reglab/statecodes huggingface dataset:
New Jersey Administrative Code › Title 8 - HEALTH › Chapter 41 - ADVANCED LIFE SUPPORT SERVICES; MOBILE INTENSIVE CARE PROGRAMS, SPECIALTY CARE TRANSPORT SERVICES AND AIR MEDICAL SERVICES › Subchapter 3 - GENERAL ADMINISTRATIVE, CREWMEMBER AND VEHICLE REQUIREMENTS › Section 8:41-3.24 - Advertising restrictions

Current through Register Vol. 56, No. 14, July 15, 2024
(a) No provider shall
				advertise or represent that it provides any health care services other than those
				services for which it is licensed.
(b)
				Mobile intensive care programs, specialty care transport services and air medical
				services may advertise under generic headings such as "Ambulances" in the Yellow
				Pages( and similar publications. The actual advertisement under such a generic
				heading shall clearly advertise only those services for which the provider is
				licensed.
(c) Advertisements by
				specialty care transport services shall not give the impression that the provider is
				capable of providing emergency medical services and shall be void of any word or
				expression indicating emergency medical services, including, but not limited to,
				"Emergency," "9-1-1," or "Emergency Response."
(d) The words "24-hour service," "Immediate
				Response," "Eliminate Delay" or similar expressions shall appear in advertisements
				only if the provider is capable of providing continuous, around-the-clock answering
				of telephone requests for service by a person qualified to:
1. Promptly summon crewmembers (if necessary);
				and/or
2. Dispatch assistance.
New Jersey Administrative Code › Title 8 - HEALTH › Chapter 41 - ADVANCED LIFE SUPPORT SERVICES; MOBILE INTENSIVE CARE PROGRAMS, SPECIALTY CARE TRANSPORT SERVICES AND AIR MEDICAL SERVICES › Subchapter 4 - SPECIFIC VEHICLE AND EQUIPMENT REQUIREMENTS: SCTUS, AMUS AND TRANSPORT-APPROVED MICUS › Section 8:41-4.1 - Patient compartment safety

Current through Register Vol. 56, No. 14, July 15, 2024
(a) The interior of the
				vehicle shall be designed for the safety of patients and crewmembers and the patient
				compartment shall have the following safety features:
1. There shall be no protruding edges;
2. Exterior corners (corners that point-out) shall
				be rounded or covered with a padded material;
3. The ceiling shall be finished with a padded
				material or with a flat, even and unbroken surface;
4. The floor shall have a flat, even, unbroken and
				impervious surface and shall be covered with a slip resistant material;
5. Any seats with under seat storage shall have a
				positive latching mechanism that holds the seat closed;
6. All cabinet doors, except a sliding door, shall
				have a positive latching mechanism that shall hold the door securely closed and
				shall prevent the contents of the cabinet from pushing the door open from the
				inside;
7. All equipment and supplies
				carried on the vehicle shall be stored in a crashworthy manner (that is, they shall
				remain firmly in place and shall not present a hazard to any vehicle occupant in the
				event of an accident or sudden change in vehicle speed or direction). There shall be
				sufficient cabinets and other storage spaces within the vehicle so as to meet this
				requirement. Crashworthy retention systems shall not incorporate rubber straps,
				"shock cords" or Velcro[R] type closures.
i. While
				the vehicle is in motion, all transport device accessories such as IV poles and
				monitor trays shall be installed per manufacturer's guidelines and utilized per
				manufacturer's standards and safety recommendations. All equipment shall be secured
				to these devices while being utilized; and
8. The bench seats in all vehicles manufactured
				after July 1, 2002 shall have a passive barrier at the forward end of the
				bench.
New Jersey Administrative Code › Title 8 - HEALTH › Chapter 41 - ADVANCED LIFE SUPPORT SERVICES; MOBILE INTENSIVE CARE PROGRAMS, SPECIALTY CARE TRANSPORT SERVICES AND AIR MEDICAL SERVICES › Subchapter 4 - SPECIFIC VEHICLE AND EQUIPMENT REQUIREMENTS: SCTUS, AMUS AND TRANSPORT-APPROVED MICUS › Section 8:41-4.3 - Vehicle heater/air conditioner

Current through Register Vol. 56, No. 14, July 15, 2024
(a) Each vehicle shall
				have a functional heater and air conditioner:
1.
				When the outside temperature is below 65 degrees Fahrenheit, the heater shall,
				within 20 minutes after initial engine start up, provide an inside ambient patient
				compartment temperature of 68 to 72 degrees Fahrenheit.
2. The air conditioner shall, within 45 minutes
				after engine start up, provide an inside ambient patient compartment temperature of:
i. Sixty-eight degrees to 72 degrees Fahrenheit
				when the outside temperature is between 75 and 85 degrees Fahrenheit; and
ii. At least 13 degrees Fahrenheit below the
				outside temperature when the outside temperature is over 85 degrees Fahrenheit.
New Jersey Administrative Code › Title 8 - HEALTH › Chapter 41 - ADVANCED LIFE SUPPORT SERVICES; MOBILE INTENSIVE CARE PROGRAMS, SPECIALTY CARE TRANSPORT SERVICES AND AIR MEDICAL SERVICES › Subchapter 4 - SPECIFIC VEHICLE AND EQUIPMENT REQUIREMENTS: SCTUS, AMUS AND TRANSPORT-APPROVED MICUS › Section 8:41-4.4 - Vehicle chassis, body and components (SCTUs and transport-approved MICUs only)

