2013draftmemsprotocols062713.pdf

8/14/2019 2013DRAFTMEMSProtocols062713.pdf

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DRAFT Posted 6/27/13Maine Emergency Medical Services

152 State House StationAugusta, Maine 04333

TEL (207) 626-3860 TTY (207) 287-3659FAX (207) 287-6251


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AUTHORIZATION FOR PROTOCOLS

These protocols are issues by the Medical Direction and Practice Board and govern the practice of EMS

licensees by the authority of 32 MRSA 86.2-A. All Maine emergency physicians and the regional EMS

programs were invited to participate in the review and adoption of these protocols through their MEMS

Regional Councils.

The Regional Medical Directors agree that when treatments are adopted in their regions, they will be

consistent with these protocol.

The protocols will be continually reviewed. New or revised protocols will be listed on the Protocol Errataform located on the Maine EMS website.

Kate Zimmerman, D.O., Regional Medical Director Region 1

Rebecca Chagrasulis, M.D., Regional Medical Director Region 2

Timothy Pieh, M.D., Regional Medical Director Region 3

Jonnathan Busko, M.D., Regional Medical Director Region 4

Peter Goth, M.D., Regional Medical Director Region 5

Whitney Randolph, D.O., Regional Medical Director Region 6

Matthew Sholl, M.D., Maine EMS Medical Director

Jay Bradshaw, Maine EMS Director


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Maine EMS Statement on "Rescue" or "Alternate"Airway Devices

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Confirmation and Monitoring of EndotracheallyIntubated Adults

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Adult Airway Algorithm

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17/134

Maine EMS Failed Intubation Algorithm

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18/134

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21/134

Pulmonary Edema (without shock)

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22/134

Chest Pain - General

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23/134

Chest Pain - Suspected Cardiac Origin #1

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24/134

Chest Pain - Suspected Cardiac Origin #2

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Red 3

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20


25/134

ST Elevation Myocardial Infarction (STEMI)

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26/134

Chest Pain Check List

C/. 1M*30 :'() /6 393:*10*D 1'.D('1 /.(@()f ()(0('0* 0M*.':K :*. :./0/1/2 hI*D ! ')D Fjf()129D()@ 0M* *'.2K 93* /6 '3:(.() ')D )(0./@2K1*.() (6 )/0 1/)0.'()D(1'0*De

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27/134

Chest Pain - Uncertain Eitiology

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28/134

Guidelines to the Prehospital Use of 12 Lead EKG bythe ALS Provider

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Red 724


29/134

Cardiac Arrest or Dysrhythmia

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30/134

Termination of Resuscitation #1

I*3931(0'0(/) 3M/92D 5* 0*.H()'0*D 9)D*. 0M* 6/22/B()@ 1(.19H30')1*3`

f'Q.('&//&5 J))&/(Y#e ZM*) 0M* :'0(*)0 .*@'()3 :923*?.*3:(.'0(/)

!e ZM*) 0M* :'0(*)0 .*H'()3 () ' )/)>3M/1V'52* .MK0MH ;-+J /. '3K30/2*8 6/. @.*'0*.0M') !" H()90*3 SI (3 9).*3:/)3(T* 0/ 'DT')1*D 1'.D('1 2(6* 39::/.0 B(0M ' )/)>3M/1V'52* .MK0MH '60*. !" H()90*3 /6 .*3931(0'0(/)e

$e U) 0M* '53*)1* /6 JW,f BM*) 0M* 3'H* &'()* +&, 2(1*)3*D 1.*BH*H5*. M'3D/19H*)0*D 0M* '53*)1* /6 '22 T(0'2 3(@)3 6/. !" H()90*3f () 3:(0* /6 AW,f *[1*:0 () 0M*1'3* /6 MK:/0M*.H('e

Fe ZM*) (..*T*.3(52* 3(@)3 /6 D*'0Mf 391M '3 D*:*)D*)0 2(T(D(0Kf :9:(23 =([*D ')D D(2'0*Df:'2:'52* MK:/0M*.H(' ;)/0 6./H *[:/39.*8 ')D )/ '9D(52* M*'.0 3/9)D3 '.* )/0*D ():'0(*)0 B(0M 9)V)/B) D/B)0(H* /. D/B)0(H* i !" H()90*3e

