Watson Chapel Fire Department
Medical Protocols
AIRWAY AND OXYGEN
Responders Will:
A. Check oral airway and remove any obstructions and suction if indicated.
B. Place adjunct if indicated and tolerated.
C. O2 as appropriate
1. Nasal Cannula
a) Patients with minor illness or injury absent severe signs or symptoms
b) Patients that can not tolerate a mask
2. NRB Mask
a) All multi system trauma patients
b) All illness or injury patients presenting with moderate to severe signs and symptoms
3. * BVM with supplemental O2
a) Any apnic patient
b) Acute pulmonary edema with evidence of cerebral hypoxemia were other measures to correct
air exchange are unsuccessful.
c) Acute CVA exhibiting hypoventilation and/or evidence of cerebral hypoxemia.
d) Traumatic head injury with GCS < 8.
e) Acute respiratory distress where all other efforts to effectively ventilate the patient have failed.
f) * Paramedics are encouraged to intubate any time BVM is indicated.
4. Blow by
a) Infant patients that will not tolerate a mask.
b) Combative patients that will not allow other O2 administration.
Note: The responder will: With combative patients consider if O2 administration will be beneficial or detrimental. If
responder determines that treatment would be detrimental to the patient O2 will NOT be administered.
Approved March 2007–- Dr. John Skowronski
1
Watson Chapel Fire Department
Medical Protocols
AMPUTATION
Responder Will:
A. Clean Stump with saline and dress to control hemorrhage.
a. Direct pressure.
b. Clean with warm water, only if no other options.
B. Splint the attached portion.
C. Cool the devitalized portion if possible.
Treatment and Preservation of the Amputated part:
A. Rinse Parts thoroughly in LR or NS, attempting to remove gross contaminations, but not
attempting thorough cleaning.
B. Wrap in sterile gauze moistened with solution of normal saline.
C. Place in a plastic bag.
D. Place the bag on cooled ice packs, taking care never to freeze the part.
Approved March 2007–- Dr. John Skowronski
2
Watson Chapel Fire Department
Medical Protocols
ANALGESIA PROTOCOL FOR
ORTHOPEDIC INJURIES
Responder Will:
A. Assess the patient’s vital signs and secure airway as appropriate.
B. Obtain AMPLE history.
C. Assess distal sensory, motor, and circulation of effected extremity before and after splinting.
D. Splint extremity to immobilize suspected fracture site, as well as the joint above and below the
suspected fracture site.
E. Apply cold pack to suspected fracture site.
F. Initiate IV normal Saline, rate as appropriate.
NOTE:
Contact medical control for pediatric patients
Approved March 2007–- Dr. John Skowronski
3
Watson Chapel Fire Department
Medical Protocols
ANAPHYLAXIS
Responder Will:
A. If respirations are unlabored and BP is adequate (over 90 systolic):
1.
2.
3.
4.
Secure airway, oxygen as appropriate.
Apply cardiac monitor.
Initiate IV NS, TKO.
Consider Benadryl 50 mg IV (may administer IM if no IV access).
B. If dyspneic with wheezing:
1.
2.
3.
4.
5.
Secure airway, hyperventilate and give 100% oxygen.
Patient has Epi Auto-Injector assist in administration
Apply cardiac monitor.
Initiate IV NS TKO.
Give Epinephrine 1:1000 0.3 – 0.5 mg SQ.
a. May repeat in 15min 1 time if patient still wheezing
6. Consider Benadryl 50 mg IV (may administer IM if no IV access).
C. If signs of shock (including BP < 90 systolic):
1. Secure airway, hyperventilate and give 100% oxygen.
2. Patient has Epi Auto-Injector assist in administration
3. Initiate 2 large bore IV’s NS or LR.
a. Administer 500 – 1000cc bolus (Unless contraindicated / CHF, etc.)
4. Apply cardiac monitor.
5. Epinephrine 1:1000 0.3 – 0.5 mg SQ.
6. Consider Benadryl 50 mg IV (may administer IM if no IV access).
7. Contact Medical Control.
8. Consider Epinephrine 1:10,000 0.1 mg IV slow.
Note: Contact Medical Control for all pediatric patients.
