ND
Uploaded byNewport Fire Department
PPTX, PDF310 views

2017 RI Statewide EMS Protocols Education Modules - Section 4

This document outlines new protocols for trauma, environmental, and toxicological emergencies in Rhode Island. It summarizes 24 new protocols which consolidate and replace several previous protocols. The protocols provide guidance for all levels of emergency responders on treatments for injuries such as burns, hypothermia, drowning, and envenomation. They emphasize rapid treatment and transport of critically injured patients.

Embed presentation

Download to read offline
Rhode Island Emergency Medical Services Statewide EMS Protocols October 2016 Rhode Island Department of Health
Trauma - Environmental - Toxicological Protocols Section 4
Trauma – Environmental – Toxicological Protocols General Changes and Additions • This is a new section in the EMS protocols • This section has 24 protocols
Trauma – Environmental – Toxicological Protocols New Protocol Previous Protocol Previous Protocol Section 04.01A Multiple Trauma - Adult 5.1 Trauma Traumatic Emergencies 04.01P Multiple Trauma - Pediatric 5.1 Trauma Traumatic Emergencies 4.02 Head Trauma - Traumatic Brain Injury 5.1 Trauma Traumatic Emergencies 4.03 Spinal Motion Restriction Precautions New – not in previous versions 4.04 External Hemorrhage Control New – not in previous versions 4.05 Extremity and Musculoskeletal Injuries New – not in previous versions 4.06 Traumatic Cardiac Arrest New – not in previous versions 04.07A Thermal - Burn Injury - Adult 5.2 Burns Traumatic Emergencies 04.07P Thermal - Burn Injury - Pediatric 5.2 Burns Traumatic Emergencies 4.08 Chemical and Electrical - Burn Injury 5.2 Burns Traumatic Emergencies 4.09 Crush Injury New – not in previous versions 4.1 Dental Trauma and Emergencies New – not in previous versions 4.11 Ocular Trauma and Emergencies New – not in previous versions
Trauma – Environmental – Toxicological Protocols New Protocol Previous Protocol Previous Protocol Section 4.12 Heat Related Illness 3.5 Heat Stroke 3.4 Heat Cramps and Heat Exhaustion Environmental Emergencies 04.13A Hypothermia and Localized Cold Injury - Adult 3.1 Cold Exposure - Frostbite 3.2 Cold Exposure - Hypothermia Environmental Emergencies 04.13P Hypothermia and Localized Cold Injury - Pediatric 3.1 Cold Exposure - Frostbite 3.2 Cold Exposure - Hypothermia Environmental Emergencies 4.14 Submersion - Near Drowning 3.3 Drowning Environmental Emergencies 4.15 Diving Emergencies New – not in previous versions 4.16 Marine Envenomation New – not in previous versions 4.17 Bites - Stings - Envenomation New – not in previous versions 04.18A Toxicological Emergencies - General - Adult 3.6 Poisoning and Overdose Environmental Emergencies 04.18P Toxicological Emergencies - General - Pediatric 3.6 Poisoning and Overdose Environmental Emergencies 4.19 Toxicological Emergencies – Nerve Agent or Organophosphate Toxicity New – not in previous versions 4.20 Carbon Monoxide Exposure New – not in previous versions 4.21 Blast Injury - Incident New – not in previous versions 4.22 Radiation Incident New – not in previous versions
4.01 Adult Multiple Trauma Protocol Summary • Previously protocol 5.1 Trauma. • This protocol recognizes and provides standing orders for adult patient with blunt or penetrating trauma. • This protocol is divided into different levels of care. ALL Providers Levels • Routine Patient Care • Manage life threatening injuries • Treat as per appropriate protocols • Vented chest seal device • Stabilize impaled Objects • Stabilize pelvis as indicated • Normothermia • Limit on scene time to ≤ 10 min • If indicated (≥45 mins to Trauma Center) follow HEMS Protocol • Transport to Level 1 Trauma Center Paramedic • Perform needle thoracostomy for suspected tension pneumothorax
4.01 Pediatric Multiple Trauma Protocol Summary • Previously protocol 5.1 Trauma. • This protocol recognizes and provides standing orders for pediatric patient with blunt or penetrating trauma. • This protocol is divided into different levels of care. ALL Provider Levels • Routine Patient Care • Manage life threatening injuries • Treat as per appropriate protocols • Vented chest seal device over open penetrating torso injury • Stabilize impaled objects • Stabilize pelvis as indicated • Maintain normothermia • Limit in scene time to ≤ 10 min • If indicated (≥45 mins to Trauma Center) follow HEMS Protocol • Transport to Level 1 Trauma Center Paramedic • Perform needle thoracostomy for suspected tension pneumothorax
4.02 Head Trauma - Traumatic Brain Injury (TBI) Protocol Summary • Previously protocol 5.1 Trauma. • This protocol recognizes and provides standing orders for adult patient with a history or clinical evidence of blunt or penetrating head trauma. In addition, patients who fell and take anticoagulant/antiplatelet medications. • This protocol is divided into different levels of care. ALL Providers Levels • Routine patient care • Baseline neurologic examination • Evaluate for increased intracranial pressure, manage as indicated per 2.01 Acute Neurologic Event with Evidence of Increased ICP • Provide airway management • Ventilate • Perform blood glucose analysis if AMS • Transport Advanced EMT Cardiac and Paramedic • Manage hypotension as per the age appropriate General Shock and Hypotension Protocol.
4.03 Spinal Motion Restriction Precautions Protocol Summary • This is a new protocol. • This protocol recognizes and provides standing orders for patients experiencing a mechanism of injury with risk for spinal injury. • This protocol is for all levels of care. ALL Providers Levels • If criteria met, apply spinal motion restriction precautions • If criteria is not met, use the algorithm • Apply cervical collar, supine on cot, secure with belts • Self-extrication allowed • Ambulatory patients may sit, then lie on cot • Scoop and flexible devices to move patients • Long spine boards for extrication and movement • Position patient supine on cot, secure with belts • Manage as per Patient Comfort protocol • Immobilize patients with penetrating trauma only if deficit Pediatric Patients • TRANSPORT IN PEDIATRIC RESTRAINT SYSTEM • Apply padding to cervical collar • Avoid movement • Move from car seat to stretcher ONLY if criteria are met
4.04 External Hemorrhage Control ALL Providers Levels • Routine Patient Care • Apply direct pressure • Liberal use of a tourniquet to achieve hemostasis • Hemostatic agent dressings and devices as needed • Use of a junctional tourniquet • If involving a dialysis fistula/shunt, use digital pressure, if tourniquet application is necessary, apply PROXIMALY as far from the fistula as possible • Manage as per the age appropriate Hemorrhagic Shock Protocol Protocol Summary • This is a new protocol. • This protocol recognizes and provides standing orders for patients with external hemorrhage. • This protocol is for all levels of care.
4.05 Extremity Trauma and Musculoskeletal Trauma ALL Provider Levels • Routine Patient Care • Manage as per appropriate protocol • Remove rings, bracelets, other constricting items • Care for amputated parts • Splint joint above and below possible fracture • Traction for isolated midshaft femoral fractures • Splint dislocations and angulated fractures in place unless distal circulation is compromised • Binder for pelvic fractures Protocol Summary • This is a new protocol. • This protocol recognizes and provides standing orders for patients with musculoskeletal injury/complaint. • This protocol is divided into different levels of care. Paramedics • CEFAZOLIN 2 mg IV/IO for open fractures/ amputations/grossly contaminated wounds • CEFAZOLIN is contraindicated if history of PCN or cephalosporin allergy
4.06 Traumatic Cardiac Arrest ALL Providers Levels • Routine Patient Care • IMMEDIATELY INITIATE CPR • Consider medical etiology • Control external hemorrhage • Binder for suspected pelvic fracture • Transport to Level 1 Trauma Center if <15 minutes Protocol Summary • This is a new protocol. • This protocol recognizes and provides standing orders for patients in cardiopulmonary arrest with presumed traumatic etiology. • This protocol is divided into different levels of care. Advanced EMT Cardiac • LACTATED RINGER’s 1L IV/IO Adult • LACTATED RINGER’s 20 ml/kg Pediatric Paramedic • LACTATED RINGER’s 1L IV/IO Adult • LACTATED RINGER’s 20 ml/kg Pediatric • Perform needle thoracostomy if suspected tension pneumothorax