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$e U) 0M* '53*)1* /6 JW,f BM*) 0M* 3'H* &'()* +&, 2(1*)3*D 1.*B H*H5*. M'3D/19H*)0*D 0M* '53*)1* /6 '22 T(0'2 3(@)3 6/. !" H()90*3f () 3:(0* /6 AW,f *[1*:0 () 0M*1'3* /6 MK:/0M*.H('e

Fe ZM*) 0M* .*319*.3 '.* :MK3(1'22K *[M'930*D /. BM*) *d9'22K /. H/.* M(@M2K 0.'()*DM*'20M 1'.* :*.3/)'2 0'V* /T*.e

Le ZM*) (0 (3 6/9)D 0M'0 0M* :'0(*)0 M'3 '


31/134

Termination of Resuscitation #2

DS H&/8/0.(*(.A& :SS@)(/ *)& 1&)4.'*(&5Y

#e C/193 '00*)0(/) /) 0M* 6'H(2K /. 5K30')D*.3e +[:2'() 0M* .'0(/)'2* 6/. 0*.H()'0(/)e

!e 7/)3(D*. '11*33()@ 39::/.0 6/. 6'H(2K H*H5*.3 0/ :/0*)0('22K ()129D* /0M*. 6'H(2Kf6.(*)D3f /. 3/1('2 39::/.0 391M '3 12*.@Ke

$e U6 0*.H()'0(/) /6 .*3931(0'0(/) /119.3f /)* H930 1/)3(D*. H')'@*H*)0 /6 :'0(*)0

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D(10'0* 0M* 5*30 /:0(/)e I*6*. 0/ :'@* ###f hR.*K Fje U6 d9*30(/)3 .*H'() .*@'.D()@

D(3:/3(0(/) /6 0M* :'0(*)0g3 .*H'()3f .*6*. 0/ SW&7e

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+&,e U0 (3 D')@*./93 0/ 1.*Bf :*D*30.(')3 ')D /0M*. H/0/.(303 0/ '00*H:0 0/.*3931(0'0* ' :'0(*)0 D9.()@ 'H592')1* 0.')3:/.0e U6 1(.19H30')1*3 D/ )/0 '22/B

0*.H()'0(/) /6 .*3931(0'0(/) 6/. 3'6*0K /. /0M*. .*'3/)3f )/0(6K SW&7e

Red 1027


32/134

Post Resuscitation Care #1

:>1#8 &')'@* '(.B'K B(0M @/'2 0/ V**: S! 3'0 @.*'0*. 0M') /. *d9'2 0/ GFl JT/(D

*[1*33(T* T*)0(2'0(/)3 ')D MK:*./[('e &'()0'() T*)0(2'0/.K .'0* 5*0B**)#">#!e

!8 I*d9*30 JW,

J5A*'0&5 :>1$8 -./T(D* 'DT')1*D '(.B'K H')'@*H*)0 (6 ()D(1'0*D ')D ()(0('0* 1':)/@.':MK

(6 'T'(2'52*e JT/(D *[1*33(T* T*)0(2'0(/)e J(H 6/. T*)0(2'0/.K .'0* 5*0B**)#">#! 5.*'0M3 :*. H()90*

F8 S50'() UY '11*33 ')D 0.*'0 MK:/0*)3(/) B(0M =29(D 5/293*3L8 -*.6/.H #! W*'D

%).(.0*+ %*)&3#*)*4&5.0C@*+ jL 7 D5&'(.S< ?1:>DE8 U6 *T(D*)1* /6 ,4+&U :*.3(303 /) #! 2*'Df .*6*. 0/ ,4+&U :./0/1/2 ')D 6/22/B

2/1'2 ,4+&U .*6*..'2 :'00*.)3

C@*+ jI 7 J;;)&//.A& >*'*;&4&'( @S U"e!L H1@?V@?H()e X39'2 H'[ D/3* (3 "eE H1@?V@?H()e J53/290* H'[ D/3* (3 $H1@?V@?H()e