Approved March 2007–- Dr. John Skowronski
4
Watson Chapel Fire Department
Medical Protocols
ANEURYSM, ABDOMINAL
Responder Will:
A. Secure airway and administer oxygen as appropriate.
B. Apply cardiac monitor.
C. Establish 2 large bore IV’s of NS or LR, if possible maintaining systolic B/P of 90*.
*
Do not attempt to get BP above 90 systolic. Higher BP may contribute to increased dissection.
Approved March 2007–- Dr. John Skowronski
5
Watson Chapel Fire Department
Medical Protocols
ASTHMA
Responder Will:
A. Secure airway, administer humidified oxygen.
B. If patient has prescribed inhaler available, assist patient in self administration.
C. Establish IV NS, TKO.
D. Apply cardiac monitor.
E. Document respiratory rate and presence of use of accessory muscles or retractions.
F. Consider Proventil updraft 2.5mg/3cc with 0.5 mg Atrovent @ 8 LPM.
G. Consider Epinephrine 1:1000 0.3 MG SQ (only with medical control).
NOTE:
Consider patient may have CARDIAC ASTHMA. Patients with CHF may wheeze and
mimic an asthma patient.
Pediatric dose (8 yrs and younger) ½ adult dose.
Approved March 2007–- Dr. John Skowronski
6
Watson Chapel Fire Department
Medical Protocols
BURNS, THERMAL
Responder Will:
A. Stop the burning process. Remove victim from scene of injury and remove burnt / burning
clothing.
B. Secure airway and administer oxygen.
C. Start IV NS or LR and run at 150 cc/hr.
D. Apply cardiac monitor.
E. Apply sterile burn dressing. Wet dressing only in burns involving < 10% BSA. * Wet dressings in
larger burns may contribute to lowering body temperature, potentially triggering shock.
Approved March 2007–- Dr. John Skowronski
7
Watson Chapel Fire Department
Medical Protocols
CARDIAC - ASYSTOLE
Paramedic Will:
A. Confirm asystole in two leads.
B. Initiate CPR.
C. Establish IV access, NS.
D. Intubate when possible, if IV access not established, Epinephrine 1:1000 10.0 mg via ET.
E. * Consider etiologies.
F. Consider external pacing if appropriate.
G. Administer Vasopressin 40 I.U. If no response, repeat once in three minutes.
H. ** After Vasopressin, wait 20 minutes, then administer Epinephrine 1:10,000 1.0 mg IV
(repeat every 3 – 5 minutes PRN).
I. Administer Atropine 1.0 mg IV or ET (repeat every 3 – 5 minutes to max of 0.04 mg/kg).
*
Consider these causes:
Hypoxia
Preexisting acidosis
Hyperkalemia
Drug overdose
Hypokalemia
Hypothermia
Pediatric Dosages:
 Epinephrine 1:10,000 0.1 cc/kg or appropriate dosage per Broselow Tape, IV, ET, or IO.
 Atropine 0.02 mg/kg (minimum of 0.1 mg).
**
Second dosage of Epinephrine should be as follows:


Adult – 3 mg Epinephrine 1:1000.
Child – 0.1 cc/kg Epinephrine 1:1000.
Approved March 2007–- Dr. John Skowronski
8
Watson Chapel Fire Department
Medical Protocols
CARDIAC - BRADYARRHYTHMIAS
Criteria:
A. Any second or third degree heart block with rate less than 60 beats/minute and
hemodynamically unstable (chest pain, dyspnea, lightheadedness, hypotension, or associated
ventricular ectopy).
B. Bradycardia rhythm which presents with any of the following:
1.
2.
3.
4.
Systolic blood pressure of less than 90mm Hg.
Neurological symptoms such as syncope, seizures, confusion, dizziness.
Chest pain.
Bradycardia with associated PVC’s.
Paramedic Will:
A. Secure airway, administer supplemental oxygen as appropriate.
B. Establish IV NS, TKO.
C. If high degree heart block, consider external pacing.
D. Administer atropine 0.5 – 1.0 mg IV, if continued sign/symptoms repeat every 5 minutes to
max of 0.04 mg/kg.