Current through Register Vol. 56, No. 14, July 15, 2024
(a) The motor vehicle
				chassis, body and components shall be standard commercial products and shall comply
				with all Federal Motor Vehicle Safety Standards (FMVSS) and Federal regulations
				applicable or specified for the year of manufacture.
(b) The curb weight and payload weight shall not
				exceed the gross motor vehicle weight rating as determined by the
				manufacturer.
(c) Tires shall be
				appropriate for the gross vehicle weight of the vehicle and shall not be damaged or
				have excessive tread wear. Radial and non-radial tires shall not be mixed on the
				vehicle.
(d) The completed/modified
				vehicle's center of gravity shall be within the parameter recommended by the chassis
				manufacturer.
(e) All seats shall comply
				with
				49 C.F.R.
				571.207 (FMVSS No. 207). Automotive safety belts
				and anchorages for seats shall comply with
				49 C.F.R.
				571.208, 209 and 210 (FMVSS Nos. 208, 209 and
				210).
(f) All glazing shall comply with
				49 C.F.R.
				571.205 (FMVSS No. 205).
(g) The provider shall, with the approval of the
				Department, permanently assign a unique nonduplicated recognition number to each
				vehicle. The recognition number shall consist of at least one, but not more than
				six, characters. For the purpose of this paragraph, a character shall mean either an
				Arabic number, an Arabic letter, a space or a dash. At least one of the characters
				in the recognition number shall be either an Arabic letter or Arabic number.
New Jersey Administrative Code › Title 8 - HEALTH › Chapter 41 - ADVANCED LIFE SUPPORT SERVICES; MOBILE INTENSIVE CARE PROGRAMS, SPECIALTY CARE TRANSPORT SERVICES AND AIR MEDICAL SERVICES › Subchapter 4 - SPECIFIC VEHICLE AND EQUIPMENT REQUIREMENTS: SCTUS, AMUS AND TRANSPORT-APPROVED MICUS › Section 8:41-4.5 - Vehicle carbon monoxide concentrations (SCTUs and transport-approved MICUs only)

Current through Register Vol. 56, No. 14, July 15, 2024
(a) In order to minimize
				the amount of carbon monoxide, noxious gases, diesel exhaust, fumes and contaminants
				entering the vehicle:
1. The vehicle exhaust
				system, as well as the vehicle exterior, doors, windows and related gaskets shall be
				in good condition and free of leaks; and
2. The vehicle exhaust system shall extend beyond
				the sides of the vehicle and away from the fuel tank filler pipes and
				doors.
New Jersey Administrative Code › Title 8 - HEALTH › Chapter 41 - ADVANCED LIFE SUPPORT SERVICES; MOBILE INTENSIVE CARE PROGRAMS, SPECIALTY CARE TRANSPORT SERVICES AND AIR MEDICAL SERVICES › Subchapter 4 - SPECIFIC VEHICLE AND EQUIPMENT REQUIREMENTS: SCTUS, AMUS AND TRANSPORT-APPROVED MICUS › Section 8:41-4.6 - Guide dogs

Current through Register Vol. 56, No. 14, July 15, 2024
In accordance with the New Jersey Law Against Discrimination,
				  10:5-1 et seq., seeing-eye dogs,
				  service dogs, hearing ear dogs, companion dogs and/or guide dogs trained by a
				  recognized agency or school to assist a blind, handicapped or hearing impaired
				  person shall be permitted on any MICU, SCTU or AMU where their presence is necessary
				  to perform the duties for which they are trained.
New Jersey Administrative Code › Title 8 - HEALTH › Chapter 41 - ADVANCED LIFE SUPPORT SERVICES; MOBILE INTENSIVE CARE PROGRAMS, SPECIALTY CARE TRANSPORT SERVICES AND AIR MEDICAL SERVICES › Subchapter 5 - RESEARCH PROPOSALS › Section 8:41-5.1 - Research proposals

Current through Register Vol. 56, No. 14, July 15, 2024
(a) As utilized in this
				subchapter, the following terms are defined as follows:
1. "Research" means a scientific investigation
				designed to establish facts and to analyze their significance, including:
i. Any study directed at systemizing data related
				to the causes, mechanisms, diagnosis and treatment of injuries;
ii. Data collection for purposes other than EMS
				management or evaluation; and
iii. Any
				other utilization of EMS client data, unless specifically authorized by this
				chapter;
New Jersey Administrative Code › Title 8 - HEALTH › Chapter 41 - ADVANCED LIFE SUPPORT SERVICES; MOBILE INTENSIVE CARE PROGRAMS, SPECIALTY CARE TRANSPORT SERVICES AND AIR MEDICAL SERVICES › Subchapter 6 - ADMINISTRATION AND STORAGE OF MEDICATIONS › Section 8:41-6.1 - Medications and therapeutic agents

Current through Register Vol. 56, No. 14, July 15, 2024
(a) The following
				medications and therapeutic agents are approved for utilization by ALS crewmembers.
				Each vehicle shall be equipped with the following medications and therapeutic agents
				in sufficient quantities to allow for the administration of therapeutic doses of the
				medication or agent:
1. Acetylsalicylic
				acid;
2. Adenosine;
3. Atropine Sulfate;
4. Benzodiazapine agent, either Ativan and/or
				Valium;
5. Calcium Chloride;
6. Dextrose, 50 percent;
7. Dextrose (5 percent in water, 10 percent in
				water and 25 percent in water);
8.
				Diphenhydramine Hydrochloride;
9.
				Dopamine Hydrochloride;
10. Epinephrine
				1:1,000 solution;
11. Epinephrine
				1:10,000 solution;
12.
				Furosemide;
13. Lidocaine
				Hydrochloride;
14. Magnesium
				Sulfate;
15. Morphine Sulfate;
16. Naloxone Hydrochloride;
17. Nitroglycerin;
18. Normal saline solution;
19. Oxygen;
20. Ringer's lactate solution;
21. Thiamine; and
22. At least one of the following:
i. Albuterol solution for inhalation;
ii. Isoetharine solution for inhalation;
				or
iii. Metaproterenol solution for
				inhalation.
New Jersey Administrative Code › Title 8 - HEALTH › Chapter 41 - ADVANCED LIFE SUPPORT SERVICES; MOBILE INTENSIVE CARE PROGRAMS, SPECIALTY CARE TRANSPORT SERVICES AND AIR MEDICAL SERVICES › Subchapter 6 - ADMINISTRATION AND STORAGE OF MEDICATIONS › Section 8:41-6.2 - Applicability of laws, rules and/or regulations

Current through Register Vol. 56, No. 14, July 15, 2024
(a) All providers and
				crewmembers shall be subject to all applicable laws, rules and/or regulations
				regarding the control and administration of medications, controlled dangerous
				substances and medical waste.
(b)
				Policies and procedures regarding the disposal of hypodermic needles and syringes
				shall be in accordance with all applicable laws, rules and/or regulations.
New Jersey Administrative Code › Title 8 - HEALTH › Chapter 41 - ADVANCED LIFE SUPPORT SERVICES; MOBILE INTENSIVE CARE PROGRAMS, SPECIALTY CARE TRANSPORT SERVICES AND AIR MEDICAL SERVICES › Subchapter 6 - ADMINISTRATION AND STORAGE OF MEDICATIONS › Section 8:41-6.3 - Medication controls, inventory, storage and recordkeeping