4.07 Adult Thermal Burn Injury ALL Provider Levels • Routine Patient Care • Assess burn/concomitant injury severity using Rule of Nines. • Minor burn management • Serious or critical burns management and transport to Burn Center Protocol Summary • Previously protocol 5.2 Burn. • This protocol recognizes and provides standing orders for patients with minor burn, serious burn and critical burn. • This protocol is divided into different levels of care. Advanced EMT Cardiac • Analgesia, IV for minor burns • IVFs for serious or critical burns and transport to Burn Center Paramedic • Analgesia, IV for minor burns • IVFs, airway management for serious or critical burns and transport to Burn Center
ALL Providers Levels • Routine Patient Care • Assess burn/concomitant injury severity using Rule of Nines. • Minor burn management • Serious or critical burns transport to Burn Center Protocol Summary • Previously protocol 5.2 Burn. • This protocol recognizes and provides standing orders for pediatric patients with minor burn, serious burn and critical burn injuries. • This protocol is divided into different levels of care. Advanced EMT Cardiac • Analgesia for minor burns • Consider IV • IVFs for serious or critical burns Paramedic • Analgesia for minor burns • Consider IV • IVFs for serious or critical burns • Airway management 4.07 Pediatric Thermal Burn Injury
4.08 Chemical and Electrical Burn Injury ALL Providers Levels • Routine Patient Care • Assess chemical source, utilize HAZMAT resources as needed • Assess electrical source • Assess burn/concomitant injury severity • Decontaminate most chemical burns with liquid • Brush off powdered chemicals • Treat Hydrofluoric Acid burns with calcium gel • Remove non-adherent clothing/rings/constricting items • Manage per the age the appropriate Thermal Burn Protocol and Trauma related protocols. • Transport to Adult Burn Center Protocol Summary • Previously protocol 5.2 Burn. • This protocol recognizes and provides standing orders for patients with partial or full thickness burn injury resulting from contact with a chemical agent or energized electrical source. • This protocol is divided into different levels of care. Advanced EMT Cardiac • Initiate cardiac monitoring Paramedic • Consider IV CALCIUM if hydrofluoric acid and hypocalcemia. • Consider nebulized CALCIUM if HF inhalation
4.09 Crush Injury ALL Providers Levels • Routine Patient Care • Manage as per Trauma Protocols/Shock Protocols/Hypothermia or Localized Cold Injury Protocols • Remove constricting items • REQUEST ALS response • Analgesia as needed per Patient Comfort Protocol • Transport Protocol Summary • This is a new protocol. • This protocol recognizes and provides standing orders for patients with extremity/body crush, entrapped and crushed under heavy load for > 30 min. • This protocol is divided into different levels of care. Advanced EMT Cardiac • IV NS with SODIUM BICARBONATE during extrication • Manage Cardiac Arrest per appropriate protocol (s) • If ECG suggests hyperkalemia or cardiac arrest occurs, contact MEDICAL CONTROL for administration of CALCIUM CHLORIDE 1 gm IV/IO or CALCIUM GLUCONATE 3 gm IV/IO and SODIUM BICARBONATE 50mEq IV/IO • Albuterol for suspected hyperkalemia Paramedic • Consider IV NS with SODIUM BICARBONATE during extrication • Manage Cardiac Arrest per appropriate protocol(s) • ECG suggestive of hyperkalemia or if cardiac arrest occurs, CALCIUM CHLORIDE 1 gm IV/IO or CALCIUM GLUCONATE 3 gm IV/IO and SODIUM BICARBONATE 50mEq IV/IO • Albuterol for suspected hyperkalemia
4.10 Dental Trauma and Emergencies ALL Provider Levels • Routine Patient Care • Consider possible cardiac etiology • Manage bleeding with direct pressure during multisystem trauma treatment • Control dental related bleeding with rolled gauze direct pressure • Put avulsed teeth in saline, milk, or commercial solution. Do NOT scrub or cleanse. • Provide analgesia as indicated per the Patient Comfort Protocol • Transport Protocol Summary • This is a new protocol. • This protocol recognizes and provides standing orders for patients with tooth pain or dental injury. • This protocol is for all levels of care.
4.11 Ocular Trauma and Emergencies ALL Providers Levels • Routine Patient Care • Assess visual acuity • Obtain history • Rigid shield over penetrating ocular injuries • Immobilize impaled objects and patch BOTH eyes • Assess EOM for blunt traumatic injuries, elevate HOB, patch • Moist saline over traumatic enucleation • Irrigate chemical eye injuries with water or LACTATED RINGER’S Protocol Summary • This is a new protocol. • This protocol recognizes and provides standing orders for patients with ocular complaint or injury. • This protocol is divided into different levels of care. Advanced EMT Cardiac • ONDANSETRON for penetrating ocular injuries Paramedic • ONDANSETRON for penetrating ocular injuries • TETRACAINE or PROPARACAINE for ocular flash burns or chemical eye injuries • Irrigate with LACTATED RINGER’S utilizing a Morgan lens • Use pH to guide irrigation
4.12 Heat Related Illness ALL Provider Levels • Routine Patient Care • Measure body temperature • Begin passive cooling • Oral rehydration for heat cramps • Active cooling for heat exhaustion and heat stroke • Transport Protocol Summary • Previously protocols 3.4 Heat Cramps and Heat Exhaustion and 3.5 Heat Stroke. • This protocol recognizes and provides standing orders for patients with heat cramps, heat exhaustion and heat stroke. • This protocol is divided into different levels of care. Advanced EMT Cardiac and Paramedic • IV NS for heat exhaustion and heat stroke
4.13 Adult Hypothermia and Localized Cold Injury ALL Providers Levels • Routine Patient Care • Provide airway management • Check pulse 60 seconds if unresponsive • Assess mental status and treat as indicated • Determine body temperature • ≥ 34 – 35°C external rewarming • < 34 – 35°C warmed humidified air or oxygen if available • Avoid refreezing if localized cold thermal injury Protocol Summary • Previously protocols 3.1 Cold Exposure Frost Bite and 3.2 Cold Exposure Hypothermia in Environmental Emergencies. • This protocol recognizes and provides standing orders for adult patients with core temperature < 35°C (95°F) and patients with cold thermal injury (frostbite). • This protocol is divided into different levels of care. Advanced EMT Cardiac and Paramedic • For patients with a core temperature < 34°C (93.2°F), administer warm (40-42°C/104-107°F) NORMAL SALINE 500 ml IV/IO boluses.
4.13 Pediatric Hypothermia and Localized Cold Injury ALL Providers Levels • Routine Patient Care • Provide airway management • Check pulse for 60 seconds if unresponsive • Assess mental status and treat as indicated • Determine body temperature • ≥ 34 – 35°C external rewarming • < 34 – 35°C warmed humidified air or oxygen if available • Avoid refreezing localized cold thermal injury Protocol Summary • Previously protocol 3.1 Cold Exposure Frost Bite 3.2 Cold Exposure Hypothermia in Environmental Emergencies. • This protocol recognizes and provides standing orders for pediatric with core temperature < 35°C (95°F) and patients with cold thermal injury (frostbite). • This protocol is divided into different levels of care. Advanced EMT Cardiac and Paramedic • For patients with a core temperature < 34°C (93.2°F), administer warm (40-42°C/104-107°F) NORMAL SALINE 20 ml/kg IV/IO boluses
4.14 Submersion – Near Drowning ALL Providers Levels • Routine Patient Care • Apply Spinal Motion Restriction Precautions • Manage Cardiac Arrest even after prolonged immersion in cold water • Manage Hypothermia and Local Cold Injury as indicated. • Remove wet clothing, dry and warm the patient. • Provide Airway Management and Altered Mental Status as indicated. • Manage per the age appropriate Respiratory Distress Protocol if indicated • Monitor and reassess the patient. • Transport Protocol Summary • Previously protocol 3.3 Drowning. • This protocol recognizes and provides standing orders for patients submersed in water regardless of depth. • This protocol is for all levels of care.