5e 4(0.'0* 0/ H'()0'() 3K30/2(1 A- @.*'0*. 0M') #"" HH ]@e1e \SI+-U\*:M.()* ()693(/)3 () 'D9203 ')D :*D('0.(13 H930 5*

'DH()(30*.*D T(' ' &'()* +&, '::./T*D H*D(1'0(/) :9H:e

C@*+ jR 7 %@'/.5&) 12&)*9&8(.0 U


33/134

Post Resuscitation Care #2

U6 -'0(*)0 H**03 ()1293(/) 1.(0*.(' 6/. 0M*.':*90(1 MK:/0M*.H('f 1/)3(D*. 0M*6/22/B()@`

G8 I*1/.D 5'3*2()* 0*H:*.'09.*

#"8 J::2K 1/2D :'1V3 0/ '[(22'f @./()f ')D )*1V##8 7/2D )/.H'2 3'2()* ;F D*@.**3 7 vF" D*@.**3 Cw8 5/293 $" H2?V@ 0/ H'[ /6

!""" H2e ,'2()* H930 5* 1//2*D 0/ 0M* '5/T* :'.'H*0*.3e

DS ?2.A&).'; =&A&+@9/Y

#!8 &(D'^/2'H !eL H@ UY H'K .*:*'0 /)1* *T*.K L H()90*3 0/ ' H'[ /6 #" H@f/.s L H@ U&f H'K .*:*'0 /)1* () #" H()90*3 0/ ' H'[ /6 #" H@e

#$8 U6 :'0(*)0 3966*.3 2/33 /6 3:/)0')*/93 1(.192'0(/) ')D .*>'..*303f .*6*. 0/'::./:.('0* @9(D*2()*

Red 12

-

!"#$%& ()* !)7- $1747/8-.6)+ 9.*1:

?= ]+3$7(&'$( ,(4 )-+,)K+() $0 , `A@SO ,-+ 3-&'3,< &( )*+ 8$%)

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,88-$8-&,)+ 0,3&--+(3+%: I2$&4 */8+-)*+-K&, ,(4*/8+-2+('


34/134

Ventricular Fibrillation/Pulseless Ventricular Tachycardia#1

:>1#8 7M*1V -923*f (6 )/ :923* 0M*)` 'e 7-I 9)0(2 J+< (3 'T'(2'52* 5e J)'2K^* B(0M J+

I*3931(0'0(/) -./0/1/2 rI*D ##r '3 )*1*33'.K

J=FJG%:= :>1E8 7/)0()9* 7-I 6/. ! H()90*3 (6 )/ :923* (3 :.*3*)0e J60*. ! H()90*3f :*.6/.H

:923* ')D J+


35/134

Ventricular Fibrillation/Pulseless Ventricular Tachycardia#2

#L8 +:()*:M.()* #`#"f""" # H@ UY?US :93Mx.*:*'0 *T*.K $>L H()90*3#E8 R(T* ! H()90*3 /6 7-If 0M*) D/ .MK0MH ')D :923* 1M*1V3 Q D*=(5.(22'0* n #

'0 $E"u ;H/)/:M'3(18 /. *d9(T'2*)0 5(:M'3(1 (6 YC /. Y4#N8 JH(/D'./)* $"" H@ UY?US :93Mf H'K 1/)3(D*. 'DD(0(/)'2 #L" H@ UY?US

/)* 0(H*#O8 R(T* ! H()90*3 /6 7-If 0M*) D/ .MK0MH ')D :923* 1M*1V3 Q D*=(5.(22'0* n #

'0 $E"u ;H/)/:M'3(18 /. *d9(T'2*)0 5(:M'3(1 (6 YC /. Y4#G8 R(T* ! H()90*3 /6 7-If 0M*) D/ .MK0MH ')D :923* 1M*1V3 Q D*=(5.(22'0* n #

'0 $E"u ;H/)/:M'3(18 /. *d9(T'2*)0 5(:M'3(1 (6 YC /. Y4

!"8 7/)0'10 SW&7 6/. S-4US\ /6 '20*.)'0* 0M*.':(*3 391M '3 3/D(9H5(1'.5/)'0*

!#8 X:/) 3911*33692 I*09.) /6 ,:/)0')*/93 7(.192'0(/)` 'e I*6*. 0/ -/30>I*3931(0'0(/) 7'.* :./0/1/2 :'@* !Of rI*D ##r 5e 7/)0'10 SW&7 6/. /:0(/)3 /6` (e -/30 .*3931(0'0(/) 'H(/D'./)* 5/293 ((e -/30 .*3931(0'0(/) 'H(/D'./)* D.(:

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D*@.** 4K:* UU JY 52/1Vf $.D