Current through Register Vol. 56, No. 14, July 15, 2024
(a) Each provider shall
				devise a plan for maintaining inventory control over medications, including all
				substances identified in Schedules II and III of the New Jersey Controlled Dangerous
				Substances Act (24:21-6 and
				24:21-7 ). The following information
				shall be recorded:
1. The name of the patient
				receiving the medication;
2. The name of
				the prescribing physician;
3. The name
				and strength of the drug;
4. The date
				the vehicle received the drug for each Schedule I through V (inclusive) drug
				received by the provider;
5. The date
				the drug was administered;
6. The dosage
				administered;
7. The method of
				administration;
8. The signature of the
				ALS crewmember administering the drug;
9. The amount of medication wasted, if any;
				and
10. The co-signature of the
				crewmember witnessing the waste.
New Jersey Administrative Code › Title 8 - HEALTH › Chapter 41 - ADVANCED LIFE SUPPORT SERVICES; MOBILE INTENSIVE CARE PROGRAMS, SPECIALTY CARE TRANSPORT SERVICES AND AIR MEDICAL SERVICES › Subchapter 7 - STANDING ORDERS FOR ADULT PATIENT › Section 8:41-7.1 - Scope

Current through Register Vol. 56, No. 14, July 15, 2024
The following treatment protocols shall be considered standing
				  orders when treating adult patients. For the purpose of this subchapter, adult
				  patients are defined as those persons who have attained the age of 13 years or older
				  (that is, from the date of the person's thirteenth birthday and beyond).
New Jersey Administrative Code › Title 8 - HEALTH › Chapter 41 - ADVANCED LIFE SUPPORT SERVICES; MOBILE INTENSIVE CARE PROGRAMS, SPECIALTY CARE TRANSPORT SERVICES AND AIR MEDICAL SERVICES › Subchapter 7 - STANDING ORDERS FOR ADULT PATIENT › Section 8:41-7.2 - Applicability and restrictions

Current through Register Vol. 56, No. 14, July 15, 2024
(a) The standing orders
				set forth in this subchapter shall be adopted in their entirety by the provider's
				medical director with the exception of the standing order for cyanide poisoning and
				standing order for nerve agent poisoning, after notification of OEMS. Except where
				specifically noted, these standing orders shall not be altered, abbreviated, or
				enhanced in any manner.
(b) The standing
				orders contained in this subchapter are initial treatment protocols that may be
				utilized by ALS crewmembers. These protocols apply only to adult patients, and may
				be implemented prior to contact with the medical command physician. In the event the
				implementation of these standing orders is delayed for any reason, the medical
				command physician shall be contacted immediately following the delay.
(c) Any situation other than those specifically
				identified in this subchapter requires the ALS crewmembers to contact the medical
				command physician before providing any ALS treatment.
(d) These standing orders shall not be interpreted
				as a requirement to administer ALS treatment prior to contact with the medical
				command physician. ALS crewmembers may elect to contact the medical command
				physician at any time during the provision of therapy. Unless otherwise provided in
				these rules, standing orders cease to be operative once contact is made with the
				medical command physician.
(e) The
				standing orders contained in this subchapter shall not be considered to represent
				total patient management. Contact with the medical command physician shall be
				established at the point indicated in the standing order, unless established sooner
				in accordance with (d) above. At no time shall communications with the medical
				command physician be delayed due to difficulty in intubating the patient and/or
				initiating an IV line.
(f) The presence
				of an allergy to any medication or therapeutic agent set forth in these standing
				orders shall be deemed to be a contraindication to the administration of that
				medication or therapeutic agent. In such instances, the medication or therapeutic
				agent shall not be administered.
(g)
				Each case utilizing these standing orders shall be fully documented on the patient
				care report. The provider's quality assurance plan shall include provisions for
				review of calls where standing orders are utilized, in accordance with the standards
				set. Cases that do not follow the standing orders as set forth in this chapter or
				where contact is never made with the medical command physician shall be forwarded to
				the medical director for a mandatory review.
New Jersey Administrative Code › Title 8 - HEALTH › Chapter 41 - ADVANCED LIFE SUPPORT SERVICES; MOBILE INTENSIVE CARE PROGRAMS, SPECIALTY CARE TRANSPORT SERVICES AND AIR MEDICAL SERVICES › Subchapter 7 - STANDING ORDERS FOR ADULT PATIENT › Section 8:41-7.3 - Standing orders for endotracheal intubation

Current through Register Vol. 56, No. 14, July 15, 2024
(a) The following
				standing orders for endotracheal intubation are authorized in the event that an
				adult patient presents:
1. In respiratory
				arrest;
2. In respiratory failure with
				associated inadequate spontaneous ventilatory volume; and/or
3. Unconscious with absent protective gag
				reflex.
New Jersey Administrative Code › Title 8 - HEALTH › Chapter 41 - ADVANCED LIFE SUPPORT SERVICES; MOBILE INTENSIVE CARE PROGRAMS, SPECIALTY CARE TRANSPORT SERVICES AND AIR MEDICAL SERVICES › Subchapter 7 - STANDING ORDERS FOR ADULT PATIENT › Section 8:41-7.4 - Standing orders for IV therapy

