TRINITY EMS SYSTEM

STANDARD OPERATING

GUIDELINES

2012

Approved by EMS Medical Director and Illinois

Department of Public Health

2/2015

TRINITY EMS SYSTEM 2012

Welcome and Introduction

The following guidelines have been established to allow the Trinity EMS System to provide excellent, aggressive, consistent, and evidence-based pre-hospital care to the communities and patients we serve. While not all-inclusive, they will cover most of the diseases and conditions EMS will encounter and provide a strong basis for all patient care delivered. The first rule of medicine should always be “Primum non nocere,” or “first, do no harm,” while also providing care and assistance. Each provider at any level will be called upon to use their knowledge, education, and skills to render care to those in need.

The following guidelines are designed based on algorithms, much like AHA/ACLS guidelines, and were devised similar to the North Carolina EMS protocols and those of Wake County EMS, available online. To assist you, color-coding for levels of providers has been adopted. Any skill or procedure at and below your level of service may be performed. The top portion of the protocol has the sections History, Signs and Symptoms, and Differential to help guide providers on essentials questions, documentation, and critical thinking for specific complaints. While not comprehensive, they provide a good foundation for initial evaluation.

The middle section of the protocols contain the flow chart which are the Guidelines for Patient Care. Simply follow the arrows, answering the questions when prompted, and proceed until patient care ceases. Each protocol has been reviewed and is based on research and evidence-based medicine and approved by the Medical Director, and should provide you with all the tools and support to provide excellent care. The Trinity logo designates protocols, the syringe indicates medication administration, and the reflex hammer denotes a procedure or skill. The protocols are divided into sections for General, Medical, Cardiac, OB/Pediatric, Trauma, Special, and Destination/Triage. The Universal Patient Care Protocol is the center “hub” for all care and is the foundation for scene safety, assessment, oxygen, vitals, monitor, glucose, IV, and basic EMS duties designed to initiate essential patient care needs in delivering care.

The last box entitled Pearls is meant to help guide care, refresh knowledge, and point to specific information helpful to individual complaints or conditions. These pearls are meant to be a good quick reference guide and source of useful medical knowledge.

The Trinity EMS System will strive to educate and assist all providers in implementing these guidelines. We will review them periodically and make necessary changes to keep up with the ever-evolving medical advances and suggestions of our providers. Medical Control and our office are always available to assist and provide support, feedback, or answer questions. Thank you all for your time and effort, your caring and compassion, the sacrifice and willingness to help those in need in our community, our homes, and our lives.

Sincerely,

Michael T. Barr, M.D.Trinity EMS Medical Director(309) 779-3057

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Trinity EMS System

Standard Operating Guidelines

2012

SIGNATURES I

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Michael Barr, MD Date

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Susan M. Beswick, RN, MSN Date

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Adam Sowells, NREMT-P, CCP Date

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Protocol Development f Revis ion I Illinois Department of Public Health Approval: 11 / 2012

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TRINITY EMS STANDARD OPERATING GUIDELINES TABLE OF CONTENTS

2012

GENERAL PROTOCOLS

Airway, Adult Protocol 1 – 01 Airway, Adult – Failed Protocol 1 – 02 Airway, Pediatric Protocol 1 – 03 Airway, Pediatric – Failed Protocol 1 – 04 Back Pain Protocol 1 – 05 Behavioral Protocol 1 – 06 Fever/Infection Control Protocol 1 – 07 IV Access Protocol 1 – 08 Pain Control: Adult Protocol 1 – 09 Pain Control: Pediatric Protocol 1 – 10 Police Custody Protocol 1 – 11 Spinal Immobilization Clearance Protocol 1 – 12 Universal Patient Care Protocol 1 – 13

MEDICAL PROTOCOLS

Abdominal Pain Protocol 2 – 01 Allergic Reaction Protocol 2 – 02 Altered Mental Status Protocol 2 – 03 Deceased Person Protocol 2 – 04 Dental Problems Protocol 2 – 05 Epistaxis Protocol 2 – 06 Overdose/Toxicity Protocol 2 – 07 Pulmonary Edema Protocol 2 – 08 Respiratory Distress Protocol 2 – 09 Seizure Protocol 2 – 10 Vomiting and Diarrhea Protocol 2 – 11

CARDIAC PROTOCOLS

Asystole Protocol 3 – 01 Atrial Fibrillation Protocol 3 – 02 Bradycardia Protocol 3 – 03 Cardiac Arrest Protocol 3 – 04 Chest Pain: Cardiac and STEMI Protocol 3 – 05 Hypertension Protocol 3 – 06 Hypotension Protocol 3 – 07 Induced Hypothermia Protocol 3 – 08 Post-Resuscitation Protocol 3 – 09 Pulseless Electrical Activity (PEA) Protocol 3 – 10 Suspected Stroke Protocol 3 – 11 Supraventricular Tachycardia Protocol 3 – 12 Syncope Protocol 3 – 13 Ventricular Fibrillation/Pulseless Ventricular Tachycardia Protocol 3 – 14 Ventricular Fibrillation/Pulseless Ventricular Tachycardia (Persistent) Protocol 3 – 15 Wide Complex Tachycardia Protocol 3 – 16

