236 Questions
Under what condition can Fire Rescue personnel examine, treat, and/or transport a patient without their informed consent?
When the patient is incapacitated
What is the purpose of the Baker Act?
To involuntarily examine patients with mental illness
When can a person be taken to a receiving facility for involuntary examination under the Baker Act?
When they have refused voluntary examination and are unable to determine the need for examination
What is the primary factor in determining the need for involuntary examination under the Baker Act?
The patient's mental illness
What is the purpose of the receiving facility in the Baker Act?
To involuntarily examine and treat patients with mental illness
What is the role of Fire Rescue personnel in regards to the Baker Act?
To transport patients to receiving facilities
What is the relationship between the Baker Act and FS 401.445?
FS 401.445 specifies the conditions for which Fire Rescue personnel may examine, treat, and/or transport patients without their informed consent
What is the primary goal of the Baker Act and FS 401.445?
To ensure the patient receives necessary medical care
Who is the Associate Medical Director for the City of Miami and Village of Key Biscayne?
Dr. Armando Clift
Which of the following fire departments is NOT associated with a Medical Director?
Miami Fire Rescue
Who is the Medical Director for Coral Gables, Hialeah, and Miami Beach?
Paul J Adams
What is the page number of the document where the Acknowledgements are found?
Page 1 of 1
Who is the Fire Chief of the City of Miami?
Zahralban
How many Medical Directors are mentioned in the document?
4
What is the name of the committee that worked on the 2022-24 Common EMS Protocols?
Protocol Review Committee
What is the initial treatment for a patient with hemodynamically unstable back pain?
Administer normal saline, 500 mL IV bolus
Who requires a 12-lead ECG with acute upper back pain?
Any male 35 years or older and any female 45 years or older
What is the next step after administering a 500 mL IV bolus of normal saline to a patient with hemodynamically unstable back pain?
Re-evaluate the vital signs
What is the appropriate management for a patient with back pain and associated shortness of breath or low SpO2?
Follow the appropriate airway management protocol
What is the dose of ondansetron (Zofran) administered to a patient with nausea and back pain?
4 mg IVP/IO/IM
What is the primary concern in a patient with back pain resulting from a traumatic injury?
Following the appropriate trauma protocol
What is the indication for performing a neurological exam in a patient with back pain?
Acute lower back pain
What is the primary consideration in a patient with back pain?
Hemodynamic stability
What is the primary reason for alerting the receiving facility of the specific snake bite?
To ensure the correct antivenom is available
What is the typical location of a Coral Snake bite on the human body?
Finger or toe
What is the purpose of wrapping an ace bandage around the affected limb following a Coral Snake bite?
To immobilize the limb and prevent movement
What is the type of venom present in Coral Snake bites?
Neurotoxin
What is the significance of the rhyme 'Red next to yellow can kill a fellow'?
It identifies the Coral Snake as venomous
What is a potential complication of Coral Snake bites that may develop over time?
Respiratory paralysis
Why should the injured area be kept low and splinted following a Coral Snake bite?
To minimize movement and prevent venom spread
What is the correct sequence of wrapping an ace bandage around the affected limb?
Starting at the site of the bite and working towards the heart
What is the primary focus of the vision of patient care and treatment?
High quality standards, patient safety, and customer service
Who is the EMS Captain mentioned in the content?
Dan Feeney
What is the title of the document?
Common EMS Protocols
Which medication is not mentioned as a substitute in the City of Miami Fire Department?
Ativan
What is the purpose of the medical director overrides?
To restrict the use of certain protocols and medications
Which of the following is not mentioned as something to be continuously improved?
Our personnel
What is the title of Robert Campos?
Special Projects Coordinator
What is a potential complication that may develop over time in patients who have had gastric bypass surgery?
Kidney stones
What is the primary concern in a patient with abdominal pain?
Nausea and vomiting
What is the recommended treatment for hypotension in a patient with abdominal pain?
Administer 500 mL IV bolus of normal saline
What is the primary goal when questioning a patient with abdominal pain?
To identify the underlying cause of the pain
What is the significance of asking about the timing of the last menses in a patient with abdominal pain?
To rule out ectopic pregnancy
What is the recommended action for patients who have had gastric bypass surgery and are now complaining of abdominal pain?