Current through Register Vol. 56, No. 14, July 15, 2024
(a) The following
				standing orders for the initiation of IV therapy are authorized in those cases where
				an emergent or potentially emergent condition exists and current ALS treatment
				protocols require the initiation of IV therapy. In such cases, ALS crewmembers may
				establish IV access at keep vein open (KVO) rate or establish IV access with a
				saline port prior to contacting the medical command physician.
(b) ALS crewmembers shall contact the medical
				command physician as soon as possible after the establishment of an IV line. Contact
				with the medical command physician shall not be delayed by, or as a result of,
				unsuccessful IV attempts in the field.
(c) The time of the initiation of IV therapy and
				the time of contact with the medical command physician shall be recorded on the
				patient care report.
(d) The provider's
				medical director shall notify the Department as to the solution to be utilized for
				IV therapy when established under this section.
New Jersey Administrative Code › Title 8 - HEALTH › Chapter 41 - ADVANCED LIFE SUPPORT SERVICES; MOBILE INTENSIVE CARE PROGRAMS, SPECIALTY CARE TRANSPORT SERVICES AND AIR MEDICAL SERVICES › Subchapter 7 - STANDING ORDERS FOR ADULT PATIENT › Section 8:41-7.5 - Standing orders for ventricular fibrillation and pulseless ventricular tachycardia

Current through Register Vol. 56, No. 14, July 15, 2024
(a) The following
				standing orders are authorized in the event that an adult patient presents with
				ventricular fibrillation or pulseless ventricular tachycardia:
1. Initiate CPR;
2. Defibrillate at 200 joules or equivalent
				biphasic;
3. Defibrillate at 300 joules
				or equivalent biphasic;
4. Defibrillate
				at 360 joules or equivalent biphasic;
5.
				Assess and secure airway, oxygenate and intubate;
6. Establish IV access with normal saline
				solution;
7. Administer Epinephrine 1 mg
				IV or 2 mg ET of a 1:10,000 concentration. Repeat every three minutes to a total of
				three administrations, or Vasopressin 40 units IV one time only. The choice between
				Epinephrine or Vasopressin shall be at the discretion of the program's medical
				director, as confirmed by a letter to OEMS;
8. Perform CPR for one minute and defibrillate at
				360 joules or equivalent biphasic;
9.
				Administration Lidocaine 1.5 mg/kg IV or 300 mg IV Amiodarone. The choice between
				Lidocaine or Amiodarone shall be at the discretion of the program's medical
				director, as confirmed by a letter to OEMS;
10. Perform CPR for one minute and defibrillate at
				360 joules or equivalent biphasic; and
11. Contact the medical command
				physician.
New Jersey Administrative Code › Title 8 - HEALTH › Chapter 41 - ADVANCED LIFE SUPPORT SERVICES; MOBILE INTENSIVE CARE PROGRAMS, SPECIALTY CARE TRANSPORT SERVICES AND AIR MEDICAL SERVICES › Subchapter 7 - STANDING ORDERS FOR ADULT PATIENT › Section 8:41-7.6 - Standing orders for asystole

Current through Register Vol. 56, No. 14, July 15, 2024
(a) The following
				standing orders are authorized in the event that an adult patient presents with
				asystole:
1. Initiate CPR;
2. Confirm asystole in a second lead. If this is a
				bradysytolic arrest, immediately proceed to pacing. If rhythm is still unclear and
				possibly ventricular fibrillation, defibrillate and, if indicated, follow protocol
				for ventricular fibrillation;
3. Assess
				and secure airway, oxygenate and intubate;
4. Establish IV access with 0.9 percent normal
				saline solution;
5. Administer
				Epinephrine 1 mg IV or 2 mg ET of a 1:10,000 solution. Repeat every three minutes
				for a total of three administrations;
6.
				Administer Atropine Sulfate 1 mg IV or 2 mg ET. Repeat every three minutes up to a
				total of 0.04 mg/kg; and
7. Contact the
				medical command physician.
New Jersey Administrative Code › Title 8 - HEALTH › Chapter 41 - ADVANCED LIFE SUPPORT SERVICES; MOBILE INTENSIVE CARE PROGRAMS, SPECIALTY CARE TRANSPORT SERVICES AND AIR MEDICAL SERVICES › Subchapter 7 - STANDING ORDERS FOR ADULT PATIENT › Section 8:41-7.7 - Standing orders for pulseless electrical activity (PEA)

Current through Register Vol. 56, No. 14, July 15, 2024
(a) The following
				standing orders are authorized in the event that an adult patient presents with
				pulseless electrical activity:
1. Initiate
				CPR;
2. Assess and secure airway,
				oxygenate and intubate;
3. Establish
				large bore IV access;
4. Administer 300
				cc fluid challenge, 0.9 percent normal saline solution;
5. Administer Epinephrine 1 mg IV or 2 mg ET of a
				1:10,000 solution. Repeat every three minutes, for a total of three
				administrations;
6. If PEA rate is slow
				(that is, less than 60 beats per minute), give Atropine 1 mg IV or 2 mg ET. Repeat
				every three minutes to a total of 0.04 mg/kg; and
7. Contact the medical command
				physician.
New Jersey Administrative Code › Title 8 - HEALTH › Chapter 41 - ADVANCED LIFE SUPPORT SERVICES; MOBILE INTENSIVE CARE PROGRAMS, SPECIALTY CARE TRANSPORT SERVICES AND AIR MEDICAL SERVICES › Subchapter 7 - STANDING ORDERS FOR ADULT PATIENT › Section 8:41-7.8 - Standing orders for multiple trauma

Current through Register Vol. 56, No. 14, July 15, 2024
(a) The following
				standing orders are authorized in the event that an adult patient presents with
				multiple traumatic injuries:
1. Provide basic life
				support as necessary;
2. Assess and
				secure airway;
3. Provide cervical spine
				precautions;
4. Assist ventilation,
				providing high flow oxygen at 100 percent by non-rebreather mask and/or performing
				intubation utilizing cervical spine precautions when indicated;
5. Transport the patient as soon as possible to
				the most appropriate facility according to the adult trauma triage guidelines;
				transportation shall not be delayed due to difficulty in intubating the patient
				and/or initiating an IV line, except at the specific direction of the medical
				command physician;
6. Enroute to the
				hospital, establish two large bore IV lines of Ringer's lactate solution or normal
				saline solution. Titrate the IV fluid administration rate to maintain a systolic
				blood pressure of greater than 90 mmHg and a pulse rate of less than 120 per minute,
				to a maximum dose of one liter; and
7.
				Contact the medical command physician.
New Jersey Administrative Code › Title 8 - HEALTH › Chapter 41 - ADVANCED LIFE SUPPORT SERVICES; MOBILE INTENSIVE CARE PROGRAMS, SPECIALTY CARE TRANSPORT SERVICES AND AIR MEDICAL SERVICES › Subchapter 7 - STANDING ORDERS FOR ADULT PATIENT › Section 8:41-7.9 - Standing orders for bradycardia