4.15 Diving Emergencies ALL Provider Levels • Routine Patient Care • Consult Diver’s Alert Network (DAN) • Analgesia for ear or sinus squeeze • Oxygen and recompression Treatment at HBO Facility for • Pulmonary Overpressure syndrome • Arterial gas embolism • Decompression sickness type I and II • Nitrogen narcosis Protocol Summary • This is a new protocol. • This protocol recognizes and provides standing orders for patients with ear squeeze/sinus squeeze, pulmonary overpressure syndrome, arterial gas embolism, decompression sickness type I and II, Nitrogen Narcosis. • This protocol is divided into different levels of care. Advanced EMT Cardiac and Paramedics • OXYMETAXOLINE or PSEUDOEPHEDRINE for ear or sinus squeeze – Patient Comfort Protocol • IV NS for decompression sickness type II
4.16 Marine Envenomation ALL Providers Levels • Routine Patient Care • Manage allergic or anaphylactic reactions • Regional Center for Poison Control and Prevention 800-222-1222 • Sting Ray, Lionfish or Urchin/Starfish related injuries • Immobilize injury and object, or remove barb if small • Jellyfish or Man o’ War related injuries • Lift away tentacles • Irrigate with vinegar or sea water NOT fresh water or ice • Treat pain as per the age appropriate Patient Comfort Protocol Protocol Summary • This is a new protocol. • This protocol recognizes and provides standing orders for patients exposed to marine organisms with intense localized pain, nausea/vomiting, allergic reaction or anaphylactic reaction. • This protocol is divided into different levels of care. Paramedic • Manage severe muscle spasm with CALCIUM IV
4.17 Bite - Stings - Envenomation Protocol Summary • This is a new protocol. • This protocol recognizes and provides standing orders for patients with bee or wasp sting, spider, snake, feline, canine, or human bite. • This protocol is divided into different levels of care. Paramedic • Manage severe muscle spasm with MIDAZOLAM ALL Providers Levels • Routine Patient Care • Manage allergic or anaphylactic reactions • Consider Regional Center for Poison Control and Prevention 800-222-1222 • Spider bites and bee or wasp stings • Elevate, ice, remove constricting jewelry • Snake bites • Immobilize, elevate, remove constricting jewelry • NO ICE • Feline, Canine or Human bites • Wound care • Immobilize • Contact animal control
4.18 Adult Toxicological Emergencies ALL Provider Levels • Routine Patient Care • Recognition symptoms (toxidromes) • OPIOID OVERDOSE • NALOXONE UNTIL ADEQUATE VENTILATION • FOLLOW THE RECOVERY COACH ALGORITHM • CONSIDER CONTACTING THE REGIONAL CENTER FOR POISON CONTROL • ORGANOPHOSPHATE NERVE AGENT or INSECTISIDE manage per appropriate protocol Protocol Summary • Previous protocol 3.6 Poisoning and Overdose. • This protocol recognizes and provides standing orders for patients intoxicated with Beta Blockers/Calcium Channel Blockers, Tricyclic Antidepressants/Sodium Channel blocking agents, Opioids, Organophosphates/nerve agents, and anticholinergics. • This protocol is divided into different levels of care. Advanced EMT Cardiac • NALOXONE for Opioid Overdose until adequate ventilation • SODIUM BICARBONATE for suspected antidepressant or other sodium channel blocking agent toxicity • GLUCAGON or CALCIUM for suspected beta blocker or calcium channel blocker toxicity • HYDROXYCOBALAMIN for suspected Cyanide toxicity • MIDAZOLAM or LORAZEPAM for suspected sympathomimetic/stimulant toxicity • Treat seizures Paramedic • INTRALIPID or NOREPINEPHRINE for antidepressant or other sodium channel blocking agent toxicity • GLUCAGON, CALCIUM or INTRALIPID for beta blocker or calcium channel blocker toxicity • SODIUM THIOSULFATE for Cyanide toxicity • ATROPINE / PRALIDOXIME for organophosphate nerve agent or insecticide exposure • MIDAZOLAM or LORAZEPEM for sympathomimetic/stimulant toxicity • DIPHENHYDRAMINE for dystonic reactions • INTRALIPID for lipid-soluble toxicity cardiac arrest / hemodynamic compromise
2.17 Obstetrical Delivery4.18 Pediatric Toxicological Emergencies ALL Provider Levels • Routine Patient Care • Recognition symptoms (toxidromes) • OPIOID OVERDOSE • NALOXONE UNTIL ADEQUATE VENTILATION • FOLLOW THE RECOVERY COACH ALGORITHM • CONSIDER CONTACTING THE REGIONAL CENTER FOR POISON CONTROL • ORGANOPHOSPHATE NERVE AGENT or INSECTISIDE • DuoDote Protocol Summary • Previous protocol 3.6 Poisoning and Overdose. • This protocol recognizes and provides standing orders for pediatric patients intoxicated with Beta Blockers/Calcium Channel Blockers, Tricyclic Antidepressants/Sodium Channel blocking agents, Opioids, Organophosphates/nerve agents, and anticholinergics. • This protocol is divided into different levels of care. Advanced EMT Cardiac • NALOXONE for Opioid Overdose until adequate ventilation • SODIUM BICARBONATE for suspected antidepressant or other sodium channel blocking agent toxicity • GLUCAGON or CALCIUM for suspected beta blocker or calcium channel blocker toxicity • HYDROXYCOBALAMIN for suspected Cyanide toxicity • MIDAZOLAM or LORAZEPAM for suspected sympathomimetic/stimulant toxicity • Treat seizures Paramedic • INTRALIPID or NOREPINEPHRINE for antidepressant or other sodium channel blocking agent toxicity • GLUCAGON, CALCIUM or INTRALIPID for beta blocker or calcium channel blocker toxicity • SODIUM THIOSULFATE for Cyanide toxicity • ATROPINE / PRALIDOXIME for organophosphate nerve agent or insecticide exposure • MIDAZOLAM or LORAZEPEM for sympathomimetic/stimulant toxicity unless < 5kg • DIPHENHYDRAMINE for dystonic reactions unless < 5 kg • INTRALIPID for lipid-soluble toxicity cardiac arrest / hemodynamic compromise
2.17 Obstetrical Delivery4.19 Nerve Agent or Organophosphate Toxicity ALL Provider Levels • Routine Patient Care • PPE • DuoDote • Adult • Pediatric Protocol Summary • New Protocol • This protocol recognizes and provides standing orders for patient with suspected or know exposure to a nerve or organophosphate agent with salivation, lacrimation, urination, defecation, GI distress, emesis [SLUDGE], muscle twitching, seizures, respiratory arrest), bradycardia, bronchorrhea, and/or bronchospasm. • This protocol is divided into different levels of care. Advanced EMT Cardiac • Manage Seizures as per the age appropriate Seizure Protocol Paramedic • Manage Seizure as per the age appropriate Seizure Protocol • ATROPINE / PRALIDOXIME for organophosphate nerve agent or insecticide exposure
4.20 Carbon Monoxide ALL Providers Levels • Routine Patient Care • OXYGEN • Treat as outlined in table Protocol Summary • This is a new protocol. • This protocol recognizes and provides standing orders for patients involved in fire or in a confined space/poorly ventilated area with potential for the presence of carbon monoxide (combustion of carbon containing fuels or inadequate ventilation of natural gas). • This protocol is divided into different levels of care. Advanced EMT Cardiac and Paramedic • Cardiac monitoring and multi-lead ECG
4.21 Blast Injury - Incident ALL Providers Levels • Routine Patient Care • Ensure scene safety. • Determine nature of incident, nature of device, nature of environment, potential for threat of particalization of hazardous materials and distance from blast. • Quantify and triage patients per the Multiple Patient Incident Protocol(s) as indicated. • Manage patient as indicated per age appropriate Trauma and Burn Protocols, Crush Injury Protocol, Radiation Incident Protocol. • Transport Protocol Summary • This is a new protocol. • This protocol recognizes and provides standing orders for Blast explosion occurring in an open space (conventional blast) or enclosed/confined space (vehicle, building, bus, train). • This protocol is divided into different levels of care.
4.22 Radiation Incident ALL Providers Levels • Routine Patient Care • Ensure scene safety. • If the incident involves a blast, also manage per Blast Incident and Injury Protocol. • Determine need for additional resources, exposure type, quantification of exposure, quantify and triage patients as per the Multiple Patient Incident Protocol as indicated. • Flush contact areas with NORMAL SALINE for 15 minutes. • If present, manage burn injuries as per age appropriate Burn Protocol(s). • Identify and manage any secondary injuries as per appropriate Trauma Protocols. • Transport Protocol Summary • This is a new protocol. • This protocol recognizes and provides standing orders for patients with radiation burn or exposure to radiation. • This protocol is for all levels of care.
Continue on to RI EMS Protocol Education Modules Section 5