D*@.** JY 52/1Vf /. :./2/)@*D o4U)0*.T'2 ;@.*'0*. 0M') "eL 38

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mm,** J(.B'K J2@/.(0MH -./0/1/2` hA29* $ ')D Lj 1/)3(D*. 5'3(1 H*'39.*3 /)2K;()129D()@ AY& ')D \-J /. S-J8 B(0M ' T*)0(2'0/.K .'0* /6 O>#! 5.*'0M3?H() 9)0(2 IS,7e

Red 14

-

31


36/134

Wide Complex Tachycardia (probable VT)If no pulse, treat as VF/Pulseless VT

#8+/& D/ #)&/&'(

Red 15

B@) #@+1$e +30'52(3M UY?USFe 7'.D('1 H/)(0/.?-*.6/.H #! 2*'D +bR (6

'T'(2'52*Le I*d9*30 7.(0(1'2 7'.*?-'.'H*D(1Ee J+< /. H')9'22K D*=(5.(22'0* [ # '0 $E" u

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%).(.0*+ %*)&3#*)*4&5.0Oe 7/)3(D*. 3K)1M./)(^*D 1'.D(/T*.3(/)`'e 7/)3(D*. 3*D'0(/) B(0M H(D'^/2'H $ H@

UY?US /. 6*)0')K2 # H1@?V@ UY?US 0/ H'[/6 #"" H1@ () ()(0('2 D/3*

5e U6 9)'52* 0/ 3K)1 /. () 0M* 1'3* /6 :'0(*)0()30'5(2(0K /. :/2KH/.:M(1 Y4f D*=(5.(22'0*[ # '0 $E" u /. *d9(T'2*)0 5(:M'3(1

7/)0'10 SW&7 6/. 69.0M*. /:0(/)3 ()129D()@'H(/D'./)* D.(:

]*'.0 I'0* (3 @.*'0*. 0M') #L" ')D :'0(*)0(3 '2*.0f 1/H6/.0'52* ')D )/0 MK:/0*)3(T*

:>1#e J(.B'K &')'@*H*)0 '3 ()D(1'0*D!e I*d9*30 JW,

J=FJG%:= :>1$e +30'52(3M UY?USFe 7'.D('1 &/)(0/.?-*.6/.H #! W*'D +bR (6

'T'(2'52*Le I*d9*30 7.(0(1'2 7'.*?-'.'H*D(1Ee 7/)0'10 SW&7

%).(.0*+ %*)&3#*)*4&5.0Ne U) X\


37/134

Asystole

,M/92D 5* 1/)=(.H*D () 0B/ 2*'D3e U6 .MK0MH (3 9)12*'. ')D :/33(52*T*)0.(192'. =(5.(22'0(/) ;YC8f 0M*) 0.*'0 '3 YCe

:>1

#8 7M*1V -923*f (6 )/ :923* 0M*)` 'e 7-I 9)0(2 J+< (3 'T'(2'52* 5e J)'2K^* B(0M J+

I*3931(0'0(/) -./0/1/2 rI*D ##r '3 )*1*33'.K

J=FJG%:= :>1L8 7/)0()9* 7-I 6/. ! H()90*3f (6 )/ :923* (3 :.*3*)0 :*.6/.H :923* ')D J+


38/134

Pulseless Electrical Activity

:>1#8 7M*1V :923*f (6 )/ :923* 0M*)` 'e 7-I 9)0(2 J+< (3 'T'(2'52* 5e J)'2K^* B(0M J+1F8 7/)0()9* 7-I 6/. ! H()90*3f (6 )/ :923* (3 :.*3*)0f J60*. ! H()90*3f

:*.6/.H :923* ')D J+


39/134

Bradycardia #1(Heart Rate Less Than 50 Beats per Minute)

1$;'5:;&;= >&=;! $: >"67#$6!` A2//D :.*339.* 2*33 0M') #"" HH ]@f '20*.*DH*)0'2 30'093f 3K)1/:*?:.*>3K)1/:*f 1M*30 :'()f DK3:)*'f /. 1K')/3(3?:'22/.e

J8 U6 \S 1/)1*.)()@ 3(@)3 /. 3KH:0/H3f 0M*) '22 2*T*23 ;+&4?JDT')1*D +&4?

