SECTION 8 – Special Operations Principles Fire and Tactical EMS Rehabilitation………….…………………………………….... Mass/Multiple Casualty Triage…………………………………………………………. Appendices Adult Medication Reference…………………………………………………………….. Pediatric Color Coded Medication Reference………………………………………… Interfacility Transfer Guidelines and Protocols……………………………………….. Scope of Practice…………………………..……………………………...……..……….. Department Approved Point of Entry Plans..…………………………………………..
exceptions, such as a patient with a potential spinal injury who cannot be logrolled while being transported and may be at risk of a compromised airway. Concerning mechanisms that may result in spinal column injury: Fall from over 3 feet, including adult fall from standing, or 5+ stair steps MVC at 30+ mph, or rollover or ejection Motorcycle, bicycle, other mobile conveyance, or pedestrian-vehicle accident Diving or axial load Electric shock Symptoms of spinal column injury may include: Posterior neck or back pain or tenderness; Paresthesias or loss of sensation in extremities; Weakness or paralysis of extremities; Conditions placing individuals at risk to not perceive or complain of the symptoms of spinal column injuries: Altered mental status due to disease, injury, intoxication, or other causes; Inability to adequately communicate; History of cervical spine injury or abnormality, or conditions causing fragile bones; Distracting injury (such as long-bone fracture); Age extremes (including >65 of age); Individuals sustaining lesser injuries, patients who do not have symptoms of spinal column injury and do not experience a condition that would impair the patient’s ability to perceive or communicate symptoms of spinal column injuries do not require spinal immobilization. Penetrating injuries to the neck generally do not require spinal immobilization. ASSESSMENT / TREATMENT PRIORITIES 1. Ensure scene safety, appropriate universal precautions, request additional EMS resources (BLS or ALS), perform thorough primary survey, any life threatening injuries immediately, appropriate oxygen and IV therapy MEDICAL CONTROL OPTIONS a. ADVANCED EMT, EMT-INTERMEDIATE AND PARAMEDIC: Additional Normal Saline 250 mL - 500 mL bolus(es), wide open or titrated to patient's hemodynamic status. b. PARAMEDIC: For suspected neurogenic shock (without hypovolemia): Norepinephrine infusion: 0.1mcg/kg/min IV/IO, titrate to goal Systolic Blood Pressure of 90mmHg, OR Dopamine IV/IO.
Executive subcommittee shall review the proposed protocol changes and make a final recommendation at its meeting. 4. A presentation of the approved changes shall be made at the first meeting of the full EMCAB following the Executive subcommittee recommendation. 5. Recommendations go to DPH/OEMS for review and action. DPH/OEMS shall timely notify all providers of approved protocol changes and any requirements regarding implementation (i.e. training and implementation date). PART B Procedures for Protocol Changes Allowable Other Than on an Annual Basis 1. The EMS Medical Director shall have the discretion to implement immediate protocol changes when such action is deemed by the Department to be necessary for the protection of public health and safety. a. The State EMS Medical Director shall base such action on a thorough review of relevant literature, any applicable national and/or state standard(s) and, when feasible, consultation with EMS Regional Councils, the Medical Services subcommittee and/or the EMCAB Executive subcommittee. b. When feasible, the State Medical Director shall convene an emergency meeting of the Medical Services subcommittee. The Medical Services subcommittee shall recommend any change to the protocols, and refer its recommendation and all supporting documents relating to the proposed change to the EMCAB Executive subcommittee for action. The EMCAB Executive subcommittee shall review the recommendation and make a final recommendation to DPH/OEMS. c. DPH/OEMS review such recommendation and take final action. It can also establish reasonable time frames for said implementation, particularly if a change requires training, and shall timely disseminate such a protocol change and any relevant implementation requirements. 2. DPH/OEMS shall always have the discretion to make changes to bring the Protocols into compliance with national standards of care. a. This shall be done, when feasible, in consultation with Regional EMS Councils, the Medical Services subcommittee, and/or EMCAB Executive subcommittee.
Epinephrine 1:1000 (by infusion only) Indications: Vasopressor Bradycardia, allergic reaction Allergic Reaction 2-10 mcg/min IV/IO infusion (maintenance) Bradycardia 2-10 mcg/min IV/IO infusion Post-Resuscitation 2-10 mcg/min IV/IO infusion Shock-Adult 2-10 mcg/min IV/IO infusion-by pump Epinephrine 1:10,000 Indications: Vasopressor used in cardiac arrest. Cardiac Arrest 1 mg IV/IO Repeat every 3 – 5 minutes per AHA guidelines Epinephrine (Racemic, for Inhalation) Indications: Croup 11.25mg in 2.5mL solution Fentanyl (Sublimaze) Indications: Opioid analgesic Pain 1 mcg/kg up to 150 mcg slow IV/IO/IM/IN Therapeutic Hypothermia, Shivering 50mcg every 5 minutes, maximum 200mcg IV/IO/IM/IN Furosemide Indications: Congestive Failure, Pulmonary Edema, Hypertensive Emergencies, Toxicology Congestive Heart Failure, Pulmonary Edema 20-40mg IV/IO Hypertensive Emergencies 0.5-1mg/kg IV/IO Toxicology 40mg IV/IO Glucagon Indications: Hypoglycemia Beta Blocker or Calcium Channel Blocker Overdose Diabetic Emergencies 1 mg IV/IO/IM/IN/SC Beta Blocker/Calcium Channel Blocker Overdose 1-5mg IV/IO/IM/IN/SC Bradycardia 1-5 mg IV/IO/IM/IN/SC Glucose Oral Glucose Solutions Indications: Use in conscious hypoglycemic states. Diabetic Emergencies Administer 1-2 tubes of commercially prepared glucose gel or equivalent.