Transport to a hospital for further evaluation
What is the primary focus of the vision of patient care and treatment?
To continuously improve patient care and treatment
What is the initial treatment for a patient with hemodynamically unstable abdominal pain?
Universal Initial Adult Patient Assessment / Care
What is the recommended treatment for a moderate to severe anaphylactic reaction?
Administer one injection from the Epi-Pen into the lateral thigh or upper arm
What is the recommended fluid bolus for a hypotensive patient?
500 mL IV fluid bolus of normal saline
What is the recommended treatment for bronchospasm that is not relieved by the administration of epinephrine?
Administer ipratropium/albuterol (DuoNeb) 0.5 mg/2.5 mg via nebulizer
What is the recommended dose of epinephrine for a hypotensive patient who remains hypotensive after the IM dose?
0.1 mg (1 mL) IV/IO
What is the purpose of administering diphenhydramine (Benadryl) in the treatment of anaphylaxis?
To provide a longer-acting treatment for anaphylaxis
What is the recommended maximum dose of epinephrine that can be administered to a hypotensive patient?
0.5 mg (5 mL)
What is the recommended treatment for a patient with dystonic reactions?
Not mentioned in the content
What is the recommended rate of administration for premix dopamine in a patient with hypotension?
30 drops per minute
What is the primary goal when treating a patient with a marine animal envenomation?
Immerse the puncture in non-scalding hot water to achieve pain relief
What is the recommended action when attempting to remove tentacles from a patient with a marine animal sting?
Use shaving cream and gentle scraping action with a wooden tongue depressor
What is the primary concern when evaluating a patient with a marine animal envenomation?
Allergic reaction
What is the recommended treatment for pain relief in a patient with a marine animal envenomation?
Immersing the puncture in non-scalding hot water
What is the primary goal when transporting a patient with a marine animal envenomation?
Provide rapid transport to the hospital
What is the recommended action when a spine is still embedded in a patient with a marine animal envenomation?
Leave the spine embedded and provide rapid transport
What is the primary concern when evaluating a patient with signs of numbness and muscle twitching?
Marine animal envenomation
What is the recommended action when a patient with a marine animal sting is experiencing severe inflammation and swelling?
Evaluate the patient's ABCs for signs of airway compromise
What is the primary consideration for administering a 500 mL IV bolus of normal saline to a patient with back pain?
The patient is hemodynamically unstable.
What is the indication for performing a 12-lead ECG in a patient with acute upper back pain?
Any male patient 35 years or older or female patient 45 years or older.
What is the next step after administering a 500 mL IV bolus of normal saline to a patient with hemodynamically unstable back pain?
Re-evaluate the vital signs and consider pain management.
What is the appropriate management for a patient with back pain and associated shortness of breath or low SpO2?
Follow the appropriate airway management protocol.
What is the dose of ondansetron (Zofran) administered to a patient with nausea and back pain?
8 mg PO or 4 mg IVP/IO/IM.
What is the primary concern in a patient with back pain resulting from a traumatic injury?
The patient's neurological status.
What is the indication for performing a neurological exam in a patient with back pain?
The patient has acute lower back pain.
What is the primary consideration in a patient with back pain?
The patient's hemodynamic stability.
What is a common sign of dystonia in a patient?
Protrusion of the tongue
What medication is commonly prescribed to combat the untoward effects of certain medications?
Benztropine mesylate (Cogentin)
What is the initial treatment for an allergic or systemic reaction?
Administer diphenhydramine (Benadryl), 50 mg slow IVP or IM
What is a rare but potential complication of certain medications?
Laryngospasm
What is a common indication for administering diphenhydramine (Benadryl)?
Allergic or systemic reaction
What is a common characteristic of medications that can cause dystonia?
Antipsychotic properties
What is the correct sequence of action if you are unable to see chest rise?
Consider an airway obstruction and manage appropriately
What is the breathing rate in respiratory/cardiac arrest?
10-12 breaths per minute
What is the next step if the patient's breathing has not improved and SpO2 is less than 94%?
Intubate the patient with an appropriate sized ETT
What medication is used for intubation in a patient with a difficult airway to open and active gag reflex, if vascular access is established?
Etomidate (Amidate)
What is the maximum number of intubation attempts allowed?
2
What is the dose of midazolam (Versed) used for sedation in a patient who becomes combative following a successful placement of an Advanced Airway, if vascular access is not established?
