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  • Patient Treatment Protocols

    Bradley J. England, EMT-P Executive Director

    Levon Vartanian, MD

    Medical Director

    CCEMS ALL RIGHTS RESERVED

    2006

  • INTRODUCTION 072006 ________________________________ Approved: Levon Vartanian, MD

    PROTOCOLS

    This manual is divided into the following sections: Introduction, Adult, Pediatric, Procedures, and a Medication

    reference. Each treatment protocol defines the required assessments, required treatments, and any available

    treatment options the In Charge Paramedic (ICP) will use in handling each particular situation.

    GENERAL STATEMENT

    The following protocols are meant to serve as general guidelines in patient care. It is impossible to

    outline treatment sequences for every situation you will run across. Each patient should be treated

    individually and appropriately, utilizing sound judgment, along with the protocols as general guidelines.

    The receiving hospital should be notified as soon as possible; however, this should not interfere with

    patient care. Each patient chart should be thoroughly documented.

    GENERAL RULES FOR FOLLOWING PROTOCOL

    1. If a dysrhythmia is to be treated, do so in the following order:

    First: Treat Rate

    Second: Treat Rhythm

    Third: Treat Blood Pressure

    NOTE: If low blood pressure and dysrhythmia are due to low intravascular volume without uncontrollable hemorrhage, Normal Saline infusion (rapid) may be used first.

    2. If a patient converts to another treatable rhythm after an intervention, refer to that appropriate protocol.

    3. The antiarrhythmic medication that initially converts a lethal dysrhythmia is the medication you should start with if the patient converts back to that lethal dysrhythmia.

    4. Protocols may overlap with one another.

    5. When a patient changes from one algorithm to another algorithm, do not administer more than the maximum total dose of a medication.

    6. Some protocols and drug dosage ranges are taught as absolutes. However, sound medical judgement, based on the individual patient, must also be used.

    CCEMS

  • INTRODUCTION 07/2006 ________________________________ Approved: Levon Vartanian, MD

    STANDARD OF CARE STATEMENT Clinical competence and high standards are vital functions in providing quality prehospital emergency

    medical care to the customers who rely on our services. The treatment protocols represent the minimum level

    of patient care that is to be provided upon request for service. Cypress Creek EMS will always provide the

    highest quality of care that has come to be expected by the people to which we provide service.

    CCEMS embraces, as fundamental components of its standard of care, the following concepts:

    The emergent patient benefits from early medical interventions, especially the early and aggressive application of airway establishment and maintenance, early administration of oxygen, early protection

    of the cervical spine, and early initiation of definitive therapies.

    The patient defines the emergency. As EMS personnel, we are often called upon to assist with social

    or psychological problems and we must respond as professionally and thoroughly to these as we do

    for medical or surgical problems.

    Our role as EMS personnel is to act as the eyes, ears, and hands of the physician. To successfully

    do so requires that we educate ourselves beyond first aid procedures and dedicate ourselves to

    being an integral part of the total health care team.

    CCEMS

  • ________________________________ Approved: Levon Vartanian, MD

    INTRODUCTION 07/2006

    CCEMS

    DELEGATION OF MEDICAL PRACTICE

    As a physician licensed to practice medicine in the State of Texas, and as the physician Medical Director for Cypress Creek EMS, I hereby authorize the following: Emergency Care Attendant: Those Members of Cypress Creek EMS that are certified as an Emergency Care Attendant by the Texas Department of State Health Services, and while operating as a Member in good standing with Cypress Creek EMS, may provide basic, non-invasive care for our patients as set forth by the United States Department of Transportation, National Highway Traffic Safety Administration, First Responder National Standard Curriculum, as adopted by the Texas Department of State Health Services. These providers may also use an impedance threshold device during CPR. EMT-Basic: Those Members of Cypress Creek EMS that are certified as an EMT-Basic by the Texas Department of State Health Services, and while operating as a Member in good standing with Cypress Creek EMS, may provide basic, non-invasive care for our patients as set forth by the United States Department of Transportation, National Highway Traffic Safety Administration, EMT-Basic National Standard Curriculum, as adopted by the Texas Department of State Health Services. These providers may also use an impedance threshold device during CPR. EMT-Basic first responders may also administer aspirin according to the Acute Coronary Syndromes Protocol. Furthermore, these EMT-Basic providers may, under the direction and direct supervision of a PII, PIII, or Field Supervisor, as credentialed by me, may perform the following:

    Application of electrodes for ECG or 12-lead acquisition Administer Nitronox Blood glucose determination Nebulized albuterol / ipratropium administration Oral acetaminophen administration Oral dextrose preparation administration Oral Ibuprofen administration Oral nitroglycerin administration Those designated as Basic In-Charges may provide patient care en route to receiving facility

    providing an ECG or 12-lead was not performed, and no medication was administered, providing a PII, PIII, or Field Supervisor is on board

    EMT-Intermediate: Those Members of Cypress Creek EMS that are certified as an EMT-Intermediate by the Texas Department of State Health Services, and while operating as a Member in good standing with Cypress Creek EMS, may provide basic, non-invasive, and invasive care for our patients as set forth by the United States Department of Transportation, National Highway Traffic Safety Administration, EMT-Intermediate/85 National Standard Curriculum, as adopted by the Texas Department of State Health Services. Furthermore, these EMT-Intermediate providers may, under the direction and direct supervision of a PII, PIII, or Field Supervisor, as credentialed by me, may perform the following:

    All procedures listed above Adult and pediatric EZ/IO intraosseous insertion/infusion Combitube insertion IV/IM/IO medication administration Those designated as Basic In-Charges may provide patient care en route to receiving facility

    providing an ECG or 12-lead was not performed, and no medication was administered, providing a PII, PIII, or Field Supervisor is on board

    (Continued)

  • INTRODUCTION 07/2006

    CCEMS

    DELEGATION OF MEDICAL PRACTICE (Continued)

    EMT-Paramedic I: Those Members of Cypress Creek EMS that are certified or licensed as an EMT-Paramedic by the Texas Department of State Health Services, and while operating as a Member in good standing with Cypress Creek EMS, may provide basic, non-invasive, and invasive care for our patients as set forth by the United States Department of Transportation, National Highway Traffic Safety Administration, EMT-Paramedic National Standard Curriculum, as adopted by the Texas Department of State Health Services. Furthermore, these EMT-Paramedic providers may, under the direction and direct supervision of a PII, PIII, or Field Supervisor, as credentialed by me, may perform the following:

    All procedures listed above May provide patient care en route to receiving facility, providing a PII, PIII, or Field Supervisor is

    on board EMT-Paramedic II: Those Members of Cypress Creek EMS that are certified or licensed as an EMT-Paramedic by the Texas Department of State Health Services, and while operating as a Member in good standing with Cypress Creek EMS, may provide basic, non-invasive, and invasive care for our patients as set forth by the United States Department of Transportation, National Highway Traffic Safety Administration, EMT-Paramedic National Standard Curriculum, as adopted by the Texas Department of State Health Services. Furthermore, these EMT-Paramedic II providers, as credentialed by me, henceforth the In-Charge Paramedic, may perform the following:

    All procedures listed above May provide and direct patient care as set forth in these patient care protocols, with the exception

    of the Rapid Sequence Induction Procedure EMT-Paramedic III: Those Members of Cypress Creek EMS that are certified or licensed as an EMT-Paramedic by the Texas Department of State Health Services, and while operating as a Member in good standing with Cypress Creek EMS, may provide basic, non-invasive, and invasive care for our patients as set forth by the United States Department of Transportation, National Highway Traffic Safety Administration, EMT-Paramedic National Standard Curriculum, as adopted by the Texas Department of State Health Services. Furthermore, these EMT-Paramedic III providers, as credentialed by me, may perform the following:

    All procedures listed above May provide and direct patient care as set forth in these patient care protocols in its entirety

    including the Rapid Sequence Induction Procedure

  • INTRODUCTION 07/2006 ________________________________ Approved: Levon Vartanian, MD

    DEFINITION OF TERMS ABC's Establishment and maintenance of an open and patent airway, including the use of

    oral/nasal airways, suctioning, and

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