More Related Content

PPTX
2017 RI Statewide EMS Protocols Education Module - Section 2
byNewport Fire Department
 
PPTX
2017 RI Statewide EMS Protocols Education Module - Section 3
byNewport Fire Department
 
PPTX
2017 RI Statewide EMS Protocols Education Modules - Section 1
byNewport Fire Department
 
PPTX
2017 RI Statewide EMS Protocols Education Module - Section 6
byNewport Fire Department
 
PDF
2017 RI EMS Statewide Protocols - 2017-01
byNewport Fire Department
 
PPTX
2017 RI Statewide EMS Protocols Education Module - Section 7
byNewport Fire Department
 
PPTX
Core measures version 3
bymjude2014
 
PPTX
VTE core measures
byQBMedTeam
 
2017 RI Statewide EMS Protocols Education Module - Section 2
byNewport Fire Department
 
2017 RI Statewide EMS Protocols Education Module - Section 3
byNewport Fire Department
 
2017 RI Statewide EMS Protocols Education Modules - Section 1
byNewport Fire Department
 
2017 RI Statewide EMS Protocols Education Module - Section 6
byNewport Fire Department
 
2017 RI EMS Statewide Protocols - 2017-01
byNewport Fire Department
 
2017 RI Statewide EMS Protocols Education Module - Section 7
byNewport Fire Department
 
Core measures version 3
bymjude2014
 
VTE core measures
byQBMedTeam
 

What's hot

PPT
"Rapid Response System"
byMohamad Fakih
 
PPTX
Scd after stemi
byPlease hit like if you really liked my PPTs
 
PPT
Preoperative Surgical Preparation
byUmm Al-Qura University Faculty of Dentistry
 
PDF
Emergency Care Summary
byPlan de Calidad para el SNS
 
PPTX
Care cardiac surgery
byJohny Wilbert
 
PPT
Multipara monitor – what is it and how does it help
bySilverline Meditech
 
PPTX
Pre anesthetic by dr.nikhil
byNikhil Panjiyar
 
PPT
Core Measures-CME 101
byevettemoss
 
PDF
Code management (for printing)
byAlhane Enriquez
 
PPTX
Icu admission, discharge criteria and triage
byfakhfas
 
PPTX
Emegency drugs in radiology department
byAbubakarMustaphaAman
 
PPTX
Post op care
byMonika Devi NR
 
DOC
Emergency and ICU Procedures
byKarna *
 
PPT
Code management
bySKYKINE INSTITUE OF NURSING ION
 
PPT
Rapid response team
byShailendra Veerarajapura
 
PPT
Patient safety During Anesthesia
byisakakinada
 
PDF
Pre anaesthetic evaluation.pdfx
byRAJESH EAPEN
 
PPTX
Pre operative and post-operative surgical care - a brief medical study
bymartinshaji
 
PPSX
Preoperative preparation for thoracic surgery
bySaneesh P J
 
PDF
Pre operative care - Dr. Somaya Banaei
bySomaya Banaei
 
"Rapid Response System"
byMohamad Fakih
 
Scd after stemi
byPlease hit like if you really liked my PPTs
 
Preoperative Surgical Preparation
byUmm Al-Qura University Faculty of Dentistry
 
Emergency Care Summary
byPlan de Calidad para el SNS
 
Care cardiac surgery
byJohny Wilbert
 
Multipara monitor – what is it and how does it help
bySilverline Meditech
 
Pre anesthetic by dr.nikhil
byNikhil Panjiyar
 
Core Measures-CME 101
byevettemoss
 
Code management (for printing)
byAlhane Enriquez
 
Icu admission, discharge criteria and triage
byfakhfas
 
Emegency drugs in radiology department
byAbubakarMustaphaAman
 
Post op care
byMonika Devi NR
 
Emergency and ICU Procedures
byKarna *
 
Code management
bySKYKINE INSTITUE OF NURSING ION
 
Rapid response team
byShailendra Veerarajapura
 
Patient safety During Anesthesia
byisakakinada
 
Pre anaesthetic evaluation.pdfx
byRAJESH EAPEN
 
Pre operative and post-operative surgical care - a brief medical study
bymartinshaji
 
Preoperative preparation for thoracic surgery
bySaneesh P J
 
Pre operative care - Dr. Somaya Banaei
bySomaya Banaei
 

Viewers also liked

PPTX
2017 RI Statewide EMS Protocols Education Module - Introduction
byNewport Fire Department
 
PPTX
2017 RI Statewide EMS Protocols Education Module - Section 8
byNewport Fire Department
 
PDF
"30 minute CPR Protocol" - Letter to the editor
byJohn Pliakas
 
PPTX
2017 RI Statewide EMS Protocols Education Module - Section 9
byNewport Fire Department
 
PPT
Electrical Injuries
byAlan Canon
 
PPTX
Electrical injuries
bySCGH ED CME
 
PPT
Electrical injuries
bySudhir Dev
 
PPTX
Management of burns
byViswa Kumar
 
PPTX
Management of burns
byImran Javed
 
PPTX
Electrical injuries
bySCGH ED CME
 
2017 RI Statewide EMS Protocols Education Module - Introduction
byNewport Fire Department
 
2017 RI Statewide EMS Protocols Education Module - Section 8
byNewport Fire Department
 
"30 minute CPR Protocol" - Letter to the editor
byJohn Pliakas
 
2017 RI Statewide EMS Protocols Education Module - Section 9
byNewport Fire Department
 
Electrical Injuries
byAlan Canon
 
Electrical injuries
bySCGH ED CME
 
Electrical injuries
bySudhir Dev
 
Management of burns
byViswa Kumar
 
Management of burns
byImran Javed
 
Electrical injuries
bySCGH ED CME
 

Similar to 2017 RI Statewide EMS Protocols Education Modules - Section 4

PDF
BLS protocol book
byDrmido Selim
 
PPTX
2015 protocol update with narration
byres1cuenyc
 
PDF
Sw protocol
byDanny Jones
 
PPTX
Statewide protocols presentation 6 21-16 (1)
bydinterlandi
 
PDF
GEMC-Proposal for Emergency Medical Services in Kumasi- for Residents
byOpen.Michigan
 
PPTX
Emergency and disaster management nursing.perspective pptx
byRashmitaDahal
 
PPTX
Emergency medical response procedure
byladdha1962
 
PPTX
emergencycareinnursingbymr-200806131713 (1).pptx
byanita433463
 
PDF
ATLS ppt.pdf
byArunKumar852941
 
PDF
EMERGENCY NURSING - POWPERPOINT PRESENTA
byJuvyVergara2
 
PPTX
BASICS OF EMERGENCY CARE-EMD.pptx........
byannaryoba34
 
PPTX
Major Trauma management in emergency room Tribhuvan university teaching hospi...
bysameerdm
 
PPTX
Esi first aid
byDrShaukat Ali
 
PPT
FIRST AID IN DISASTER MANAGEMENT POWERPOINT
by0408sashi
 
PPTX
TRAUMA AZSCFHP'LJHKDFGUHJIND EMERGENCY-1.pptx
byFREDRICK CIIRA
 
PPTX
Stp update 2016
byLYFDEMStraining
 
PPTX
1ฉุกเฉินไทยก้าวไกล อ.ศิริอร สินธุ
bytaem
 
PPTX
Scene size up and initial assessment
bykkirkemtp
 
PDF
First Aid course for health science students | Chapter 1
byMr Awel
 
PPT
Things That Make You Go Hmm Part 1ppt
byShore EMS Conference 2010
 
BLS protocol book
byDrmido Selim
 
2015 protocol update with narration
byres1cuenyc
 
Sw protocol
byDanny Jones
 
Statewide protocols presentation 6 21-16 (1)
bydinterlandi
 
GEMC-Proposal for Emergency Medical Services in Kumasi- for Residents
byOpen.Michigan
 