7.(0(1'2 7'.*?-'.'H*D(18 H'K D/ 0M* 6/22/B()@`

#8 S!'3 '::./:.('0*

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A8 U6 J\a 1/)1*.)()@ 3(@)3 /. 3KH:0/H3f 0M*)`

:>1#8 S!'3 '::./:.('0*

!8 I*d9*30 JW,

J=FJG%:= :>1$8 UY *) ./90*F8 7'.D('1 H/)(0/.L8 7'22 6/. 7.(0(1'2 7'.*?-'.'H*D(1 A'1V>9:?U)0*.1*:0

%HD1D%J- %JH: 3 #JHJ>:=D%E8 J0./:()* "eL H@ UY?USmfmms @(T* () .*:*'0 D/3*3 *T*.K $>L H()90*3 9: 0/ '

H'[(H9H D/3* /6 "e"F H@?V@mm ;/. 9: 0/ ' 0/0'2 /6 $ H@ () 0M* 'D920:'0(*)08N8 J::2K *[0*.)'2 :'1*.xU)(0('0* 0.')3190')*/93 :'1()@ ;47-8 6/. :'0(*)03

BM/ D/ )/0 .*3:/)D 0/ '0./:()*s (6 3*.(/93 3(@)3 /. 3KH:0/H3f D/ )/0 D*2'K47- BM(2* 'B'(0()@ UY?US '11*33 /. 6/. '0./:()* 0/ 0'V* *66*10e 7/)3(D*.:.*H*D(1'0()@ B(0M H(D'^/2'H ;Y*.3*D8 $ H@ UY?US SI 6*)0')K2 # H1@?V@UY?US 0/ ' H'[(H9H =(.30 D/3* /6 #"" H1@e \/0(6K SW&7 '3 3//) '3:/33(52*e

O8U6 1/)0()9*D ,(@)3 /. 3KH:0/H3f 0M*) 1/)0'10 SW&7 6/. /:0(/)3 /6 0M*

6/22/B()@` 'e I*:*'0 '0./:()* 5e \SI+-U\*:M.()* ;O H@ () !L" H2 \,8e ,0'.0()@ D/3* "e"$ H1@?V@?H()e

4(0.'0* 5K "e"$ H1@?V@?H() *T*.K $>L H()90*3e X39'2 D/3* (3 "e"$>"e!LH1@?V@?H()e X39'2 H'[ D/3* (3 "eE H1@?V@?H()e J53/290* H'[ D/3* (3$ H1@?V@?H()e 4(0.'0* 0/ H'()0'() 3K30/2(1 A- @.*'0*. 0M') #"" HH ]@e\SI+-U\*:M.()* ()693(/)3 H930 5* 'DH()(30*.*D T(' ' &'()* +&,'::./T*D H*D(1'0(/) :9H:e

Red 18

+

J

-

35

+ J -


40/134

Bradycardia #2(Heart Rate Less Than 50 Beats per Minute)

Red 19

-

!"#$%& ()*


41/134

Narrow Complex Tachycardia

\S4+` C/. '22 1'3*3f '00*H:0 0/ (D*)0(6K ')D 0.*'0 0M* 9)D*.2K()@ 1'93* /6 0M* :'0(*)0g30'1MK1'.D(' BM(1M H'K ()129D*f H'[(H(^()@ /[K@*)'0(/) /. ;6/. JDT')1*D +&4g3?7.(0(1'27'.*?-'.'H*D(138 H'[(H(^()@ M*H/DK)'H(13e U6 9)1*.0'()0K *[(303 5*0B**) 3()930'1MK1'.D(' ')D ,Y4f :2*'3* 1/)0'10 SW&7e

Red 20

]*'.0 .'0* (3 @.*'0*. 0M') #L" ')D :'0(*)0(3 MK:/0*)3(T*f M'3 '20*.*D 30'0* /61/)31(/93)*33f *T(D*)1* /6 3M/1Vf

(31M*H(1 1M*30 :'()f /. *T(D*)1* /6 M*'.06'(29.*

:>1#e &')'@* '(.B'K '3 ()D(1'0*D!e I*d9*30 JW,

J5A*'0&5 :>13%).(.0*+ %*)&$e +30'52(3M UY '11*33 ')D :*.6/.H =29(D

5/293Fe 7'.D('1 &/)(0/.?-*.6/.H #! 2*'D +bR (6

'T'(2'52*Le I*d9*30 -'.'H*D(1

#*)*4&5.0n: I'0* 1/)0./2 6/. J C(5?J C2900*. S\Waf

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:>1#e &')'@* '(.B'K '3 ()D(1'0*D!e I*d9*30 JW,