NOTE:
It is acceptable to administer atropine while setting up for external pacing if this will not
significantly delay pacing.
Approved March 2007–- Dr. John Skowronski
9
Watson Chapel Fire Department
Medical Protocols
CARDIAC – CARDIOGENIC SHOCK
Responder Will:
A. Secure airway, administer oxygen as appropriate.
B. Observe vital signs closely.
C. Monitor cardiac rhythm
D. Establish IV NS, TKO or as appropriate.
E. Consider 200 – 500 cc fluid bolus.
F. Contact Medical Control.
G. Consider Dopamine drip:
400 mg Dopamine in 250 cc to run at 5 – 10 mcg/kg/min. Titrate to BP of 90 systolic.
NOTE:
If patient’s condition deteriorates so that he no longer generates a palpable pulse and is
Unconscious without spontaneous respirations, go to PEA algorithm.
Approved March 2007–- Dr. John Skowronski
10
Watson Chapel Fire Department
Medical Protocols
CARDIAC – CHEST PAIN
Responder Will:
A. Secure airway and administer oxygen as appropriate.
B. Take blood pressure: ^ 100 systolic and patient has prescribed nitroglycerin available. Assist
patient with self administration (1 tablet or spray every 3-5 min for max of 3 tablets). Maintaining
a systolic B/P ^ 100
C. Monitor cardiac rhythm and vital signs.
D. If hemodynamically unstable rhythm, treat per appropriate protocol.
E. Establish IV NS, TKO.
F. Have patient chew 1 adult aspirin or 4 – 81mg child chewable aspirin.
G. Administer nitroglycerine 0.4 mg sublingually every 5 minutes to max of 3 tablets
maintaining B/P >90 systolic.
H. If BP drops below 90 systolic, consider 200 – 500 cc fluid bolus.
Approved March 2007–- Dr. John Skowronski
11
Watson Chapel Fire Department
Medical Protocols
CARDIAC – CONGESTIVE HEART
FAILURE
Responder Will:
A. Secure airway and administer oxygen as appropriate.
B. Monitor cardiac rhythm and vital signs.
C. Establish IV NS, TKO.
D. Have patient chew 1 adult aspirin or 4 – 81 mg children’s chewable aspirin.
E. Consider nitroglycerine 0.4 sublingually every 5 minutes to max of 3 tablets maintaining B/P
of > 90 systolic.
F. Consider administration of Furosemide 40 – 80 mg IV.
Approved March 2007–- Dr. John Skowronski
12
Watson Chapel Fire Department
Medical Protocols
CARDIAC – PSVT (STABLE)
Paramedic Will:
A. Secure airway and administer oxygen as appropriate.
B. Establish IV NS, AC or higher.
C. Perform vagal maneuvers:
a. Valsalva
b. Carotid sinus massage (if no bruits) – Do not compress both carotids at the same
time.
D. Administer Adenosine 6.0 mg fast IV.
E. Administer Adenosine 12.0 mg fast IV (may repeat once).
F. Consider Verapamil 5.0 mg slow IV.
G. Contact Medical Control.
H. Consider cardioversion.
Approved March 2007–- Dr. John Skowronski
13
Watson Chapel Fire Department
Medical Protocols
CARDIAC – PSVT (UNSTABLE)
Paramedic Will:
A. Secure airway and administer oxygen as appropriate.
B. Establish IV NS and administer 200 – 500 cc fluid bolus.
C. If patient is conscious, consider cardiovert with out sedation.
D. Synchronize Cardiovert 75 – 100 joules.
E. Synchronize Cardiovert 200 joules.
F. Synchronize Cardiovert 300 joules.
G. Synchronize Cardiovert 360 joules.
Approved March 2007–- Dr. John Skowronski
14
Watson Chapel Fire Department
Medical Protocols
CARDIAC – PULSELESS ELECTRICAL
ACTIVITY (PEA)
Paramedic Will:
Consider the following etiologies:
Hypovolemia
Cardiac Tamponade
Hypoxia
Acidosis
MI
Drug Overdose
Hyperkalemia
Tension Pheumothorax
Pulmonary Embolus
Hypothermia
If patient presents with monitored rhythm but is pulseless without palpable blood pressure, follow
these procedures:
A. Initiate CPR.
B. Establish IV NS as appropriate.
C. Intubate.
D. Consider 200 – 500 cc fluid bolus.
E. * Administer epinephrine 1:10,000 1.0 mg IV repeated every 3 – 5 minutes. If no IV access,
ET dosage should be 10.0 mg epinephrine 1:1000.