Emergency and disaster management nursing.perspective pptx
byRashmitaDahal
 
Emergency medical response procedure
byladdha1962
 
emergencycareinnursingbymr-200806131713 (1).pptx
byanita433463
 
ATLS ppt.pdf
byArunKumar852941
 
EMERGENCY NURSING - POWPERPOINT PRESENTA
byJuvyVergara2
 
BASICS OF EMERGENCY CARE-EMD.pptx........
byannaryoba34
 
Major Trauma management in emergency room Tribhuvan university teaching hospi...
bysameerdm
 
Esi first aid
byDrShaukat Ali
 
FIRST AID IN DISASTER MANAGEMENT POWERPOINT
by0408sashi
 
TRAUMA AZSCFHP'LJHKDFGUHJIND EMERGENCY-1.pptx
byFREDRICK CIIRA
 
Stp update 2016
byLYFDEMStraining
 
1ฉุกเฉินไทยก้าวไกล อ.ศิริอร สินธุ
bytaem
 
Scene size up and initial assessment
bykkirkemtp
 
First Aid course for health science students | Chapter 1
byMr Awel
 
Things That Make You Go Hmm Part 1ppt
byShore EMS Conference 2010
 

More from Newport Fire Department

PPSX
2014 NFD Incident Command # 4 Deployment
byNewport Fire Department
 
PPSX
2013.05.02 NFD Driver training introduction
byNewport Fire Department
 
PPSX
Strip Mall Fire Tactics & Strategies
byNewport Fire Department
 
PPSX
NBMTF search patterns
byNewport Fire Department
 
PPSX
GAR Model
byNewport Fire Department
 
PPSX
NBMTF Communications Overview
byNewport Fire Department
 
PPSX
NFD Incident Command # 3 Communications
byNewport Fire Department
 
PPSX
Fire Alarm Control Panel Operations
byNewport Fire Department
 
PPSX
Fire Officer Detail Training Program
byNewport Fire Department
 
PPS
Rope rescue set up
byNewport Fire Department
 
2014 NFD Incident Command # 4 Deployment
byNewport Fire Department
 
2013.05.02 NFD Driver training introduction
byNewport Fire Department
 
Strip Mall Fire Tactics & Strategies
byNewport Fire Department
 
NBMTF search patterns
byNewport Fire Department
 
GAR Model
byNewport Fire Department
 
NBMTF Communications Overview
byNewport Fire Department
 
NFD Incident Command # 3 Communications
byNewport Fire Department
 
Fire Alarm Control Panel Operations
byNewport Fire Department
 
Fire Officer Detail Training Program
byNewport Fire Department
 
Rope rescue set up
byNewport Fire Department
 

Recently uploaded

PPTX
How to Create SMS Marketing Campaigns in Odoo 18
byCeline George
 
PPTX
Blood, Blood Composition, Blood Groups, Disorders of Blood.pptx
byAshish Umale
 
PDF
BÀI GIẢNG POWERPOINT CHÍNH KHÓA PHIÊN BẢN AI TIẾNG ANH 6 CẢ NĂM, THEO TỪNG BÀ...
byNguyen Thanh Tu Collection
 
PPTX
Report for Prepare Time Management in Odoo 19 POS
byCeline George
 
PPTX
Redox Titration - Oxidation and Reduction
byKhushbu Shah
 
PPTX
special senses-eye, ear, nose, tongue.pptx
byAshish Umale
 
PPTX
Introduction of Carbohydrates - Dr.M.Jothimuniyandi
byJothimuniyandi
 
PPTX
Nanomaterials and its types - Dr.M.Jothimuniyandi
byJothimuniyandi
 
PPTX
When UDL is no longer enough: Examining post-UDL reflections on inclusive des...
byFrederic Fovet
 
PPTX
Complete Overview of Roles in Odoo 18 Planning
byCeline George
 
PDF
Freshman Geography Chapter 7-Population of Ethiiopia
bytfeven44
 
PPTX
VITAMINS CHAPTER NO.05 PHARMACOGNOSY D. PHARMACY
byGanu Gavade
 
PPTX
How to Add or Remove Multiple Followers in a Records
byCeline George
 
PPTX
Electric Charges and Fields 25.pptx notes of lecture 25 by lakshay neet 2026 2.0
byhh3360156
 
PPTX
Ethiopian soil types , degradation and conservation
byMahlet
 
PPTX
Allow Quantity Modification in Combo in Odoo 19 pos
byCeline George
 
PPTX
ANTISEPTICS AND DISINFECTANTS CHAPTER NO.05.pptx
byGanu Gavade
 
PDF
CHUYÊN ĐỀ ÔN LUYỆN TUYỂN SINH 9 LÊN 10 - MÔN TOÁN - CÓ LỜI GIẢI CHI TIẾT - TH...
byNguyen Thanh Tu Collection
 
PPTX
ANTI- RHEUMATICS CHAPTER NO.05 PHARMACOGNOSY
byGanu Gavade
 
PDF
19 January 2026 Andreas Schleicher Digital Education Outlook 2026.pdf
byEduSkills OECD
 
How to Create SMS Marketing Campaigns in Odoo 18
byCeline George
 
Blood, Blood Composition, Blood Groups, Disorders of Blood.pptx
byAshish Umale
 
BÀI GIẢNG POWERPOINT CHÍNH KHÓA PHIÊN BẢN AI TIẾNG ANH 6 CẢ NĂM, THEO TỪNG BÀ...
byNguyen Thanh Tu Collection
 
Report for Prepare Time Management in Odoo 19 POS
byCeline George
 
Redox Titration - Oxidation and Reduction
byKhushbu Shah
 
special senses-eye, ear, nose, tongue.pptx
byAshish Umale
 
Introduction of Carbohydrates - Dr.M.Jothimuniyandi
byJothimuniyandi
 
Nanomaterials and its types - Dr.M.Jothimuniyandi
byJothimuniyandi
 
When UDL is no longer enough: Examining post-UDL reflections on inclusive des...
byFrederic Fovet
 
Complete Overview of Roles in Odoo 18 Planning
byCeline George
 
Freshman Geography Chapter 7-Population of Ethiiopia
bytfeven44
 
VITAMINS CHAPTER NO.05 PHARMACOGNOSY D. PHARMACY
byGanu Gavade
 
How to Add or Remove Multiple Followers in a Records
byCeline George
 
Electric Charges and Fields 25.pptx notes of lecture 25 by lakshay neet 2026 2.0
byhh3360156
 
Ethiopian soil types , degradation and conservation
byMahlet
 
Allow Quantity Modification in Combo in Odoo 19 pos
byCeline George
 
ANTISEPTICS AND DISINFECTANTS CHAPTER NO.05.pptx
byGanu Gavade
 
CHUYÊN ĐỀ ÔN LUYỆN TUYỂN SINH 9 LÊN 10 - MÔN TOÁN - CÓ LỜI GIẢI CHI TIẾT - TH...
byNguyen Thanh Tu Collection
 