J5A*'0&5 :>1$e +30'52(3M UY '11*33

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U6 .MK0MH :*.3(303f 1/)0'10 SW&7 6/.69.0M*. /:0(/)3

37


42/134

Cardiogenic Shock

:>1#e S! '3 '::./:.('0*!e I*d9*30 JW,

J=FJG%:= :>1$e 7'.D('1 H/)(0/.Fe UY *) ./90*Le 7'22 6/. 7.(0(1'2 7'.* ? -'.'H*D(1 A'1V>9: ? U)0*.1*:0

Ee 7/)0'10 SW&7 B(0M 6/22/B()@ ()6/.H'0(/)`Y(0'2 3(@)3f 29)@ 3/9)D3f 1'.D('1 .MK0MHf :*D'2 *D*H' '33*33H*)0 6/. S-4US\SC` 'e C29(D 5/293

%HD1D%J- %JH: 3 #JHJ>:=D%Ne C29(D 5/293

q: 7/)0'10 SW&7 6/. 0M* 6/22/B()@ S-4US\`

'e \SI+-U\*:M.()*` .M #)&9*)*(.@' k H([ \SI+-U\*:M.()* O H@ () !L" H2 \,e

..M =@/.'; 7,0'.0()@ D/3* (3 \SI+-U\*:M.()* "e"$ H1@?V@?H()e 4(0.'0*5K "e"$ H1@?V@?H() *T*.K $>L H()90*3e X39'2 D/3* (3 "e"$>"e!L H1@?

V@?H()e X39'2 H'[ D/3* (3 "eE H1@?V@?H()e J53/290* H'[ D/3* (3 $H1@?V@?H()e

5e 4(0.'0* 0/ H'()0'() 3K30/2(1 A- @.*'0*. 0M') #"" HH ]@e1e \SI+-U\*:M.()* ()693(/)3 () 'D9203 ')D :*D('0.(13 H930 5*

'DH()(30*.*D T(' ' &'()* +&, '::./T*D H*D(1'0(/) :9H:e

Red 21

+

J

-

38


43/134

Syncope

:>1Y#e S50'() M(30/.K ;3*(^9.*f 30./V*f =29(D 2/33f :'2:(0'0(/)3f 1M*30 :'()f D(^^Kf0.'9H'8 7/)3(D*. 3:()'2 (HH/5(2(^'0(/) (6 '::./:.('0*!e S!'3 '::./:.('0*

$e S50'() 52//D @291/3* (6 0.'()*DFe 4.*'0 6/. 3M/1V (6 '::./:.('0*Le I*d9*30 JW,

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Red 22

+

J

-

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39


44/134


45/134

Allergy/Anaphylaxis #2

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5e -*D('0.(1` !H@?V@ UYf 0/ ' H'[(H9H D/3* /6 #!L H@ UY1e 7/)3(D*. @291'@/) # H@ UY d L H()90*3 6/. :'0(*)03 0'V()@ 5*0'>

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46/134

Adult Coma #1(Decreased Level of Consciousness)

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J=FJG%:= :>1Ee &')'@* '(.B'K '3 '::./:.('0* ,** hA29* $ P LjNe UY *) ./90*Oe


47/134

Adult Coma #2(Decreased Level of Consciousness)

#$e U6 .*3:(.'0(/)3 2*33 0M') #! :*. H()90* J\< )'.1/0(1 /T*.D/3* 393:*10*D 'e \'2/[/)* ;\'.1')8 "e# Q ! H@ UY?US?U& /. ()0.')'3'2 ;H'K /:0 0/ @(T* !