F. Consider Atropine 0.5 – 1.0 mg if absolute bradycardia.
G. ** Contact Medical Control.
*
Second dosage of epinephrine should be as follows:
 Adult – 3 mg Epinephrine 1:1000.
 Child – 0.1 cc/kg Epinephrine 1:1000.
**
If traumatic incident, extended scene time is contraindicated. Establish presence or
absence of heart sounds prior to initiation of CPR.
Approved March 2007–- Dr. John Skowronski
15
Watson Chapel Fire Department
Medical Protocols
CARDIAC – VENTRICULAR
FIBRILLATION
Paramedic Will:
A. Perform CPR.
B. Apply cardiac monitor.
C. Defibrillate 200, 300, 360 joules if no monitor change.
D. Initiate IV NS as appropriate.
E. Intubate. If IV not established, administer 10.0 mg Epinephrine 1:1000 ET every 5 minutes.
F. Epinephrine 1:10,000 1.0 mg IV, repeat after 3 minutes 3.0 mg 1:1000 IV.
G. Vasopressin 40 iu IV, may repeat X 1 after 20 minutes.
H. Lidocaine 1.5 mg/kg IV. May repeat 0.5 – 0.75 mg/kg every 8 minutes to max of 3.0 mg/kg.
I. Contact Medical Control.
J. Consider Sodium Bicarbonate.
NOTE:
*
Pulseless V-Tach should be treated as V-Fib. After circulating each medication with CPR
for approximately 1 minute defibrillate at 360 joules.
Second dosage of Epinephrine for peds should be as follows:
 Child – 0.1 cc/kg Epinephrine 1:1000 or per Broselow Tape.
Approved March 2007–- Dr. John Skowronski
16
Watson Chapel Fire Department
Medical Protocols
CARDIAC – VENTRICULAR
TACHYCARDIA (STABLE)
Paramedic Will:
A. Secure airway and administer oxygen as appropriate.
B. Establish IV NS, TKO.
C. Administer Lidocaine 1.5 mg/kg IV.
D. Repeat Lidocaine 0.5 – 0.75 mg/kg every 8 minutes to max of 3.0 mg/kg.
E. Contact Medical Control.
F. Consider Procainamide 20 mg/min to max of 1000mg.
G. Consider cardioversion @ 50 – 100 joules.
NOTE:
When patient converts, begin intravenous infusion of antiarrhythmic agent that has aided
resolution of VT.
Approved March 2007–- Dr. John Skowronski
17
Watson Chapel Fire Department
Medical Protocols
CARDIAC – VENTRICULAR
TACHYCARDIA (UNSTABLE)
Paramedic Will:
A. Secure airway and administer oxygen as appropriate.
B. Establish IV NS, TKO.
C. Synchronize Cardiovert 50 joules.
D. Synchronize Cardiovert 100 joules.
E. Synchronize Cardiovert 200 joules.
F. Synchronize Cardiovert 300 joules.
G. Synchronize Cardiovert 360 joules.
H. Contact Medical Control.
I. If recurrent, administer Lidocaine 1.5 mg/kg and cardiovert at previously successful energy
level.
NOTE:
When patient converts, begin intravenous infusion of antiarrhythmic agent that has aided
resolution of VT.