ANTI- RHEUMATICS CHAPTER NO.05 PHARMACOGNOSY
byGanu Gavade
 
19 January 2026 Andreas Schleicher Digital Education Outlook 2026.pdf
byEduSkills OECD
 

2017 RI Statewide EMS Protocols Education Modules - Section 4

  • 2.
    Rhode Island Emergency MedicalServices Statewide EMS Protocols October 2016 Rhode Island Department of Health
  • 3.
    Trauma - Environmental- Toxicological Protocols Section 4
  • 5.
    Trauma – Environmental– Toxicological Protocols General Changes and Additions • This is a new section in the EMS protocols • This section has 24 protocols
  • 6.
    Trauma – Environmental– Toxicological Protocols New Protocol Previous Protocol Previous Protocol Section 04.01A Multiple Trauma - Adult 5.1 Trauma Traumatic Emergencies 04.01P Multiple Trauma - Pediatric 5.1 Trauma Traumatic Emergencies 4.02 Head Trauma - Traumatic Brain Injury 5.1 Trauma Traumatic Emergencies 4.03 Spinal Motion Restriction Precautions New – not in previous versions 4.04 External Hemorrhage Control New – not in previous versions 4.05 Extremity and Musculoskeletal Injuries New – not in previous versions 4.06 Traumatic Cardiac Arrest New – not in previous versions 04.07A Thermal - Burn Injury - Adult 5.2 Burns Traumatic Emergencies 04.07P Thermal - Burn Injury - Pediatric 5.2 Burns Traumatic Emergencies 4.08 Chemical and Electrical - Burn Injury 5.2 Burns Traumatic Emergencies 4.09 Crush Injury New – not in previous versions 4.1 Dental Trauma and Emergencies New – not in previous versions 4.11 Ocular Trauma and Emergencies New – not in previous versions
  • 7.
    Trauma – Environmental– Toxicological Protocols New Protocol Previous Protocol Previous Protocol Section 4.12 Heat Related Illness 3.5 Heat Stroke 3.4 Heat Cramps and Heat Exhaustion Environmental Emergencies 04.13A Hypothermia and Localized Cold Injury - Adult 3.1 Cold Exposure - Frostbite 3.2 Cold Exposure - Hypothermia Environmental Emergencies 04.13P Hypothermia and Localized Cold Injury - Pediatric 3.1 Cold Exposure - Frostbite 3.2 Cold Exposure - Hypothermia Environmental Emergencies 4.14 Submersion - Near Drowning 3.3 Drowning Environmental Emergencies 4.15 Diving Emergencies New – not in previous versions 4.16 Marine Envenomation New – not in previous versions 4.17 Bites - Stings - Envenomation New – not in previous versions 04.18A Toxicological Emergencies - General - Adult 3.6 Poisoning and Overdose Environmental Emergencies 04.18P Toxicological Emergencies - General - Pediatric 3.6 Poisoning and Overdose Environmental Emergencies 4.19 Toxicological Emergencies – Nerve Agent or Organophosphate Toxicity New – not in previous versions 4.20 Carbon Monoxide Exposure New – not in previous versions 4.21 Blast Injury - Incident New – not in previous versions 4.22 Radiation Incident New – not in previous versions
  • 8.
    4.01 Adult MultipleTrauma Protocol Summary • Previously protocol 5.1 Trauma. • This protocol recognizes and provides standing orders for adult patient with blunt or penetrating trauma. • This protocol is divided into different levels of care. ALL Providers Levels • Routine Patient Care • Manage life threatening injuries • Treat as per appropriate protocols • Vented chest seal device • Stabilize impaled Objects • Stabilize pelvis as indicated • Normothermia • Limit on scene time to ≤ 10 min • If indicated (≥45 mins to Trauma Center) follow HEMS Protocol • Transport to Level 1 Trauma Center Paramedic • Perform needle thoracostomy for suspected tension pneumothorax
  • 9.
    4.01 Pediatric MultipleTrauma Protocol Summary • Previously protocol 5.1 Trauma. • This protocol recognizes and provides standing orders for pediatric patient with blunt or penetrating trauma. • This protocol is divided into different levels of care. ALL Provider Levels • Routine Patient Care • Manage life threatening injuries • Treat as per appropriate protocols • Vented chest seal device over open penetrating torso injury • Stabilize impaled objects • Stabilize pelvis as indicated • Maintain normothermia • Limit in scene time to ≤ 10 min • If indicated (≥45 mins to Trauma Center) follow HEMS Protocol • Transport to Level 1 Trauma Center Paramedic • Perform needle thoracostomy for suspected tension pneumothorax
  • 10.
    4.02 Head Trauma- Traumatic Brain Injury (TBI) Protocol Summary • Previously protocol 5.1 Trauma. • This protocol recognizes and provides standing orders for adult patient with a history or clinical evidence of blunt or penetrating head trauma. In addition, patients who fell and take anticoagulant/antiplatelet medications. • This protocol is divided into different levels of care. ALL Providers Levels • Routine patient care • Baseline neurologic examination • Evaluate for increased intracranial pressure, manage as indicated per 2.01 Acute Neurologic Event with Evidence of Increased ICP • Provide airway management • Ventilate • Perform blood glucose analysis if AMS • Transport Advanced EMT Cardiac and Paramedic • Manage hypotension as per the age appropriate General Shock and Hypotension Protocol.
  • 11.
    4.03 Spinal MotionRestriction Precautions Protocol Summary • This is a new protocol. • This protocol recognizes and provides standing orders for patients experiencing a mechanism of injury with risk for spinal injury. • This protocol is for all levels of care. ALL Providers Levels • If criteria met, apply spinal motion restriction precautions • If criteria is not met, use the algorithm • Apply cervical collar, supine on cot, secure with belts • Self-extrication allowed • Ambulatory patients may sit, then lie on cot • Scoop and flexible devices to move patients • Long spine boards for extrication and movement • Position patient supine on cot, secure with belts • Manage as per Patient Comfort protocol • Immobilize patients with penetrating trauma only if deficit Pediatric Patients • TRANSPORT IN PEDIATRIC RESTRAINT SYSTEM • Apply padding to cervical collar • Avoid movement • Move from car seat to stretcher ONLY if criteria are met
  • 12.
    4.04 External HemorrhageControl ALL Providers Levels • Routine Patient Care • Apply direct pressure • Liberal use of a tourniquet to achieve hemostasis • Hemostatic agent dressings and devices as needed • Use of a junctional tourniquet • If involving a dialysis fistula/shunt, use digital pressure, if tourniquet application is necessary, apply PROXIMALY as far from the fistula as possible • Manage as per the age appropriate Hemorrhagic Shock Protocol Protocol Summary • This is a new protocol. • This protocol recognizes and provides standing orders for patients with external hemorrhage. • This protocol is for all levels of care.
  • 13.
    4.05 Extremity Traumaand Musculoskeletal Trauma ALL Provider Levels • Routine Patient Care • Manage as per appropriate protocol • Remove rings, bracelets, other constricting items • Care for amputated parts • Splint joint above and below possible fracture • Traction for isolated midshaft femoral fractures • Splint dislocations and angulated fractures in place unless distal circulation is compromised • Binder for pelvic fractures Protocol Summary • This is a new protocol. • This protocol recognizes and provides standing orders for patients with musculoskeletal injury/complaint. • This protocol is divided into different levels of care. Paramedics • CEFAZOLIN 2 mg IV/IO for open fractures/ amputations/grossly contaminated wounds • CEFAZOLIN is contraindicated if history of PCN or cephalosporin allergy
  • 14.
    4.06 Traumatic CardiacArrest ALL Providers Levels • Routine Patient Care • IMMEDIATELY INITIATE CPR • Consider medical etiology • Control external hemorrhage • Binder for suspected pelvic fracture • Transport to Level 1 Trauma Center if <15 minutes Protocol Summary • This is a new protocol. • This protocol recognizes and provides standing orders for patients in cardiopulmonary arrest with presumed traumatic etiology. • This protocol is divided into different levels of care. Advanced EMT Cardiac • LACTATED RINGER’s 1L IV/IO Adult • LACTATED RINGER’s 20 ml/kg Pediatric Paramedic • LACTATED RINGER’s 1L IV/IO Adult • LACTATED RINGER’s 20 ml/kg Pediatric • Perform needle thoracostomy if suspected tension pneumothorax
  • 15.