Current through Register Vol. 56, No. 14, July 15, 2024
(a) The following
				standing orders are authorized in the event that an adult patient presents with
				bradycardia (heart rate less than 60 beats per minute) in which the patient displays
				hypotension, shock or other significant symptoms consistent with hemodynamic
				instability:
1. Assess and secure airway;
2. Establish IV access;
i. If IV access cannot be established, proceed
				directly to transcutaneous pacing;
3. Administer Atropine Sulfate 1 mg IV;
4. If there is no response to the Atropine
				Sulfate, administer transcutaneous pacing at a rate of 70, at the lowest amount of
				energy necessary to obtain capture;
i. Note:
				Denervated hearts will not respond to Atropine Sulfate. In such cases, consider
				external cardiac pacing; and
5. Contact the medical command
				physician.
New Jersey Administrative Code › Title 8 - HEALTH › Chapter 41 - ADVANCED LIFE SUPPORT SERVICES; MOBILE INTENSIVE CARE PROGRAMS, SPECIALTY CARE TRANSPORT SERVICES AND AIR MEDICAL SERVICES › Subchapter 7 - STANDING ORDERS FOR ADULT PATIENT › Section 8:41-7.10 - Standing orders for pulmonary edema/congestive heart failure

Current through Register Vol. 56, No. 14, July 15, 2024
(a) The following
				standing orders are authorized in the event that an adult patient presents with
				pulmonary edema/congestive heart failure with systolic blood pressure greater than,
				or equal to, 110 mmHg:
1. Assess and secure
				airway;
2. Administer 0.4 mg
				Nitroglycerin sublingually every five minutes, to a maximum dose of 1.2 mg (which is
				three tablets or sprays of 0.4 mg each), provided the systolic blood pressure is
				greater than or equal to 110 mmHg;
3.
				Establish IV access;
4. Administer
				Furosemide 1 mg/kg IV;
i. A provider's medical
				director may elect to substitute Bumetanide 2 mg IV for Furosemide. The medical
				director shall notify the Department if he or she elects to utilize this
				substitution; and
5. Contact
				the medical command physician.
New Jersey Administrative Code › Title 8 - HEALTH › Chapter 41 - ADVANCED LIFE SUPPORT SERVICES; MOBILE INTENSIVE CARE PROGRAMS, SPECIALTY CARE TRANSPORT SERVICES AND AIR MEDICAL SERVICES › Subchapter 7 - STANDING ORDERS FOR ADULT PATIENT › Section 8:41-7.11 - Standing orders for suspected acute myocardial infarction/chest pain

Current through Register Vol. 56, No. 14, July 15, 2024
(a) The following
				standing orders are authorized in the event that an adult patient presents with
				acute myocardial infarction/chest pain with systolic blood pressure greater than, or
				equal to, 110 mmHg:
1. Assess and secure
				airway;
2. Administer at least 4 lpm
				nasal oxygen;
3. Administer 0.4 mg
				Nitroglycerin sublingually every five minutes, to a maximum dose of 1.2 mg (which is
				three tablets or sprays of 0.4 mg each), provided the systolic blood pressure is
				greater than or equal to 110 mmHg;
4.
				Administer Acetylsalicylic Acid by mouth after the first dose of Nitroglycerin; The
				provider's medical director shall notify the Department whether the program will
				administer 81 mg or 324 mg of Acetylsalicylic Acid;
5. Establish IV access;
6. If time and clinical condition of the patient
				allows, obtain a 12-lead electrocardiogram tracing;
7. If the patient is having an acute myocardial
				infarction, review patient's eligibility for thrombolytic therapy as determined by
				the provider's medical director; and
8.
				Contact the medical command physician.
New Jersey Administrative Code › Title 8 - HEALTH › Chapter 41 - ADVANCED LIFE SUPPORT SERVICES; MOBILE INTENSIVE CARE PROGRAMS, SPECIALTY CARE TRANSPORT SERVICES AND AIR MEDICAL SERVICES › Subchapter 7 - STANDING ORDERS FOR ADULT PATIENT › Section 8:41-7.12 - Standing orders for sustained ventricular tachycardia

Current through Register Vol. 56, No. 14, July 15, 2024
(a) The following
				standing orders are authorized in the event that an adult patient presents with a
				stable ventricular tachycardia (that is, with a systolic blood pressure greater than
				or equal to 110 mmHg):
1. Assess and secure
				airway;
2. Establish IV
				access;
3. Perform patient assessment,
				including medical history and allergies;
4. Continue to assess the patient and monitor the
				cardiac rhythm;
5. Administer Lidocaine
				1 mg/kg IV or Amidarone 150 mg IV over 10 minutes. The antiarrhythmic agent shall be
				predetermined by the medical director, who shall notify OEMS of his or her choice
				prior to utilization on any vehicle; and
6. Contact the medical command physician.
New Jersey Administrative Code › Title 8 - HEALTH › Chapter 41 - ADVANCED LIFE SUPPORT SERVICES; MOBILE INTENSIVE CARE PROGRAMS, SPECIALTY CARE TRANSPORT SERVICES AND AIR MEDICAL SERVICES › Subchapter 7 - STANDING ORDERS FOR ADULT PATIENT › Section 8:41-7.13 - Standing orders for unstable ventricular tachycardia