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1e S)1* '(.B'K H')'@*D 5K +44 /. AUJ


48/134


49/134

Adult Seizures #1

:>1#e &')'@* '(.B'K '3 '::./:.('0*!e W*60 2'0*.'2 .*19H5*)0 :/3(0(/) ')D :./0*10 :'0(*)0 6./H ()c9.K$e ,:()'2 (HH/5(2(^'0(/) (6 ()D(1'0*D ,** :'@* LG ,:()* J33*33H*)0

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'::./T*D 0*1M)(d9*?D*T(1* 2(H(0*D 0/ :./T(D*.3 BM/ M'T* 1/H:2*0*D0M* &+&, AR H/)(0/.()@ 0.'()()@ :./@.'H

J=FJG%:= :>1Ee &')'@* '(.B'K '3 )**D*D ,** hA29* $ P LjNe 7'.D('1 H/)(0/.Oe UY *) ./90*Ge


50/134


51/134

Acute Stroke #1

,0./V* 3M/92D 5* 393:*10*D (6 ')K /6 0M* 6/22/B()@ M'T* '::*'.*D () 0M* 2'30

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Le UY *) ./90*

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52/134

Acute Stroke #2

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9B 1&;'&;;9#& 2:58$!7% >#:$C5 >'9%5` .M ?9&&02Y ]'T* :0e 30'0* ha/9 1')g0 0*'1M ') /2D D/@ )*B 0.(1V3j #e J5)/.H'2 z B./)@ B/.Df 329..*Df /. '53*)0 3:**1M ..M B*0.*+ 5)@@9 BM*) '3V*D 0/ 3M/B 0**0M /. 3H(2* #e J5)/.H'2 z /)* 3(D* D/*3 )/0 H/T* '3 B*22 '3 /0M*. ...M >@(@)Y ]'T* :'0(*)0 12/3* *K*3 ')D M/2D /90 5/0M '.H3 #e J5)/.H'2 z '.H 1'))/0 H/T* /. D.(603 D/B) BM*) M*2D /90

5e J23/ '33*33 -&A&+ @S 0@'/0.@8/'&// .M J5)/.H'2 z 2*0M'.@(1f 309:/./93f 1/H'0/3*

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53/134


54/134

Medical Shock #1

1#e J00*H:0 0/ (D*)0(6K 1'93* ;(e*e '22*.@(1 .*'10(/)8!e &')'@* '(.B'K '3 '::./:.('0*$e I*d9*30 JW, ()0*.1*:0Fe 4.')3:/.0

,** :'@* $O 7'.D(/@*)(1 ,M/1V rI*D !#r (6 '::./:.('0*

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,** :'@* #! JD920 J(.B'K J2@/.(0MH rA29* $r (6 '::./:.('0*

50


55/134

Medical Shock #2

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'e &'33(T* RU 52**Df T'@()'2 52**D()@f T/H(0()@f D('..M*'f .9:09.*D')*9.K3H > 4.*'0 :*. ]K:/T/2*H(1 ,M/1V -./0/1/2

5e 7'.D(/@*)(1 ,M/1V -./0/1/2 1e J)':MK2'[(3 -./0/1/2 De ,*T*.* ,*:3(3 (e J33*33 6/. '190* :92H/)'.K *D*H'e U6 :.*3*)0f .*6*. 0/ :'@* $O

1'.D(/@*)(1 3M/1V rI*D !#r ((e U6 'T'(2'52* ')D 0.'()*D :*.6/.H :/()0 /6 1'.* 2'10'0*` Je U6 -S7 2'10'0* i F ')D )/ *T(D*)1* /6 :92H/)'.K *D*H'f 'DH()(30*.

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Gold 12

J

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51


56/134

Abdominal Pain

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Gold 13

+

J

-

52


57/134

Nausea and Vomiting

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58/134


59/134

Minimum Landing Zone (LZ) Area #2

Green 2

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55


60/134


61/134

Trauma Triage Protocol #2(Patient with Blunt or Penetrating Trauma)

Green 4

J,,+,,&+\4 p$J,,+,, &+7]J\U,& SC U\uXIa J\< +YU


62/134


63/134


64/134

Glasgow Coma Scale

Green 7

J58+( #&5.*().0 ?0@)&

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65/134

Chest Trauma

Green 8

:>1#e S!'3 '::./:.('0*!e J33(30 T*)0(2'0(/)3 ;--Y8 (6 )**D*D

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J

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61


66/134

Hemorrhage

Green 9

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67/134


68/134

Hypovolemic Shock #1

Green 11

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Hypovolemic Shock #2

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71/134


72/134


73/134

Pain Management In Trauma #2

Green 16

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69


74/134

Prehospital Termination of Resuscitation For TraumaticCardiac Arrest (Adult and Pediatric)

