Medical Scene Safety Protocol Verify Scene Safety with Police or Dispatch UNKWN Scene Safe? Enter Continue to Appropriate Protocol Possible to Make Safe Make Safe Then Continue Exit Area and Stage Outside Agencies Needed Stay Staged Contact Agency and Wait Contact EMS with Update Document Time and Events
Chest Pain Protocol Pt. C/O Chest Pain 100% O 2 via Nasal Cannula (4 lpm) Obtain Vital Signs Is Pain Suggestive of Cardiac / Heart Pain? (no change on movement, deep breaths or palpation) Continue with treatment and update EMS Right Person Right Medication Right Dosage Right Time Right Route Right Documentation (Time, dose, route, effect) 6 Rights of Medication -Pt. Supine position Assist w/ Patient Medication. Max 3 Doses Nitro Contraindications - BP < 100 Systolic - Pulse < 60 bpm - Viagra/Levitra < 24 hrs - Cialis < 48 hrs Contraindications Give 2 X 80mg Chewable ASA if no contraindications -Asthma - Allergic to ASA - Recent Significant Bleeding Contact with Update EMS On- Scene Assist EMS Recheck Vitals q5min Document Time and Events
Anaphylaxis Protocol Pt. Presents with Severe Allergic Reaction 100% O 2 via NRB (10-12 lpm) Pt. In Respiratory Distress Plus one of the following -Hives - Tongue Swelling -Throat Swelling -Previous Reaction Epi Pen Available? Prepare EPI-PEN Jr. Pt. > 12 y/o Prepare EPI-PEN 6 Rights of Medications Right Person Right Medication Right Dosage Right Time Right Route Right Documentation (Time, dose, route, effect) Document Time and Events Remove Safety Cap Place injection tip against outer thigh & push auto injector firmly against thigh quick motion You should hear a click, hold for 10 sec Remove epinephrine auto-injector and send to hospital w/ patient. Monitor ABC s and Vitals until arrival
Diabetic Reaction Protocol Pt. conscious and known diabetic Primary and Secondary Survey plus Vitals Patient is diabetic symptoms and/or states they feel like their sugars are low Monitor ABC s and Vital Signs Give pt. half tube of oral glucose, sugar and water or something sweet to eat or drink ***gag reflex must be present Go to appropriate protocol Provide Oxygen Monitor ABC s and Vitals Document Time and Events
Cardiac Arrest Protocol Patient Presents with No Pulse and No Respirations Do Not Resuscitate conditions met? Start CPR Suspend treatment Defibrillator Available? Continue CPR and Pt > 1 y/o Pt. > 8 y/o Attach Adult Pads Assess Rhythm Shock Advised? Attach Pedi Pads if available, if not use Adult/Child Pads Shockable Rhythm Non-Shockable Rhythm Clear pt.- ANALYZE 1 Shock ** Only 1 shock if pt. Hypothermic/ check pulse for 45 sec. Immediately Resume CPR 30:2* for 2 Min CPR 30:2* Immediately Resume CPR 30:2* for 2 Min Repeat steps until EMS arrives or Shock Indicated Continue CPR until EMS arrives *PLEASE TE Repeat Steps till EMS arrives or No Shock Indicated Child & Pediatric CPR cycle consists of 30 compressions (1 rescuer) or 15 compressions (2 rescuers) per 2 breaths Document Time and Events
Respiratory Arrest Protocol Pt. presents not breathing Airway Opened with appropriate maneuver Breathing Absent? Attempt to ventilate X2 Pt. tolerates OPA? Continue with Primary Survey Continue with Manual Airway Technique Go to Choking protocol Air Goes In? Check if pulse present Goto Cardiac Arrest Protocol Document Time and Events Insert OPA Does Pt Tolerate OPA? Continue with Manual Airway Technique Ventilate Pt Adult- every 5 sec Child- every 3 sec Check for pulse after 1 min and every few minutes
Choking Adult/Child Protocol Pt. presents with signs of choking Pt. unable to breath, cough or speak? Encourage pt. to continue to cough Document Time and Events Deliver 5 back blows / 5 abdominal thrusts Airway cleared? Monitor ABC s and check vital signs Pt. conscious? Tongue jaw lift Look into mouth Finger sweep only if FBAO visible ADULT Lower pt. to ground CHILD Tongue jow lift Look into mouth Finger sweep only if FBAO seen Start CPR Start CPR FBAO Relieved? Pt Breathing on own? FBAO Relieved? Goto Resp arrest protocol Monitor Vital Signs and ABC s
Choking Infant Protocol Infant < 1yr presents unable to breathe, cough or cry 5 chest compressions with 2 fingers Conscious? Look into mouth and sweep only if FBAO seen 5 back blows Position head in sniffing position and ventilate Repeat until FBAO is relieved or pt. goes unconscious Give 2 nd breath Air goes in? Document Time and Events Check Pulse Give 30 chest compressions with 2 fingers Goto Cardiac Arrest protocol Is there a pulse? Is pt. breathing on own? Goto Respiratory Arrest Protocol Monitor ABC s and Vital Signs
Do Not Resuscitate Protocol Patient presents in Cardiac Arrest Are any of the following circumstances present: - DNR order present signed by Doctor? - Decapitation? -Rigor Mortis? -Lividity? -Gross Evisceration? -Incineration? -Transection? -Decomposition? Go to Cardiac Arrest Protocol Do Not Resuscitate or Cease resuscitation efforts Document Time and Events
Trauma with Suspected C-spine Injury Protocol Mechanism of Injury suspect of c-spine injury Scene Safe/ Stable? Prepare for Emergency Rapid Extrications Manual c-spine taken by one rescuer Manual c-spine taken by one rescuer Second rescuer complete primary and secondary survey Pt. placed on long spine board Continue to hold c-spine until EMS arrives EMS Request pt immobilization Pt. moved to safer location With c-spine held move pt. onto long spine board Document Time and Events Strap patient s body to long spine board Put on head immobilizers and secure head Monitor Vital Signs and ABC s
Opioid Protocol Pt. Presents unconscious & not responding to verbal stimuli Evidence of Opiate use Pt. In Respiratory Distress No detectable breathing or poor respiratory effort Bystander Information Drug Paraphernalia Known History Pinpoint Pupils Other Opioid use indications Naloxone Kit Avaialable? Prepare syringe, Draw entire vial of Naloxone. Depress plunger to remove air. Known Naloxone Alergy **PATIENT MAY RESPOND VIOLENTLY** Place patient in recovery position Right Person Right Medication Right Dosage Right Time Right Route Right Documentation (Time, dose, route, effect) 6 Rights of Medications Inject at 90 o angle into shoulder or thigh. Document Time and Events Repeat in 3-5 minutes if no or minimal responsiveness. Send used kit to hospital w/ patient. Monitor ABC s and Vitals until arrival Approved and Added Oct 19/2017