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EMS Protocols
INTRODUCTION
The following protocols have been written to unify and simplify the roles of the various levels of EMS personnel in the field. The format has been written to provide historical information, as well as step-wise care instructions. The EMS provider is expected to be responsible for all the steps in the delivery of care up to the level of training they hold.
For example, an EMT Intermediate is expected to have followed all outlined care up to and including the EMT Intermediate section. If your specific endorsement level is not listed you are expected to practice up to the next lower level of skill AND NOT BEYOND. Protocols have been structured around the New 2006 State of Montana EMS protocols, Current ACLS protocols, ATLS protocols, PALS protocols and the most recent medical literature. The protocols have been reviewed and edited by area medical directors and specialist in specific categories. These protocols represent a template for the care of the sick and injured and in no way should be used like a cookbook approach. The care of a patient requires individualized clinical assessment and treatment. The EMS provider should always administer rapid assessment, treatment, and expedient transport to the hospital. Scene times are to be kept to a minimum. Gregory J. Moore, MD, FACEP Chairman Department of Emergency Medicine CMC Medical Director MESI, MFD, MRFD, MCAA, AERIE, FVFD, CVFD, Potomac QRU Kari Jones, MD Pediatric Intensivist Kristin Janczewski, MD Trauma Director CMC Craig McCoy, MD Obstetrics These protocols were written for EMS Services under the direction of Gregory J. Moore, MD FACEP.
Unauthorized replication or use of these protocols without written consent is prohibited. Permission may be
obtained by contacting the author.
ESSENTIAL LIFE SUPPORT
General EMS Principals………………………………………………………………………… 2-3 MEDICAL EMERGENCIES
Chest Pain: Suspected Myocardial Infarction…………………………………………………20-21 Acute Coronary Syndrome algorithm……….……………………………………………….22 Congestive Heart Failure/Pulmonary Edema .23 Adult BLS algorithm………………………………………………………………………….25 Bradycardic algorithm…………………………………………………………………………27 MEDICAL EMERGENCIES (continued)
CVA algorithm……………………………………………………………………………….42 Stroke Score…………………………………………………………………………………….43 Seizure Disorder……………………………………………………………………………….44-45 Carbon Monoxide Poisoning and Lime Poisoning.…49-50 OBSTETRICAL EMERGENCIES
PEDIATRIC EMERGENCIES
Intravenous and Intraosseous Access.…66 Cardiac Emergencies - Pulseless Arrest.….67 Pediatric Tachycardia…………………….………………………………………………………….69 Neonatal resuscitation…………………….…………………………………………………………70 Pediatric BLS algorithm…………………………………………………………………………….71 Diabetic Ketoacidosis and Hypoglycemia .….74 Pediatric Patient with Altered Level of Consciousness .….79 Algorythm……………………………………………………………………………………………84 INFECTION CONTROL
Universal Precautions/Personal Protective Equipment.….108-109 Ambulance Equipment Weekly Cleaning Checklist.….113 Tuberculosis Exposure Control Plan .….115 Exposure Plan……………………………………………………………………………………….116 Specific Disease Prophylaxis…………………………………………………………………………117-122 Hepatitis A………………………………………………………………………………….117 Hepatitis B……………………………………………………………………………………….118 Work Restrictions for Health Care Workers with Communicable Diseases .….123-125 HIV and/or HBV Infected Health Care Workers .….124 PHARMACY
Acetylsalicylic acid (Aspirin)……………………………………………………………………….129 Charcoal………………………………………………………………………………………….134 Fentynl……………………………………………………………………………………………….140 Glucagon…………………………………………………………………………………………….142 Ipratropium (Atrovent)……………………………………………………………………………….143 Methylprednisolone (Solu-Medrol) .….147 Midazolam (Versed)………………………………………………………………………………….148 Vasopressin……………………………………………………………………………………………157 SPECIAL CONSIDERATIONS
CRITICAL CARE TRANSPORT STANDING ORDERS 172-183
Pediatric ALS Orders General…………………………………………………………………….173-174 Pediatric Airway Orders……………………………………………………………………………175 Pediatric Head trauma Orders………………………………………………………………………176 Pediatric Ventilation Orders……………………………………………………………………….177 Pediatric Trauma Orders…………………………………………………………………………….178 Pediatric Respiratory Orders……………………………………………………………………….179 Pediatric RSI……………………………………………………………………………………….180 Pediatric Seizure Orders…………………………………………………………………………….181 Adult General Orders……………………………………………………………………………….182 Adult RSI Orders…………………………………………………………………………………….183

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