    4.07 Adult ThermalBurn Injury ALL Provider Levels • Routine Patient Care • Assess burn/concomitant injury severity using Rule of Nines. • Minor burn management • Serious or critical burns management and transport to Burn Center Protocol Summary • Previously protocol 5.2 Burn. • This protocol recognizes and provides standing orders for patients with minor burn, serious burn and critical burn. • This protocol is divided into different levels of care. Advanced EMT Cardiac • Analgesia, IV for minor burns • IVFs for serious or critical burns and transport to Burn Center Paramedic • Analgesia, IV for minor burns • IVFs, airway management for serious or critical burns and transport to Burn Center
  • 16.
    ALL Providers Levels •Routine Patient Care • Assess burn/concomitant injury severity using Rule of Nines. • Minor burn management • Serious or critical burns transport to Burn Center Protocol Summary • Previously protocol 5.2 Burn. • This protocol recognizes and provides standing orders for pediatric patients with minor burn, serious burn and critical burn injuries. • This protocol is divided into different levels of care. Advanced EMT Cardiac • Analgesia for minor burns • Consider IV • IVFs for serious or critical burns Paramedic • Analgesia for minor burns • Consider IV • IVFs for serious or critical burns • Airway management 4.07 Pediatric Thermal Burn Injury
  • 17.
    4.08 Chemical andElectrical Burn Injury ALL Providers Levels • Routine Patient Care • Assess chemical source, utilize HAZMAT resources as needed • Assess electrical source • Assess burn/concomitant injury severity • Decontaminate most chemical burns with liquid • Brush off powdered chemicals • Treat Hydrofluoric Acid burns with calcium gel • Remove non-adherent clothing/rings/constricting items • Manage per the age the appropriate Thermal Burn Protocol and Trauma related protocols. • Transport to Adult Burn Center Protocol Summary • Previously protocol 5.2 Burn. • This protocol recognizes and provides standing orders for patients with partial or full thickness burn injury resulting from contact with a chemical agent or energized electrical source. • This protocol is divided into different levels of care. Advanced EMT Cardiac • Initiate cardiac monitoring Paramedic • Consider IV CALCIUM if hydrofluoric acid and hypocalcemia. • Consider nebulized CALCIUM if HF inhalation
  • 18.
    4.09 Crush Injury ALLProviders Levels • Routine Patient Care • Manage as per Trauma Protocols/Shock Protocols/Hypothermia or Localized Cold Injury Protocols • Remove constricting items • REQUEST ALS response • Analgesia as needed per Patient Comfort Protocol • Transport Protocol Summary • This is a new protocol. • This protocol recognizes and provides standing orders for patients with extremity/body crush, entrapped and crushed under heavy load for > 30 min. • This protocol is divided into different levels of care. Advanced EMT Cardiac • IV NS with SODIUM BICARBONATE during extrication • Manage Cardiac Arrest per appropriate protocol (s) • If ECG suggests hyperkalemia or cardiac arrest occurs, contact MEDICAL CONTROL for administration of CALCIUM CHLORIDE 1 gm IV/IO or CALCIUM GLUCONATE 3 gm IV/IO and SODIUM BICARBONATE 50mEq IV/IO • Albuterol for suspected hyperkalemia Paramedic • Consider IV NS with SODIUM BICARBONATE during extrication • Manage Cardiac Arrest per appropriate protocol(s) • ECG suggestive of hyperkalemia or if cardiac arrest occurs, CALCIUM CHLORIDE 1 gm IV/IO or CALCIUM GLUCONATE 3 gm IV/IO and SODIUM BICARBONATE 50mEq IV/IO • Albuterol for suspected hyperkalemia
  • 19.
    4.10 Dental Traumaand Emergencies ALL Provider Levels • Routine Patient Care • Consider possible cardiac etiology • Manage bleeding with direct pressure during multisystem trauma treatment • Control dental related bleeding with rolled gauze direct pressure • Put avulsed teeth in saline, milk, or commercial solution. Do NOT scrub or cleanse. • Provide analgesia as indicated per the Patient Comfort Protocol • Transport Protocol Summary • This is a new protocol. • This protocol recognizes and provides standing orders for patients with tooth pain or dental injury. • This protocol is for all levels of care.
  • 20.
    4.11 Ocular Traumaand Emergencies ALL Providers Levels • Routine Patient Care • Assess visual acuity • Obtain history • Rigid shield over penetrating ocular injuries • Immobilize impaled objects and patch BOTH eyes • Assess EOM for blunt traumatic injuries, elevate HOB, patch • Moist saline over traumatic enucleation • Irrigate chemical eye injuries with water or LACTATED RINGER’S Protocol Summary • This is a new protocol. • This protocol recognizes and provides standing orders for patients with ocular complaint or injury. • This protocol is divided into different levels of care. Advanced EMT Cardiac • ONDANSETRON for penetrating ocular injuries Paramedic • ONDANSETRON for penetrating ocular injuries • TETRACAINE or PROPARACAINE for ocular flash burns or chemical eye injuries • Irrigate with LACTATED RINGER’S utilizing a Morgan lens • Use pH to guide irrigation
  • 21.
    4.12 Heat RelatedIllness ALL Provider Levels • Routine Patient Care • Measure body temperature • Begin passive cooling • Oral rehydration for heat cramps • Active cooling for heat exhaustion and heat stroke • Transport Protocol Summary • Previously protocols 3.4 Heat Cramps and Heat Exhaustion and 3.5 Heat Stroke. • This protocol recognizes and provides standing orders for patients with heat cramps, heat exhaustion and heat stroke. • This protocol is divided into different levels of care. Advanced EMT Cardiac and Paramedic • IV NS for heat exhaustion and heat stroke
  • 22.
    4.13 Adult Hypothermiaand Localized Cold Injury ALL Providers Levels • Routine Patient Care • Provide airway management • Check pulse 60 seconds if unresponsive • Assess mental status and treat as indicated • Determine body temperature • ≥ 34 – 35°C external rewarming • < 34 – 35°C warmed humidified air or oxygen if available • Avoid refreezing if localized cold thermal injury Protocol Summary • Previously protocols 3.1 Cold Exposure Frost Bite and 3.2 Cold Exposure Hypothermia in Environmental Emergencies. • This protocol recognizes and provides standing orders for adult patients with core temperature < 35°C (95°F) and patients with cold thermal injury (frostbite). • This protocol is divided into different levels of care. Advanced EMT Cardiac and Paramedic • For patients with a core temperature < 34°C (93.2°F), administer warm (40-42°C/104-107°F) NORMAL SALINE 500 ml IV/IO boluses.
  • 23.
    4.13 Pediatric Hypothermiaand Localized Cold Injury ALL Providers Levels • Routine Patient Care • Provide airway management • Check pulse for 60 seconds if unresponsive • Assess mental status and treat as indicated • Determine body temperature • ≥ 34 – 35°C external rewarming • < 34 – 35°C warmed humidified air or oxygen if available • Avoid refreezing localized cold thermal injury Protocol Summary • Previously protocol 3.1 Cold Exposure Frost Bite 3.2 Cold Exposure Hypothermia in Environmental Emergencies. • This protocol recognizes and provides standing orders for pediatric with core temperature < 35°C (95°F) and patients with cold thermal injury (frostbite). • This protocol is divided into different levels of care. Advanced EMT Cardiac and Paramedic • For patients with a core temperature < 34°C (93.2°F), administer warm (40-42°C/104-107°F) NORMAL SALINE 20 ml/kg IV/IO boluses
  • 24.
    4.14 Submersion –Near Drowning ALL Providers Levels • Routine Patient Care • Apply Spinal Motion Restriction Precautions • Manage Cardiac Arrest even after prolonged immersion in cold water • Manage Hypothermia and Local Cold Injury as indicated. • Remove wet clothing, dry and warm the patient. • Provide Airway Management and Altered Mental Status as indicated. • Manage per the age appropriate Respiratory Distress Protocol if indicated • Monitor and reassess the patient. • Transport Protocol Summary • Previously protocol 3.3 Drowning. • This protocol recognizes and provides standing orders for patients submersed in water regardless of depth. • This protocol is for all levels of care.
  • 25.