Current through Register Vol. 56, No. 14, July 15, 2024
(a) The following
				standing orders are authorized in the event that an adult patient presents with an
				unstable ventricular tachycardia where the patient is unconscious or hemodynamically
				compromised:
1. Assess and secure airway;
2. Establish IV access;
3. If the patient is conscious, strongly consider
				contacting the medical command physician for an order for sedation prior to
				cardioversion;
4. Perform a synchronized
				cardioversion at 100 joules or equivalent biphasic. Check the patient's pulse and
				cardiac rhythm after the shock;
i. If the rhythm
				fails to convert, perform a synchronized cardioversion at 200 joules or equivalent
				biphasic. Check the patient's pulse and cardiac rhythm after the shock;
ii. If the rhythm fails to convert, perform a
				synchronized cardioversion at 300 joules or equivalent biphasic. Check the patient's
				pulse and cardiac rhythm after the shock;
iii. If the rhythm fails to convert, perform a
				synchronized cardioversion at 360 joules or equivalent biphasic. Check the patient's
				pulse and cardiac rhythm after the shock;
5. If the rhythm is converted at any point,
				administer 1 mg/kg Lidocaine or Amiodarone 150 mg IV over 10 minutes. The
				antiarrhythmic agent shall be predetermined by the medical director, who shall
				notify OEMS of his or her choice prior to utilization on any vehicle; and
6. Contact the medical command physician.
New Jersey Administrative Code › Title 8 - HEALTH › Chapter 41 - ADVANCED LIFE SUPPORT SERVICES; MOBILE INTENSIVE CARE PROGRAMS, SPECIALTY CARE TRANSPORT SERVICES AND AIR MEDICAL SERVICES › Subchapter 7 - STANDING ORDERS FOR ADULT PATIENT › Section 8:41-7.14 - Standing orders for stable narrow complex tachycardia (non-atrial fibrillation or non-atrial flutter)

Current through Register Vol. 56, No. 14, July 15, 2024
(a) The following
				standing orders are authorized in the event that an adult patient presents with a
				stable narrow complex tachycardia with systolic blood pressure greater than or equal
				to 110 mmHg:
1. Assess and secure airway;
2. Establish IV access;
3. Perform a patient assessment, including medical
				history and allergies;
4. Perform a
				12-lead electrocardiogram tracing, if applicable, and continue to assess the patient
				and monitor the cardiac rhythm;
5.
				Attempt vagal maneuver;
6. Administer 6
				mg Adenosine rapid IV push over a period of one to three seconds, followed by a 20
				cc bolus of normal saline solution rapid IV push; and
7. Contact the medical command physician.
New Jersey Administrative Code › Title 8 - HEALTH › Chapter 41 - ADVANCED LIFE SUPPORT SERVICES; MOBILE INTENSIVE CARE PROGRAMS, SPECIALTY CARE TRANSPORT SERVICES AND AIR MEDICAL SERVICES › Subchapter 7 - STANDING ORDERS FOR ADULT PATIENT › Section 8:41-7.15 - Standing orders for unstable narrow complex tachycardia (non-atrial fibrillation or non-atrial flutter)

Current through Register Vol. 56, No. 14, July 15, 2024
(a) The following
				standing orders are authorized in the event that an adult patient presents with an
				unstable narrow complex tachycardia where the patient is unconscious or
				hemodynamically unstable:
1. Assess and secure
				airway;
2. Establish IV access (in the
				antecubital fossa, if possible);
3. If
				the patient is conscious and IV access has been established, administer Adenosine 6
				mg rapid, followed by 20 cc normal saline solution rapid bolus;
4. If IV access cannot be established, if the
				patient is unconscious or if there is no response to the Adenosine, perform a
				synchronized cardioversion at 50 joules or equivalent biphasic. Check the patient's
				pulse and cardiac rhythm after the shock;
i. If the
				rhythm fails to convert, perform a synchronized cardioversion at 100 joules or
				equivalent biphasic. Check the patient's pulse and cardiac rhythm after the
				shock;
ii. If the rhythm fails to
				convert, perform a synchronized cardioversion at 200 joules or equivalent biphasic.
				Check the patient's pulse and cardiac rhythm after the shock;
iii. If the rhythm fails to convert, perform a
				synchronized cardioversion at 300 joules or equivalent biphasic. Check the patient's
				pulse and cardiac rhythm after the shock;
iv. If the rhythm fails to convert, perform a
				synchronized cardioversion at 360 joules or equivalent biphasic. Check the patient's
				pulse and cardiac rhythm after the shock; and
5. Contact the medical command physician.
New Jersey Administrative Code › Title 8 - HEALTH › Chapter 41 - ADVANCED LIFE SUPPORT SERVICES; MOBILE INTENSIVE CARE PROGRAMS, SPECIALTY CARE TRANSPORT SERVICES AND AIR MEDICAL SERVICES › Subchapter 7 - STANDING ORDERS FOR ADULT PATIENT › Section 8:41-7.16 - Standing orders for allergic reaction/anaphylactic shock

Current through Register Vol. 56, No. 14, July 15, 2024
(a) The following
				standing orders are authorized in the event that an adult patient presents with
				signs of generalized allergic findings such as urticaria with signs of acute
				significant respiratory distress and/or profound hypotension (systolic blood
				pressure less than or equal to 80 mmHg) with clinical evidence of shock, including
				altered mental status; cool, clammy or mottled skin; and/or delayed capillary
				refill.
1. Assess and secure airway;
2. Fifteen lpm of oxygen via NRB should be
				placed;
3. Administer 0.5 cc Epinephrine
				1:1,000 subcutaneous and vigorously rub the area of injection;
4. Establish IV access and administer normal
				saline solution and initiate 300 cc fluid bolus. The bolus should be repeated once
				if blood pressure remains less than 100 systolic;
5. Administer 0.25 mg Epinephrine 1:10,000 IV over
				the course of one minute;
6. Administer
				50 mg Diphenhydramine HCL IV;
7. If
				wheezing is present, administer 2.5 mg Albuterol/3 cc normal saline solution via
				nebulizer; and
8. Contact the medical
				command physician.
New Jersey Administrative Code › Title 8 - HEALTH › Chapter 41 - ADVANCED LIFE SUPPORT SERVICES; MOBILE INTENSIVE CARE PROGRAMS, SPECIALTY CARE TRANSPORT SERVICES AND AIR MEDICAL SERVICES › Subchapter 7 - STANDING ORDERS FOR ADULT PATIENT › Section 8:41-7.17 - Standing orders for respiratory distress with wheezing due to COPD or bronchoconstriction