Approved March 2007–- Dr. John Skowronski
18
Watson Chapel Fire Department
Medical Protocols
COPD
Responder Will:
A. Secure airway and administer oxygen as appropriate.
B. Monitor respirations and assist if necessary.
C. Apply cardiac monitor.
D. Establish IV NS, TKO.
E. Document use of accessory muscles or wheezing.
H. Consider Proventil updraft 2.5mg/3cc with 0.5 mg Atrovent @ 8 LPM.
Approved March 2007–- Dr. John Skowronski
19
Watson Chapel Fire Department
Medical Protocols
DEHYDRATION
Responder Will:
A. Secure airway and administer oxygen as appropriate.
B. Apply cardiac monitor.
C. Establish IV NS or LR and infuse at 125 cc/hr.
D. If patient has BP < 90 systolic, bolus with 200 – 500 cc NS or LR.
Approved March 2007–- Dr. John Skowronski
20
Watson Chapel Fire Department
Medical Protocols
DIABETIC / HYPOGLYCEMIA
Responder Will:
A. Secure airway and administer oxygen as appropriate.
B. Administer oral glucose if tolerated by patient
C. Apply cardiac monitor.
D. Determine blood glucose level.
E. Establish IV NS, TKO. Draw blood if possible.
F. If patient has decreased level of consciousness, refer to unconscious patient protocol
Approved March 2007–- Dr. John Skowronski
21
Watson Chapel Fire Department
Medical Protocols
DOA
On arrival at the scene of a possible DOA, the responders will immediately assess the patient to determine
if resuscitative efforts are indicated. Full resuscitative efforts will be immediately initiated unless one of
the following findings are observed:

Decomposition

Rigor Mortis

Lividity

Obvious mortal injury

Completed EMS DNR
The responders will not perform a “slow code” or a “chemical code”. If the patient is a candidate for
resuscitation, the appropriate protocol will be followed.
Any deviation from this protocol must be authorized by Medical Control.
Approved March 2007–- Dr. John Skowronski
22
Watson Chapel Fire Department
Medical Protocols
HYPERTENSIVE CRISIS
Responder Will:
A. Secure airway and administer oxygen as appropriate.
B. Apply cardiac monitor.
C. Establish IV NS, TKO.
D. * If patient’s diastolic BP is > 120 mm Hg, administer 20 mg Labetalol slow IV.
E. If unable to establish an IV administer SL nitro
*
The patient should be in a supine position when receiving Labetalol. Labetalol is contraindicated
under the following circumstances:




Obvious signs of CHF
Wheezing
Bradycardia (HR < 60)
History of asthma or COPD
Approved March 2007–- Dr. John Skowronski
23
Watson Chapel Fire Department
Medical Protocols
HYPERTHERMIA
Responder Will:
A. Heat Cramps
1.
2.
3.
4.
Move patient to cool area.
Give salted water or 50/50 mix Gatorade and water to sip.
Massage cramped muscle.
If condition worsens, follow heat exhaustion protocol.
B. Heat Exhaustion
1.
2.
3.
4.
Secure airway and administer oxygen as appropriate.
Establish IV NS as appropriate.
Cool patient without chilling.
Apply cardiac monitor.
C. Heat Stroke
1.
2.
3.
4.
5.
Secure airway and administer oxygen as appropriate.
Cool as rapidly as possible.
Establish IV NS as appropriate.
Treat for shock as appropriate.
Apply cardiac monitor.
Approved March 2007–- Dr. John Skowronski
24
Watson Chapel Fire Department
Medical Protocols
HYPOTENSION
Responder Will:
A. Secure airway and administer oxygen as appropriate.
B. Establish IV NS or LR and give 200 – 500 cc fluid bolus. If patient responds, titrate fluids to
B/P > 100 systolic, monitoring for fluid overload.
C. Apply cardiac monitor.
D. Consider Dopamine drip at 5 – 10 mcg/kg/min titrated to B/P > 100 systolic.
Approved March 2007–- Dr. John Skowronski
25
Watson Chapel Fire Department
Medical Protocols
HYPOTHERMIA
Responder Will:
A. Secure airway and administer oxygen as appropriate.
B. Remove wet clothing and cover with warm blanket.
C. Establish IV NS, TKO.
D. Apply cardiac monitor.
NOTE:
Handle these patients with extreme care… rough handling can cause fibrillation.