    4.15 Diving Emergencies ALLProvider Levels • Routine Patient Care • Consult Diver’s Alert Network (DAN) • Analgesia for ear or sinus squeeze • Oxygen and recompression Treatment at HBO Facility for • Pulmonary Overpressure syndrome • Arterial gas embolism • Decompression sickness type I and II • Nitrogen narcosis Protocol Summary • This is a new protocol. • This protocol recognizes and provides standing orders for patients with ear squeeze/sinus squeeze, pulmonary overpressure syndrome, arterial gas embolism, decompression sickness type I and II, Nitrogen Narcosis. • This protocol is divided into different levels of care. Advanced EMT Cardiac and Paramedics • OXYMETAXOLINE or PSEUDOEPHEDRINE for ear or sinus squeeze – Patient Comfort Protocol • IV NS for decompression sickness type II
  • 26.
    4.16 Marine Envenomation ALLProviders Levels • Routine Patient Care • Manage allergic or anaphylactic reactions • Regional Center for Poison Control and Prevention 800-222-1222 • Sting Ray, Lionfish or Urchin/Starfish related injuries • Immobilize injury and object, or remove barb if small • Jellyfish or Man o’ War related injuries • Lift away tentacles • Irrigate with vinegar or sea water NOT fresh water or ice • Treat pain as per the age appropriate Patient Comfort Protocol Protocol Summary • This is a new protocol. • This protocol recognizes and provides standing orders for patients exposed to marine organisms with intense localized pain, nausea/vomiting, allergic reaction or anaphylactic reaction. • This protocol is divided into different levels of care. Paramedic • Manage severe muscle spasm with CALCIUM IV
  • 27.
    4.17 Bite -Stings - Envenomation Protocol Summary • This is a new protocol. • This protocol recognizes and provides standing orders for patients with bee or wasp sting, spider, snake, feline, canine, or human bite. • This protocol is divided into different levels of care. Paramedic • Manage severe muscle spasm with MIDAZOLAM ALL Providers Levels • Routine Patient Care • Manage allergic or anaphylactic reactions • Consider Regional Center for Poison Control and Prevention 800-222-1222 • Spider bites and bee or wasp stings • Elevate, ice, remove constricting jewelry • Snake bites • Immobilize, elevate, remove constricting jewelry • NO ICE • Feline, Canine or Human bites • Wound care • Immobilize • Contact animal control
  • 28.
    4.18 Adult ToxicologicalEmergencies ALL Provider Levels • Routine Patient Care • Recognition symptoms (toxidromes) • OPIOID OVERDOSE • NALOXONE UNTIL ADEQUATE VENTILATION • FOLLOW THE RECOVERY COACH ALGORITHM • CONSIDER CONTACTING THE REGIONAL CENTER FOR POISON CONTROL • ORGANOPHOSPHATE NERVE AGENT or INSECTISIDE manage per appropriate protocol Protocol Summary • Previous protocol 3.6 Poisoning and Overdose. • This protocol recognizes and provides standing orders for patients intoxicated with Beta Blockers/Calcium Channel Blockers, Tricyclic Antidepressants/Sodium Channel blocking agents, Opioids, Organophosphates/nerve agents, and anticholinergics. • This protocol is divided into different levels of care. Advanced EMT Cardiac • NALOXONE for Opioid Overdose until adequate ventilation • SODIUM BICARBONATE for suspected antidepressant or other sodium channel blocking agent toxicity • GLUCAGON or CALCIUM for suspected beta blocker or calcium channel blocker toxicity • HYDROXYCOBALAMIN for suspected Cyanide toxicity • MIDAZOLAM or LORAZEPAM for suspected sympathomimetic/stimulant toxicity • Treat seizures Paramedic • INTRALIPID or NOREPINEPHRINE for antidepressant or other sodium channel blocking agent toxicity • GLUCAGON, CALCIUM or INTRALIPID for beta blocker or calcium channel blocker toxicity • SODIUM THIOSULFATE for Cyanide toxicity • ATROPINE / PRALIDOXIME for organophosphate nerve agent or insecticide exposure • MIDAZOLAM or LORAZEPEM for sympathomimetic/stimulant toxicity • DIPHENHYDRAMINE for dystonic reactions • INTRALIPID for lipid-soluble toxicity cardiac arrest / hemodynamic compromise
  • 29.
    2.17 Obstetrical Delivery4.18Pediatric Toxicological Emergencies ALL Provider Levels • Routine Patient Care • Recognition symptoms (toxidromes) • OPIOID OVERDOSE • NALOXONE UNTIL ADEQUATE VENTILATION • FOLLOW THE RECOVERY COACH ALGORITHM • CONSIDER CONTACTING THE REGIONAL CENTER FOR POISON CONTROL • ORGANOPHOSPHATE NERVE AGENT or INSECTISIDE • DuoDote Protocol Summary • Previous protocol 3.6 Poisoning and Overdose. • This protocol recognizes and provides standing orders for pediatric patients intoxicated with Beta Blockers/Calcium Channel Blockers, Tricyclic Antidepressants/Sodium Channel blocking agents, Opioids, Organophosphates/nerve agents, and anticholinergics. • This protocol is divided into different levels of care. Advanced EMT Cardiac • NALOXONE for Opioid Overdose until adequate ventilation • SODIUM BICARBONATE for suspected antidepressant or other sodium channel blocking agent toxicity • GLUCAGON or CALCIUM for suspected beta blocker or calcium channel blocker toxicity • HYDROXYCOBALAMIN for suspected Cyanide toxicity • MIDAZOLAM or LORAZEPAM for suspected sympathomimetic/stimulant toxicity • Treat seizures Paramedic • INTRALIPID or NOREPINEPHRINE for antidepressant or other sodium channel blocking agent toxicity • GLUCAGON, CALCIUM or INTRALIPID for beta blocker or calcium channel blocker toxicity • SODIUM THIOSULFATE for Cyanide toxicity • ATROPINE / PRALIDOXIME for organophosphate nerve agent or insecticide exposure • MIDAZOLAM or LORAZEPEM for sympathomimetic/stimulant toxicity unless < 5kg • DIPHENHYDRAMINE for dystonic reactions unless < 5 kg • INTRALIPID for lipid-soluble toxicity cardiac arrest / hemodynamic compromise
  • 30.
    2.17 Obstetrical Delivery4.19Nerve Agent or Organophosphate Toxicity ALL Provider Levels • Routine Patient Care • PPE • DuoDote • Adult • Pediatric Protocol Summary • New Protocol • This protocol recognizes and provides standing orders for patient with suspected or know exposure to a nerve or organophosphate agent with salivation, lacrimation, urination, defecation, GI distress, emesis [SLUDGE], muscle twitching, seizures, respiratory arrest), bradycardia, bronchorrhea, and/or bronchospasm. • This protocol is divided into different levels of care. Advanced EMT Cardiac • Manage Seizures as per the age appropriate Seizure Protocol Paramedic • Manage Seizure as per the age appropriate Seizure Protocol • ATROPINE / PRALIDOXIME for organophosphate nerve agent or insecticide exposure
  • 31.
    4.20 Carbon Monoxide ALLProviders Levels • Routine Patient Care • OXYGEN • Treat as outlined in table Protocol Summary • This is a new protocol. • This protocol recognizes and provides standing orders for patients involved in fire or in a confined space/poorly ventilated area with potential for the presence of carbon monoxide (combustion of carbon containing fuels or inadequate ventilation of natural gas). • This protocol is divided into different levels of care. Advanced EMT Cardiac and Paramedic • Cardiac monitoring and multi-lead ECG
  • 32.
    4.21 Blast Injury- Incident ALL Providers Levels • Routine Patient Care • Ensure scene safety. • Determine nature of incident, nature of device, nature of environment, potential for threat of particalization of hazardous materials and distance from blast. • Quantify and triage patients per the Multiple Patient Incident Protocol(s) as indicated. • Manage patient as indicated per age appropriate Trauma and Burn Protocols, Crush Injury Protocol, Radiation Incident Protocol. • Transport Protocol Summary • This is a new protocol. • This protocol recognizes and provides standing orders for Blast explosion occurring in an open space (conventional blast) or enclosed/confined space (vehicle, building, bus, train). • This protocol is divided into different levels of care.
  • 33.
    4.22 Radiation Incident ALLProviders Levels • Routine Patient Care • Ensure scene safety. • If the incident involves a blast, also manage per Blast Incident and Injury Protocol. • Determine need for additional resources, exposure type, quantification of exposure, quantify and triage patients as per the Multiple Patient Incident Protocol as indicated. • Flush contact areas with NORMAL SALINE for 15 minutes. • If present, manage burn injuries as per age appropriate Burn Protocol(s). • Identify and manage any secondary injuries as per appropriate Trauma Protocols. • Transport Protocol Summary • This is a new protocol. • This protocol recognizes and provides standing orders for patients with radiation burn or exposure to radiation. • This protocol is for all levels of care.
  • 34.
    Continue on toRI EMS Protocol Education Modules Section 5