El Paso Fire Department EMS Guidelines

Emergency Medical Service (EMS) Medical Care Guidelines are a set of instructions for EPFD EMS personnel to guide patient care.

Guidelines are designed to be adaptable, not absolute. They provide a framework for critical thinking and decision-making.

EPFD EMS personnel may deviate from the guidelines based on the individual patient's needs and the judgment of the Medical Control Emergency Physician (MCEP).

The guidelines are organized with different levels of care, starting with general principles and progressing to specific interventions for varying levels of EMS providers.

Basic interventions are marked in blue, advanced interventions in green, and paramedic interventions in red in the guidelines.

The guidelines allow for skipping certain steps or medications based on the patient's clinical condition. The provider may move directly to more advanced procedures or medications.

When a medication dosage states 'may repeat x1, x2, etc.', it indicates the number of additional doses allowed. For example, 'may repeat x1' means 2 doses total.

Critical thinking is encouraged and the guidelines are not a rigid checklist requiring every step to be followed.

Online Medical Control Physician (OLMC) is a physician who provides medical direction and treatment orders to EMS personnel via telephone or radio.

Standing orders authorize EMT-Basics to perform specific procedures without direct communication with a physician, if needed for optimal patient care.

Non-guideline orders are issued by the MCEP for situations not covered in standard EMS guidelines, requiring specific actions.

The EPFD EMS Medical Guideline #18 and Section 10 discuss EMT certification levels and allowed medications.

A MCEP must issue orders within the scope of the EMT's certification level and according to Texas regulations.

The Medical Control section of the ePCR documents any Non-guideline orders given by the MCEP, including their ID and instructions.

The medical control physician is responsible for providing medical advice and treatment orders to EMS personnel.

Contacting Medical Control is routine in cases of complex or unclear patient situations, allowing for expert guidance.

The individual at an emergency scene with the most appropriate training and knowledge of pre-hospital emergency care is in charge.

When an Advanced Life Support (ALS) team is called, a medical relationship is established between the patient and the physician directing the EMS system.

The pre-hospital provider at the scene follows the physician's orders, acting as the physician's representative during the emergency.

Telehealth practitioners providing medical services are held to the same standards as in-person healthcare providers.

If a patient's telehealth orders conflict with EMS guidelines, the telehealth practitioner must communicate with Medical Control for guidance.

If a patient's private physician is present and in charge, the pre-hospital provider should defer to the physician's orders unless they conflict with established guidelines.

The private physician must document their orders, including their name, signature, and medical license number.

If a private physician's orders conflict with EMS guidelines, the private physician must communicate with Medical Control to reach an agreement.

Opioid overdose requires immediate action and is characterized by slowed or absent breathing (respiratory depression or apnea).

Naloxone, a medication that reverses the effects of opioids, is a crucial treatment for opioid overdose. It can be administered by EMS personnel.

Emergency medical personnel should prioritize airway clearance, oxygen delivery, and adequate blood circulation (circulation) before administering naloxone.

Naloxone's effect is temporary, lasting about an hour, while opioids can remain in the body for several hours. Multiple naloxone doses may be needed.

In certain opioid overdose cases, particularly involving fentanyl or similar drugs, the chest muscles may become stiff and require additional measures like positive pressure ventilation (PEEP) to help the patient breathe.

Methadone and tramadol, two medications that can be particularly challenging in overdose cases, can lead to irregular heart rhythms (QT prolongation) and seizures respectively.

Opioids are available in various forms, including patches that release medicine through the skin. If found, these patches should be removed during emergency care.

It should be remembered that these guidelines (EPFD EMS Guidelines) are meant to be flexible and adaptable to individual patients' needs. Emergency medical personnel may adjust treatment based on the patient's condition and consultation with a Medical Control Emergency Physician (MCEP).

A 12-lead ECG is a diagnostic tool used to assess electrical activity of the heart using 10 electrodes placed on the chest, arms and legs.

For patients over 35 with chest pain, pressure, tightness, discomfort or heartburn, electrical injuries, syncope, weakness, new stroke symptoms, difficulty breathing, or suspected overdose, a 12-Lead ECG is recommended.

Lead V4R is placed on the right side of the chest, in the 5th intercostal space, midclavicular line.

ST elevation in Lead V4R can indicate a right ventricular myocardial infarction (RVMI).

Applying the leads correctly ensures accurate ECG readings for diagnosis.

A paramedic must record the patient's age, monitor the patient, and document the procedure, time and results on the patient care report.

The patient should remain still during the procedure to avoid interference with the ECG readings.

The proper procedure for acquiring a 12-Lead ECG is essential for accurate diagnosis and treatment.

Vasopressin increases water reabsorption in the kidneys by activating V2 receptors, leading to more concentrated urine.

Vasopressin is useful for hemodynamic support in vasodilatory shock, like septic shock.

Dobutamine stimulates beta-1 receptors in the heart, increasing heart muscle contraction and stroke volume, ultimately leading to increased blood output.

Dobutamine's primary use is in cardiogenic shock, a condition where the heart struggles to pump enough blood, often accompanied by fluid buildup in the lungs.

Norepinephrine strongly activates both alpha and beta receptors, leading to increased heart rate and output, while constricting blood vessels, which can impact blood pressure.

Norepinephrine is used to improve blood pressure in situations like shock, especially when other vasopressors have not been effective.

Simultaneous administration of Dobutamine and sodium nitroprusside can create a synergistic effect, enhancing the benefits of both medications.

Beta-blockers diminish the effects of Dobutamine, while tricyclic antidepressants can lead to a dangerous increase in blood pressure when combined with it.