Approved March 2007–- Dr. John Skowronski
26
Watson Chapel Fire Department
Medical Protocols
PRE-ECLAMPSIA / ECLAMPSIA
Responder Will:
A. Secure airway and administer oxygen as appropriate.
B. Establish IV NS or LR, TKO.
C. If delivery not imminent, keep mother on left side. Cover eyes to minimize CNS stimulation.
D. Apply cardiac monitor.
E. Contact Medical Control.
F. For seizures, consider magnesium sulfate 1 – 2 g over 2 minutes.
Approved March 2007–- Dr. John Skowronski
27
Watson Chapel Fire Department
Medical Protocols
OBSTETRICS / PROLAPSED CORD
Responder Will:
A. Secure airway and administer oxygen as appropriate.
B. Initiate IV NS, TKO.
C. Place mother in knee – chest position.
D. Place gloved hand in vagina between public bone and presenting part with cord between fingers
and exert counter pressure against presenting part.
NOTE:
If birth is imminent, allow it to proceed.
Approved March 2007–- Dr. John Skowronski
28
Watson Chapel Fire Department
Medical Protocols
ORGANOPHOSPHATE POISONING
Responder Will:
A. Remove patient from exposure, remove clothes, and decontaminate skin.
B. Secure airway and administer oxygen as appropriate.
C. Apply cardiac monitor.
D. Initiate IV NS, TKO.
E. Consider Atropine 1.0 mg IV. May repeat every three to five minutes as needed.
Approved March 2007–- Dr. John Skowronski
29
Watson Chapel Fire Department
Medical Protocols
NARCOTIC OVERDOSE
Responder Will:
A. Secure airway and administer oxygen as appropriate.
B. Initiate IV NS, TKO.
C. Apply cardiac monitor.
D. Administer up to 2.0 mg Narcan IV slow titrated to respirations. May repeat PRN.
Approved March 2007–- Dr. John Skowronski
30
Watson Chapel Fire Department
Medical Protocols
POISONING / INGESTIONS
Responder Will:
A. Secure airway and administer oxygen as appropriate.
B. Identify nature of poison if possible and preserve containers for transport.
C. If nature of poison determined contact poison control 1-800-222-1222
D. Initiate IV NS, TKO.
E. Apply cardiac monitor.
F. Contact Medical Control.
NOTE: Do not induce vomiting.
Approved March 2007–- Dr. John Skowronski
31
Watson Chapel Fire Department
Medical Protocols
SNAKE BITE
Responder Will:
A. Secure airway and administer oxygen as appropriate.
B. Remove constricting items.
C. Immobilize bitten extremity.
D. Establish IV NS, TKO.
NOTE:
In the event snake is still on scene, separate head from body and place both in sack or
pillow case. Take care to avoid fangs – Reflex biting may occur in an apparent dead snake.
Approved March 2007–- Dr. John Skowronski
32
Watson Chapel Fire Department
Medical Protocols
SEIZURES
Responder Will:
A. Secure airway and administer oxygen as appropriate.
B. Establish IV NS, TKO with blood drawn if possible.
C. Apply cardiac monitor.
D. If no history of seizures, check blood sugar.
E. If febrile, begin cooling patient slowly.
Approved March 2007–- Dr. John Skowronski
33
Watson Chapel Fire Department
Medical Protocols
SPINAL IMMOBILIZATION
Responder Will:
A. Spinal immobilize if at least one of the following exist:
Altered mental status (ETOH, drugs, head injury, etc)
Neck pain
*Back pain
Neurological deficit
Other significant injuries
B. Secure airway and administer oxygen as appropriate.
C. Apply appropriately sized cervical collar.
D. If indicated, consider use of KED.
E. Keeping spine in-line, position patient on LSB.
F. Secure patient to board.
*
NOTE:
If the patient’s only back pain is lumbar or lower, and in the absence of the other criteria,
cervical immobilization is not required for spinal immobilization.
If the MOI is severe, the responder will deviate from this protocol and immobilize patients
falling outside this criteria.
Approved March 2007–- Dr. John Skowronski
34
Watson Chapel Fire Department
Medical Protocols
STROKE (CVA)
Responder Will:
A. Secure airway and administer oxygen as appropriate.
B. If onset of symptoms within the last three hours, notify dispatch to contact EASI ambulance that
stroke protocol being initiated. If onset of symptoms unknown or occurred while asleep, rapid
transport is not indicated.
