Protocol 01 Initial Assessment 07/31/2020

Medical Operations Manual Overview

• Developed by Miami-Dade Fire Rescue Protocol Advisory Committee and Medical Director.
• Serves as part of the medical control program for Miami-Dade Fire Rescue Department.
• Outlines emergency medical procedures for certified Emergency Medical Responders (EMR), EMTs, and Paramedics.
• Protocols act as clinical guides rather than teaching documents.
• Flexibility in treatment approach is encouraged; personnel may use judgment outside of specified protocols.

Structure of the Medical Operations Manual

• Protocols: Treatment guidelines detailing "when and why" approved by the Medical Director.
• Procedures: Specific step-by-step processes for EMS personnel, detailing "how to".
• Medications: Information on indications, contraindications, side effects, and dosing for medications used.
• Appendix: Reference materials including abbreviations, trauma alert criteria, and Glasgow Coma Score.

Protocols and Procedures Designation

• Basic Life Support (BLS) tasks are indicated by the prefix BLS.
• Advanced Life Support (ALS) tasks are identified with the prefix ALS.
• HAZMAT specific treatments utilize the prefix HTX.
• Medical Control Physician (MCP) approval indicated with the prefix MCP.
• Protocols are sequential, with sub-steps allowing for concurrent treatment when applicable.

Initial Assessment Protocol

• Protocol 1 focuses on systematic evaluation and treatment for medically ill or injured patients.
• Judgment is necessary to determine if patients require ALS or BLS care.

Scene Size-Up

• Assess scene safety, mechanism of injury (MOI) or nature of illness (NOI), patient count, severity, and resource needs.
• Identify and notify about any Alert Criteria (e.g., STEMI, STROKE, TRAUMA).
• Prepare for immediate life-saving interventions upon initial contact.
• Determine medical priority, treatment strategies, and notify corresponding facilities.

Primary Assessment

• Conducted for every patient to identify and rapidly address life-threatening issues.
• Airway: Ensure patent airway and apply Spinal Motion Restriction if spinal injury is suspected.
• Breathing: Assess for difficulty breathing; record rate, rhythm, and quality; listen for abnormal sounds.
• Circulation: Measure pulse rate and location, assess for active bleeding, and evaluate skin and perfusion.
• Neurological Exam: Determine level of consciousness, perform a FAST-ED stroke assessment, check pupils, and evaluate extremity movement.

Medical Patient Management

• Manage airway using specified protocols and procedures.
• Assess the need for oxygen and document pulse oximetry and capnography.
• Conduct blood glucose checks as needed.
• Administer Narcan for respiratory depression due to opiate overdose.
• Assist patients with prescribed medications (e.g., nitroglycerin for chest pain, inhalers, oral glucose, EpiPen).
• Advanced airway management and cardiac evaluations are performed as necessary.

Trauma Patient Management

• Perform airway management with C-spine control.
• Administer oxygen and control any hemorrhage.
• Bandage, splint, backboard, and package the patient for transport.
• Document vital signs and pulse oximetry readings.
• Position the patient in Trendelenburg if they are in shock (systolic BP < 90 mmHg).

Secondary Assessment

• Conduct potentially simultaneous to primary assessment.
• Identify chief complaint and document vital signs.
• Obtain a second set of vitals for specific patient categories (e.g., transported patients, unstable patients).
• Document pertinent medical history using the SAMPLE method (Signs and Symptoms, Allergies, Medications, Past medical history, Last oral intake, Events leading to call).
• Complete a head-to-toe survey guided by the patient's complaint.

This quiz covers the essential aspects of the Medical Operations Manual developed by Miami-Dade Fire Rescue. It outlines emergency medical procedures, protocols, and the structure of the manual, guiding certified Emergency Medical Responders, EMTs, and Paramedics in their clinical practice. Test your knowledge on the protocols, procedures, and medications included in this comprehensive guide.