10 mg IM/IntraNasal
What is the purpose of reconfirming proper Advance Airway placement with ETCO2 and SpO2 measurements?
To confirm correct tube placement
What is the primary focus of the vision of patient care and treatment?
To provide high-quality patient care
What is the primary function of the capacitor in an Automatic Implantable Cardioverter/Defibrillator (AICD)?
To store and deliver shocks to the heart when indicated
What is the initial treatment for a patient with an AICD that is discharging inappropriately?
Monitor ECG and verify rhythm
What is the purpose of the wallet card given to patients with an AICD?
To provide identification information of the AICD type
What is the primary concern when performing CPR on a patient with an AICD?
There is no risk to the paramedic, CPR can be performed as usual
What is the purpose of airway management in the care of a patient with an AICD?
To assess the patient's respiratory status
What should be done if external defibrillation is required for a patient with an AICD?
Avoid placing the defibrillator patches over the implanted device
What should be done if a patient with an AICD has repetitive discharges?
Consider pain management in the conscious patient
What should accompany the patient to the hospital when they have an AICD?
The wallet card with identification information
What is the primary function of the upper airway?
To allow air to enter the lungs
What is the purpose of evaluating the lower airway?
To determine the patient's ability to ventilate and oxygenate
What is a common complication in patients with an altered mental status?
All of the above
What is the significance of a CO2 monitor in evaluating a patient's airway?
It determines the patient's ability to ventilate
What is a sign of an upper airway obstruction?
Gurgling, gasping, snoring, or stridor
When is the evaluation of the upper airway considered easier?
In patients who are alert and able to speak clearly
What is the primary concern in patients with a compromised upper airway?
Their ability to get air into their lungs
What is the significance of the gag reflex in patients with an altered mental status?
It increases the risk of airway obstruction from the tongue falling back against the back of the throat
When can a person be taken to a receiving facility for involuntary examination under the Baker Act?
When they are deemed to be a danger to themselves or others
Who can impose the Baker Act?
All of the above
What is the primary goal of the Baker Act?
To preserve the rights of the individual
What is the purpose of documentation on the Patient Care Record?
To record the name and agency of the person imposing the Baker Act
What is the primary consideration when using restraint on a patient?
The use of a supine or recovery position
What is the primary concern when dealing with a patient who poses a threat to themselves or others?
Preventing harm to the patient or others
What is the primary goal of the Baker Act in relation to patient care?
To preserve the patient's rights
What is the primary consideration when dealing with a patient who is deemed to be a threat to themselves or others?
The patient's ability to cause harm
What is the typical location of a Coral Snake bite on the human body?
Finger or toe
What is the purpose of wrapping an ace bandage around the affected limb following a Coral Snake bite?
To constrict the venom from spreading
What is the type of venom present in Coral Snake bites?
Neurotoxin
What is a potential complication of Coral Snake bites that may develop over time?
Respiratory paralysis
Why should the injured area be kept low and splinted following a Coral Snake bite?
To minimize movement
What is the significance of the rhyme 'Red next to yellow can kill a fellow'?
It describes the color pattern of a Coral Snake
What is the correct sequence of wrapping an ace bandage around the affected limb?
Starting at the site of the bite and working towards the heart
What is the primary concern in a patient with a Coral Snake bite?
Neurological disturbances
What is the primary goal of treatment for a patient with a mild allergic reaction?
To make the patient comfortable and continually assess for respiratory distress and/or anaphylaxis
What is the critical component in evaluating the severity of an allergic reaction?
Evaluating lung sounds
What medication is administered to treat bronchospasm in a patient with an allergic reaction?
Ipratropium/albuterol (DuoNeb)
What is the primary concern in a patient with anaphylaxis?
Treating respiratory failure
What is the indication for administering diphenhydramine (Benadryl) in a patient with an allergic reaction?
To alleviate mild allergic reactions
What is the dose of diphenhydramine (Benadryl) administered to a patient with a mild allergic reaction?
50 mg slow IVP or IM
What is the potential complication that may develop over time in patients with anaphylaxis?
Angioedema
What is the primary focus of treatment for a patient with anaphylaxis?
Treating respiratory failure
Under what circumstances can a person be taken into involuntary custody for substance abuse impairment?