C. Initiate IV NS, TKO.
D. Apply cardiac monitor.
E. Check blood sugar and treat accordingly.
Approved March 2007–- Dr. John Skowronski
35
Watson Chapel Fire Department
Medical Protocols
SYNCOPE
Responder Will:
A. Secure airway and administer oxygen as appropriate.
B. Apply cardiac monitor.
C. Check blood sugar.
D. If patient symptomatic, initiate IV NS, TKO.
a. Consider a 250 – 500cc bolus if patient is tachy cardic or hypotensive
Approved March 2007–- Dr. John Skowronski
36
Watson Chapel Fire Department
Medical Protocols
TENSION PNEUMOTHORAX
Responder Will:
A. Recognize signs and symptoms:
 Extreme dyspnea
 Restlessness / anxiety
 Pulse weak and rapid
 Breath sounds diminished on side of pneumothorax
 Possible JVD and tracheal deviation (late signs)
B. Secure airway and administer high flow oxygen.
C. Initiate IV NS as appropriate.
D. Apply cardiac monitor.
E. If sucking chest wound has been treated, release one corner.
F. If closed chest injury, consider chest decompression.
Approved March 2007–- Dr. John Skowronski
37
Watson Chapel Fire Department
Medical Protocols
TRAUMA - CRITICAL
Responder Will:
A. Perform complete rapid primary survey including ABC’s with C-spine precautions.
B. Correct life-threatening problems ASAP.
C. Expose patient, recovering to retain body heat.
D. Initiate treatment as appropriate:
 Secure airway and administer oxygen as appropriate.
 Apply cardiac monitor.
 Establish 2 large bore IV’s, NS or LR and run as indicated (second IV should be
initiated during transport).
E. If time and patient’s condition permit and ambulance has not arrived, do secondary survey and
treat accordingly.
NOTE:
Definitive therapy for trauma patients is surgery. As circumstances permit, scene times
should be less than 10 minutes.
Approved March 2007–- Dr. John Skowronski
38
Watson Chapel Fire Department
Medical Protocols
UNCONSCIOUS PATIENT
Responder Will:
A. * Secure airway and administer oxygen as appropriate.
B. If patient pulse less and apnic; Place AED and follow prompts
C. Initiate IV NS, TKO, draw blood if possible.
D. Apply cardiac monitor.
E. Check blood sugar and administer D50 if appropriate.
F. Consider Narcan, 2.0 mg slow IV titrated to respirations. Repeat PRN.
G. When administering D50, if patient possibly malnourished (ETOH abuse, elderly, etc),
administer Thiamine 100 mg IV.
*
Paramedics: Oral intubation may be indicated with patients in the following
circumstances:
 Acute pulmonary edema with evidence of cerebral hypoxemia where other
measures to correct air exchange are unsuccessful.
 Acute CVA exhibiting hypoventilation and/or evidence of cerebral hypoxemia.
 Traumatic head injury with GCS < 8.
 Acute respiratory distress where all other efforts to effectively ventilate the
patient have failed.
Approved March 2007–- Dr. John Skowronski
39
Watson Chapel Fire Department
Medical Protocols
REFUSAL OF TREATMENT OR
TRANSPORT
Responder Will:
A.
On all emergency requests for service, the responder will strive to convince the patient
to be treated and/or transported to the closest appropriate facility.
B.
If, after your best efforts, the patient refuses to be transported. The responders will
initiate BLS treatment until ambulance arrival. At no point will a responder tell a
patient that they do not need to go to the hospital.
C.
If, after your best efforts, the patient refuses to be treated. The responders will ask the
patient their Name, Date of Birth, and Location. If patient answers correctly,
responders will honor patient’s request. Monitoring patient until ambulance arrival. If
patient has a decreased LOC, and can not answer questions appropriately. Responder
will then assume implied consent and treat accordingly.
Approved March 2007–- Dr. John Skowronski
40
Watson Chapel Fire Department
Medical Protocols
SALINE LOCKS
Paramedic Will:
A. Recognize that in cases needing an IV Lifeline, saline locks may be interchanged.
B. During initiation of saline locks, procedure must be aseptic.
C. If administration of medications or IV bolus fluids is anticipated, normal IV therapy
should be utilized rather than saline locks.
Approved March 2007–- Dr. John Skowronski
41