3 A-P diameter of chest~(2 in or 5 cm)

Infant (<1) 30:2 15:2 1 rescuer: 2 fingers center of chest below nipple line2 rescuers: 2 thumbs encircling hands in center of chest below nipple line

At least 1/3 A-P diameter of chest ~(1.5 in or 4 cm)

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Sample Medical Emergency Response Protocol

Emergency Treatment RecordPt Name: ______________________ Date: ___________ Time: __________

Pt Age: ______________________ Pt Weight: ______________________

Pt Gender: ______________________ Allergies: ______________________

Meds taken/administered prior to emergency: ________________________________________

Time BP Pulse RR O2 Sat O2 Flow L/min

Meds Administered

Med Dosage

Med Route

Time Called 911: _______________________ Time EMS Arrived: _____________________

Hospital transported to: __________________________________________________________

Condition of pt at time of transportation: ____________________________________________

EMS Personnel: _________________________________________________________________

Office staff present: _____________________________________________________________

Name of Recorder: __________________________ Date: __________________________

Signature: __________________________

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Sample Medical Emergency Response Protocol

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