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PEDIATRIC AND OBSTETRICAL PROTOCOLS

Childbirth/Labor Protocol 4 – 01 Newly Born Protocol 4 – 02 Obstetrical Emergency Protocol 4 – 03 Pediatric Bradycardia Protocol 4 – 04 Pediatric Head Trauma Protocol 4 – 05 Pediatric Hypotension Protocol 4 – 06 Pediatric Multiple Trauma Protocol 4 – 07 Pediatric Pulseless Arrest Protocol 4 – 08 Pediatric Respiratory Distress Protocol 4 – 09 Pediatric Seizure Protocol 4 – 10 Pediatric Supraventricular Tachycardia Protocol 4 – 11

TRAUMA PROTOCOLS

Bites and Envenomations Protocol 5 – 01 Burns: Chemical and Electrical Protocol 5 – 02 Burns: Thermal Protocol 5 – 03 Crush Syndrome Protocol 5 – 04 Drowning Protocol 5 – 05 Extremity Trauma Protocol 5 – 06 Head Trauma Protocol 5 – 07 Hyperthermia Protocol 5 – 08 Hypothermia Protocol 5 – 09 Multi-System Trauma Protocol 5 – 10 Sexual Assault Protocol 5 – 11 Traumatic Arrest Protocol 5 – 12

SPECIAL RESPONSE PROTOCOLS

School Bus Accident Protocol 6 – 01 START/JumpSTART Algorithm Protocol 6 – 02

EMS TRIAGE AND DESTINATION PROTOCOLS

ROSC/ POST-RESUSCITATION Protocol 7 – 01 STEMI Protocol 7 – 02 SUSPECTED STROKE Protocol 7 – 03 TRAUMA FIELD CRITERIA Protocol 7 – 04

PROCEDURES

12 Lead EKG Procedure 1 Airway: BPAP Procedure 2 Airway: CPAP Procedure 3 Airway: End-Tidal CO2 Procedure 4 Airway: ETT Introducer (Bougie) Procedure 5 Airway: Foreign Body Obstruction Procedure 6

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Airway: Intubation Nasotracheal Procedure 7 Airway: Intubation Orotracheal Procedure 8 Airway: King LTD Procedure 9 Airway: Nebulizer Inhalation Therapy Procedure 10 Airway: Rapid Sequence Intubation Procedure 11 Airway: Respirator Operation Procedure 12 Airway: Suctioning - Advanced Procedure 13 Airway: Suctioning – Basic Procedure 14 Airway: Surgical Cricothyrotomy Procedure 15 Airway: Tracheostomy Tube Change Procedure 16 Airway: Ventilator Operation Procedure 17 Arterial Line Maintenance Procedure 18 Assessment: Adult Procedure 19 Assessment: Pain Procedure 20 Assessment: Pediatric Procedure 21 Blood Glucose Analysis Procedure 22 Capnography Procedure 23 Cardiac: External Pacing Procedure 24 Cardiac: Internal Pacemaker Maintenance Procedure 25 Cardiopulmonary Resuscitation (Automated) Procedure 26 Cardiopulmonary Resuscitation (Manual) Procedure 27 Cardioversion Procedure 28 Chest Decompression Needle Procedure 29 Chest Tube Maintenance Procedure 30 Childbirth Procedure 31 Decontamination Procedure 32 Defibrillation: Automated External Defibrillator (AED) Procedure 33 Defibrillation: Manual Procedure 34 EKG Monitoring Procedure 35 Impedance Threshold Device (ITD) Procedure 36 Injections: Subcutaneous and Intramuscular Procedure 37 Intranasal Medication Administration Procedure 38 Pulse Oximetry Procedure 39 Restraints: Physical/Chemical Procedure 40 Spinal Examination Procedure 41 Spinal Immobilization Procedure 42 Splinting Procedure 43 Stroke Screen: Cincinnati Pre-hospital Procedure 44 Temperature Measurement Procedure 45 Venous Access: Existing Catheters Procedure 46 Venous Access: External Jugular Procedure 47 Venous Access: Extremity Procedure 48 Venous Access: Intraosseous Procedure 49 Wellness Check Procedure 50 Wound Care: General Procedure 51 Wound Care: Taser Probe Removal Procedure 52 Wound Care: Tourniquet Procedure 53

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APPENDICES

Appendix A – General Reference Documents State of Illinois Do Not Resuscitate Form Trinity EMS Medication Scope of Practice for Credentialed Personnel Trinity EMS Procedure Scope of Practice for Credentialed Personnel Standardized Medical Abbreviations APGAR Scores Burn Resources/Guidelines Difficult Airway Evaluation RSI Audit Form RSI Flow Chart Appendix B – Medication Delivery Trinity EMS System Medication List Pediatric Color-coded Medication List Standardized Medication Delivery Guide Amiodarone Dopamine Etomidate Rocuronium Succinylcholine Versed (Pediatric) Appendix C – General Forms Preliminary Report Form Short Report Form – Non-transport Services Disposition/Refusal Form Patient Instructions for Disposition/Refusal Form School Bus Incident Form Appendix D – Trinity EMS System Forms EMS Incident Report Improvement Opportunity Report (IOR) Form Service Excellence Form

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