Current through Register Vol. 56, No. 14, July 15, 2024
(a) The following
				standing orders are authorized in the event that an adult patient presents with
				dyspnea where the signs and symptoms are consistent with asthma, COPD or any other
				dyspnea associated with wheezing or suspected bronchospasm:
1. Assess and secure airway;
2. Administer 2.5 mg Albuterol/3 cc normal saline
				solution via nebulizer;
i. A provider's medical
				director may elect to substitute Metaproterenol or Isoetharine for Albuterol. This
				substitution shall be declared at the time these standing orders are authorized by
				the medical director and approved by the Department.
3. Establish IV access;
4. Administer additional 2.5 mg Albuterol/3 cc
				normal saline solution treatments via nebulizer, up to a total of three treatments;
				and
5. Contact the medical command
				physician.
New Jersey Administrative Code › Title 8 - HEALTH › Chapter 41 - ADVANCED LIFE SUPPORT SERVICES; MOBILE INTENSIVE CARE PROGRAMS, SPECIALTY CARE TRANSPORT SERVICES AND AIR MEDICAL SERVICES › Subchapter 7 - STANDING ORDERS FOR ADULT PATIENT › Section 8:41-7.18 - Standing orders for unconscious person/altered mental status

Current through Register Vol. 56, No. 14, July 15, 2024
(a) The following
				standing orders are authorized in the event that an adult patient is unconscious or
				presents with altered mental status. The treatment of an unconscious person/altered
				mental status patient shall be directed by the suspected etiology of the event.
				Specific orders may be omitted by an ALS crewmember if the order does not pertain to
				the suspected etiology of the medical emergency:
1.
				Assess and secure airway;
2. Evaluate a
				blood glucose reagent strip;
3.
				Establish IV access;
4. Draw blood, if
				possible;
5. If the blood reagent strip
				indicates a blood glucose level less than 60 mg/dl;
i. Administer 25 gm of 50 percent Dextrose in
				water intravenously;
(1) If unable to establish IV
				access, administer 1 mg Glucagon intramuscularly; and
ii. Administer 100 mg Thiamine IV;
iii. If there is no response to (a)5i and ii
				above, or if the blood glucose level is greater than 60 mg/dl, administer up to 2 mg
				Naloxone IV. Start with 1 mg and titrate the dose to reversal of any respiratory
				depression;
iv. If IV access is
				unobtainable administer Naloxone 2 mg IM; and
6. Contact the medical command physician.
New Jersey Administrative Code › Title 8 - HEALTH › Chapter 41 - ADVANCED LIFE SUPPORT SERVICES; MOBILE INTENSIVE CARE PROGRAMS, SPECIALTY CARE TRANSPORT SERVICES AND AIR MEDICAL SERVICES › Subchapter 7 - STANDING ORDERS FOR ADULT PATIENT › Section 8:41-7.19 - Standing orders for nontraumatic hypotension

Current through Register Vol. 56, No. 14, July 15, 2024
(a) The following
				standing orders are authorized in the event that an adult patient presents with
				significant and symptomatic hypotension (systolic blood pressure less than 90 mmHg)
				unaccompanied by bradycardia or trauma, with patient exhibiting signs of shock due
				to dehydration, sepsis, and nontraumatic hemorrhage (for example, gastrointestinal
				bleeding):
1. Assess and secure airway;
2. Establish at least one large bore IV line of
				Ringer's lactate solution or normal saline solution, and administer a 300 cc bolus
				of IV solution;
3. Reassess vital signs
				and the condition of the patient; and
4.
				Contact the medical command physician.
New Jersey Administrative Code › Title 8 - HEALTH › Chapter 41 - ADVANCED LIFE SUPPORT SERVICES; MOBILE INTENSIVE CARE PROGRAMS, SPECIALTY CARE TRANSPORT SERVICES AND AIR MEDICAL SERVICES › Subchapter 7 - STANDING ORDERS FOR ADULT PATIENT › Section 8:41-7.20 - Standing orders for active seizures

Current through Register Vol. 56, No. 14, July 15, 2024
(a) The following
				standing orders are authorized in the event that an adult patient presents with
				active seizures:
1. Assess and secure
				airway;
2. Establish IV access and
				administer normal saline solution at KVO rate;
3. Follow unconscious protocol as directed by the
				suspected etiology of the event; and
4.
				Contact the medical command physician.
New Jersey Administrative Code › Title 8 - HEALTH › Chapter 41 - ADVANCED LIFE SUPPORT SERVICES; MOBILE INTENSIVE CARE PROGRAMS, SPECIALTY CARE TRANSPORT SERVICES AND AIR MEDICAL SERVICES › Subchapter 7 - STANDING ORDERS FOR ADULT PATIENT › Section 8:41-7.21 - Standing orders for cyanide poisoning (optional, at medical director$DQ$s discretion)

Current through Register Vol. 56, No. 14, July 15, 2024
(a) The following
				standing orders (optional, at the medical director's discretion) are authorized in
				the event that an adult patient presents with cyanide poisoning:
1. Do not enter or attempt to rescue a person in
				an area suspected or documented to be contaminated with cyanide poison;
2. Before making patient contact, ensure that
				appropriate decontamination has been performed;
i.
				If the patient has been exposed to liquid cyanide, ensure that all of the patient's
				clothing has been removed;
ii. No
				decontamination is needed for pure vapor exposure;
3. Determine the level of exposure;
i. If the level of exposure is mild (that is, the
				patient is conscious and breathing):
(1) Assess
				and secure the airway;
(2) Administer
				high concentration oxygen; and
(3)
				Observe the patient for respiratory distress;
ii. If the level of exposure is severe (that is,
				the patient is unconscious or if respirations are severely compromised):
(1) Assess and secure the airway;
(2) Administer high concentration
				oxygen;
(3) Provide suctioning (if
				necessary);
(4) If Cyanide kit is
				available, break and hold an aspirol of Amyl Nitrite in front of the patient's nose
				for 15 seconds, followed by removal for 15 seconds; use a new aspirol of Amyl
				Nitrite approximately every three minutes thereafter until IV access has been
				established. If the patient is unconscious, place the aspirol of Amyl Nitrite in the
				mask of the bag-valve-mask device or in the bag-valve-mask device itself;
(5) Establish IV access;
(6) Administer Sodium Thiosulfate 12.5 grams IV;
				and
4. Contact the
				medical command physician.
New Jersey Administrative Code › Title 8 - HEALTH › Chapter 41 - ADVANCED LIFE SUPPORT SERVICES; MOBILE INTENSIVE CARE PROGRAMS, SPECIALTY CARE TRANSPORT SERVICES AND AIR MEDICAL SERVICES › Subchapter 7 - STANDING ORDERS FOR ADULT PATIENT › Section 8:41-7.22 - Standing orders for nerve agent poisoning (optional, at medical director$DQ$s discretion)