All of the above
What is the primary goal of the initial assessment for a patient with a reptile or spider bite?
To provide general treatment and care to the patient.
What is the purpose of attempting to identify the insect, reptile, or animal that caused the injury?
To determine the type of treatment to provide.
What is the significance of the criteria for involuntary admission under the Baker Act?
It provides a framework for involuntary admission for substance abuse impairment.
What is the primary consideration in a patient with back pain resulting from a traumatic injury?
The potential for hemodynamic instability.
What is the primary focus of the vision of patient care and treatment?
Providing high-quality patient care.
What is the recommended treatment for a patient with hemodynamically unstable back pain?
Administration of a 500 mL IV bolus of normal saline.
What is the primary concern in a patient with abdominal pain?
The potential for hemodynamic instability.
What is the replacement for Ativan?
Versed
What will be used in place of a Scoop Stretcher?
Backboard
On which page can the Adult Trauma protocols be found?
Page 181
What is the page number of the Pediatric Trauma protocols?
Page 325
What is the title of the document that outlines the protocols for EMS?
2022-24 Common EMS Protocols
On which page can the Abdominal Pain protocols be found?
Page 5
What is the version of the Common EMS Protocols?
Version 1.8
Where can the Medications Section be found?
Page 349
What is the primary function of the capacitor in an Automatic Implantable Cardioverter/Defibrillator (AICD)?
To store and deliver shocks to the heart when indicated
What is the initial step in managing a patient with an AICD discharging inappropriately?
Monitor the ECG and verify the rhythm
Why is it safe for paramedics to perform CPR on a patient with an actively firing internal defibrillator?
The paramedic will not be at risk of electrical shock
What information should accompany the patient to the hospital when they have an AICD?
The AICD type, as indicated on the wallet card
What is the primary focus of airway management in a patient?
Assessment of the patient's respiratory status
What is the significance of maintaining a SpO2 of 94% or greater in a patient with an AICD?
It reduces the risk of cardiac complications
What is the primary goal when managing a patient with an AICD?
To stabilize the patient's cardiac rhythm
What should be done if the patient with an AICD is experiencing repetitive discharges?
Administer pain management to the patient
What is the primary goal when managing a patient with a marine animal envenomation?
Achieve pain relief using non-scalding hot water
What is the recommended method for removing visible tentacles from a marine animal sting?
Using a 4x4 gauze with a double-gloved hand
What is the temperature of the non-scalding hot water used for pain relief in marine animal envenomations?
110-113°F
What is the primary concern when evaluating a patient with a marine animal sting?
Allergic reaction and airway compromise
What is the recommended treatment for pain relief in a patient with a marine animal envenomation?
Immersing the affected area in non-scalding hot water
What is the purpose of applying a vinegar-soaked gauze to a marine animal sting?
To neutralize the venom
What is the recommended duration for immersing the affected area in non-scalding hot water?
30-90 minutes
What is the primary goal when transporting a patient with a marine animal envenomation?
To rapidly transport the patient to a medical facility
Who is the Medical Director of the City of Miami and Village of Key Biscayne?
Dr. Armando Clift
Which Fire Department does not have a Medical Director mentioned in the document?
None of the above
What is the title of the document that the Protocol Review Committee has worked on?
2022-24 Common EMS Protocols
Who is the Fire Chief of the Coral Gables Fire Department?
Marcos DelaRosa
How many Medical Directors are mentioned in the document?
3
What is the name of the committee that worked on the 2022-24 Common EMS Protocols?
Protocol Review Committee
Who is the Associate Medical Director for the City of Miami and Village of Key Biscayne?
Dr. Armando Clift
On which page is the Acknowledgements section found?
Page I
Which of the following adjuncts is best for acute pulmonary edema?
CPAP
In which mode is an Automatic Ventilator used with an advanced airway in apneic patients?
Automatic mode
What is the primary indication for using a BVM?
When an Automatic Ventilator is not available
When should an advanced airway be properly placed?
When the patient is in respiratory arrest
What is the purpose of giving 100% oxygen while preparing for an advanced airway procedure?
To increase oxygenation
Which of the following is a type of advanced airway?
Oral Endotracheal Tube
When is a Supraglottic Airway placed?
In the initial set of compressions in cardiac arrest
What should be set to 10 when using a BVM?