Green 17

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76/134


77/134

Toxins #3

Yellow 3

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78/134


79/134

Antidotes for Specific Toxins:Opiates

Yellow 5

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5e \S4+` -'0(*)03 '5.9:02K ')D 6922K 'B'V*)*D 6./H )'.1/0(1 /T*.D/3* H'K5*1/H* 1/H5'0(T* /. 3966*. '190* )'.1/0(1 B(0MD.'B'2 3KH:0/H3e ,/H*D.9@3 391M '3 :./2/)@*D .*2*'3* /:(/(D3f 59:.*)/.:M()* /. H*0M'D/)*H'K .*d9(.* D/3*3 @.*'0*. 0M') F H@e

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80/134


81/134


82/134

Hypothermia #2

Yellow 8

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83/134

Hyperthermia - Heat Exhaustion

Yellow 9

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.*30 () ' 1//2f 3M'DK :2'1*e!e S.'2 =29(D3 1') 5* *66*10(T* (6 0M* :'0(*)0 (3 )/0 T/H(0()@e X3* D(290* ;2*33

0M') Ll 39@'.8 =29(D3 @(T*) () 3H'22 3(:3e J::./:.('0* =29(D3 0/ 93* ()129D*0M* Z/.2D ]*'20M S.@')(^'0(/)g3 S.'2 I*MKD.'0(/) ,/290(/) SI 'hM/H*H'D*j 3/290(/) 93()@ # 0*'3://) /6 3'20 ')D O 0*'3://)3 /6 39@'. :*.

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79


84/134

Hyperthermia - Heat Stroke

Yellow 10

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)*1V () 1/2D B'0*. 5e J23/ 1/)3(D*. )/)>.'D(1'2 1//2()@ BM(1M ()129D*3f U1* :'1V3f B*0 :'0(*)0f

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85/134

Ophthalmology

Yellow 11

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!e U6 )/ :*)*0.'0()@ *K* 0.'9H' ')D (6 0M* :'0(*)0 M'3 )/ '22*.@K 0/ 2/1'2')*30M*0(13` JDH()(30*. ! D./:3 0*0.'1'()* /:M0M'2H/2/@(1 D./:3 *T*.K LH()90*3 '3 )**D*D 0/ '66*10*D *K* 0/ 6'1(2(0'0* *K* =293M()@e 4M(3 H'K 5*.*:*'0*D 6/. ' 0/0'2 /6 0M.** D/3*3e C/. 69.0M*. D/3()@f :2*'3* 1/)0'10H*D(1'2 1/)0./2e'e 4M(3 (3 0/ 5* :./T(D*D 5K 0M* 7.(0(1'2 7'.* ?-'.'H*D(1?:./T(D*. /)2K ')D

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81


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Combative Patient Protocol

Yellow 12

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@291/3* (3 2*33 0M') O" H@?DWf *30'52(3M UY ')D 'DH()(30*. D*[0./3* !L @H;L" H2 /6 L"l 3/290(/) UY /. !L" H2 /6 #"l 3/290(/) UY8e I*1M*1V 52//D@291/3* () L H()90*3e

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Ee 7/)3(D*.` H(D'^/2'H ;Y*.3*D8 F H@ Q #" H@ U& 6/. :'0(*)0 3'6*0K ')D

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7/)0'10 SW&7 6/. D/3()@ d9*30(/)3 /. (6 :'0(*)0 .*d9(.*3 .*:*'0 D/3()@e

82


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88/134

Known or Suspected Cyanide Exposure #2

Yellow 14

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89/134


90/134


91/134

Pediatric Nausea and Vomiting

Pink 2

+

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92/134

Pediatric Traumatic Pain Management #1

Pink 3

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93/134

Pediatric Traumatic Pain Management #2

Pink 4

+ J

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89


94/134

Pediatric Coma #1(Decreased Level of Consciousness)

Pink 5

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Pediatric Respiratory Distress with Wheezing

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102/134

Pediatric Diabetic Emergencies

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Pediatric Medical Shock #1

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Pediatric Medical Shock #2

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106/134

Pediatric Cardiac Arrest Medication Dosages

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APGAR Score

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Neonatal Resuscitation

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Normal Pediatric Vital Signs

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112/134

Do Not Resuscitate (DNR) Guidelines #1

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115/134

Death Situation Guidelines for Emergency Responders#1

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Death Situation Guidelines for Emergency Responders#2

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2013draftmemsprotocols062713.pdf

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