Current through Register Vol. 56, No. 14, July 15, 2024
(a) The following
				standing orders (optional, at medical director's discretion) are authorized in the
				event that an adult patient presents with nerve agent poisoning:
1. Do not enter or attempt to rescue a person in
				an area suspected or documented to be contaminated with nerve agent
				poison;
2. Before making patient
				contact, ensure that appropriate decontamination has been performed. No
				decontamination is need for pure vapor exposure;
3. Assess the patient for signs of nerve agent
				toxicity (SLUDGE) and constricted pupils (miosis);
i. SLUDGE stands for:
(1) Salivation (excessive production of
				saliva);
(2) Lacrimation (excessive
				production of tears);
(3) Urination
				(uncontrolled urine production);
(4)
				Defecation (uncontrolled bowel movements);
(5) Gastrointestinal distress (cramps, hyperactive
				bowel sounds); and
(6) Emesis (excessive
				vomiting);
4.
				Determine the level of exposure;
i. If the level
				of exposure is mild (that is, the patient is conscious and breathing):
(1) Assess and secure the airway;
(2) Administer high concentration
				oxygen;
(3) Observe the patient for
				respiratory distress; and
(4) Establish
				IV access;
ii. If the level
				of exposure is severe (that is, the patient is unconscious or if respirations are
				severely compromised):
(1) Assess and secure the
				airway;
(2) Administer high
				concentration oxygen;
(3) Establish IV
				access;
(4) Administer Atropine 2 mg/kg
				IV; and
(5) Administer Pralidoxime
				Chloride 1 gram IV;
iii. If
				unable to establish IV access, administer Nerve Agent Antidote Kit (NAAK),
				consisting of auto injectors of Atropine 2 mg and Pralidoxime Chloride 600 mg
				intramuscularly; and
5.
				Contact the medical command physician.
New Jersey Administrative Code › Title 8 - HEALTH › Chapter 41 - ADVANCED LIFE SUPPORT SERVICES; MOBILE INTENSIVE CARE PROGRAMS, SPECIALTY CARE TRANSPORT SERVICES AND AIR MEDICAL SERVICES › Subchapter 8 - STANDING ORDERS FOR PEDIATRIC PATIENTS › Section 8:41-8.1 - Scope

Current through Register Vol. 56, No. 14, July 15, 2024
With the exception of
				  8:41-8.4, the following treatment
				  protocols shall be considered standing orders for treating pediatric patients. The
				  standing orders set forth at
				  8:41-8.4 are for the exclusive
				  utilization in resuscitating neonatal patients. As defined at
				  8:41-1.3, "neonatal" means the period of
				  time from the moment of birth up to and including the 28th day following birth and
				  "pediatric" means the period of time beginning with the 29th day following birth up
				  to, but not including, a person's 13th birthday.
New Jersey Administrative Code › Title 8 - HEALTH › Chapter 41 - ADVANCED LIFE SUPPORT SERVICES; MOBILE INTENSIVE CARE PROGRAMS, SPECIALTY CARE TRANSPORT SERVICES AND AIR MEDICAL SERVICES › Subchapter 8 - STANDING ORDERS FOR PEDIATRIC PATIENTS › Section 8:41-8.2 - Applicability and restrictions

Current through Register Vol. 56, No. 14, July 15, 2024
(a) The standing orders
				established in this subchapter shall be adopted in their entirety by the provider's
				medical director, after notification to OEMS. Except where specifically noted, these
				standing orders shall not be altered, abbreviated or enhanced in any
				manner.
(b) The standing orders
				contained in this subchapter are initial treatment protocols for unstable patients
				that may be utilized by ALS crewmembers. These protocols apply only to pediatric
				patients and may be implemented prior to contact with the medical command physician.
				In the event the implementation of these standing orders is delayed for any reason,
				the medical command physician shall be contacted immediately following the
				delay.
(c) Any situations other than
				those specifically identified in this subchapter requires ALS crewmembers to contact
				the medical command physician before providing any ALS treatment.
(d) These standing orders shall not be interpreted
				as a requirement to administer ALS treatment prior to contact with the medical
				command physician. The ALS crewmembers may elect to contact the medical command
				physician at any earlier time during the provision of therapy. Unless otherwise
				provided in these rules, standing orders cease to be operative once contact is made
				with the medical command physician.
(e)
				The standing orders contained in this subchapter shall not be considered to
				represent total patient management. Contact with the medical command physician shall
				be established at the point indicated in the standing order, unless established
				sooner in accordance with (d) above. At no time shall communications with the
				medical command physician be delayed due to difficulty in intubating the patient
				and/or initiating IV access.
(f) The
				presence of an allergy to any medication or therapeutic agent set forth in these
				standing orders shall be deemed to be a contraindication to the administration of
				that medication or therapeutic agent. In such instances, the medication or
				therapeutic agent shall not be administered.
(g) Each case utilizing these standing orders
				shall be fully documented on the patient care report. The provider's quality
				assurance plan shall include provisions for review of calls where standing orders
				are utilized, in accordance with the standards set. Cases that do not follow the
				standing orders as set forth in this chapter or where contact is never made with the
				medical command physician shall be forwarded to the medical director for a mandatory
				review.
New Jersey Administrative Code › Title 8 - HEALTH › Chapter 41 - ADVANCED LIFE SUPPORT SERVICES; MOBILE INTENSIVE CARE PROGRAMS, SPECIALTY CARE TRANSPORT SERVICES AND AIR MEDICAL SERVICES › Subchapter 8 - STANDING ORDERS FOR PEDIATRIC PATIENTS › Section 8:41-8.3 - Standard terms

Current through Register Vol. 56, No. 14, July 15, 2024
(a) As utilized in this
				subchapter, the term "stable" means vital signs, cardiovascular parameters and level
				of response within the ranges defined in Appendix D, incorporated herein by
				reference.
(b) As utilized in this
				subchapter, the term "unstable" means vital signs, cardiovascular parameters and
				level of response not within the ranges defined in Appendix D.