The manometer
What is the primary concern in patients taking ACE-inhibitors?
Angioedema of the lips, tongue, and throat
What is the treatment for a patient experiencing respiratory difficulty due to ACE-inhibitor use?
Epinephrine and Benadryl
What is the potential complication of ACE-inhibitor use that can occur at any time?
Angioedema
What is the dose of epinephrine administered to a patient experiencing respiratory difficulty due to ACE-inhibitor use?
0.3 mg IM
Why is Benadryl used in the treatment of respiratory difficulty due to ACE-inhibitor use?
To prolong the effect of epinephrine
What is the indication for administering diphenhydramine (Benadryl) in patients experiencing respiratory difficulty due to ACE-inhibitor use?
As an adjunct to epinephrine administration
What is the route of administration for diphenhydramine (Benadryl) in patients experiencing respiratory difficulty due to ACE-inhibitor use?
Slow IV infusion
What is the dose of diphenhydramine (Benadryl) administered to a patient experiencing respiratory difficulty due to ACE-inhibitor use?
50 mg IV
What is the primary consideration for patients categorized as Yellow?
Transportation via an ALS unit to the closest appropriate facility
What is the appropriate action for a patient who refuses transportation and is of legal age?
Having the patient sign AMA
What is the characteristic of a patient categorized as Green?
Walking and talking
What is the primary reason for transporting a patient categorized as Red?
The patient's condition is life-threatening
What is the ultimate goal of the treatment protocol for patients with alcohol intoxication?
To provide medical care to the patient
What is the primary consideration for patients who are disoriented to person, place, time, or event?
Transportation via an ALS unit to the closest appropriate facility
What is the appropriate action for a patient who requires medical attention but refuses transportation?
Having the patient sign an AMA form
What is the primary consideration for patients categorized as Green in terms of transportation?
Transportation via BLS unit when appropriate
What is the primary reason for identifying the scientific or common name of an exotic snake in a bite victim?
To alert the receiving facility and prepare for potential antivenin administration
What is the characteristic sign of a Brown Recluse spider bite?
Small bleb surrounded by a white ring
What is the recommended treatment for severe muscle spasms in a Black Widow spider bite victim?
Administer midazolam (Versed)
What is the primary concern in a patient with a scorpion sting?
Neurological symptoms
What is the purpose of alerting Venom 1 in the case of an exotic snake bite?
To prepare for potential antivenin administration
What is the typical presentation of a Brown Recluse spider bite?
Localized tissue necrosis and ulceration
What is the recommended treatment for a patient with a Black Widow spider bite who is experiencing severe muscle spasms?
Administer midazolam (Versed) and consider morphine sulfate if necessary
What is the primary focus in the management of a patient with a scorpion sting?
Neurological symptom management and supportive care
What is the primary purpose of assessing a patient's mental status during a clinical assessment of the lower airway?
To assess the patient's level of consciousness and responsiveness
What is the term for the fine crackling sound heard when listening to lung sounds with a stethoscope?
Rales
What is the least invasive option for managing a patient in apparent respiratory distress?
Blow-by
What is the significance of assessing a patient's skin color during a clinical assessment of the lower airway?
To assess for cyanosis, a potential indicator of respiratory distress
What is the primary focus of the clinical assessment of the lower airway?
Listening to lung sounds and identifying respiratory patterns
What is the purpose of assessing the chest wall and ribs during a clinical assessment of the lower airway?
To assess for retractions or accessory muscle use
What is the term for the deeper, coarse sound heard when listening to lung sounds with a stethoscope?
Rhonchi
What is the most invasive advanced airway?
Cricothyrotomy
What is the significance of assessing a patient's abdominal breathing pattern during a clinical assessment of the lower airway?
To assess for abdominal muscle use and breathing patterns
What is the primary consideration when choosing an airway management device?
Severity of respiratory distress
What is the purpose of monitoring SpO2 levels?
To measure sufficient oxygen in the blood
What is the next step if the initial airway management device is not effective?
Move to a more invasive device
What is the significance of monitoring capnography waveforms?
To measure ventilation
Why is repeated re-evaluation important in airway management?
To determine if the initial management choice is correct
What is the primary focus of airway management?
Oxygenation
When are invasive airways usually reserved?
For patients with severe respiratory distress with depressed levels of consciousness
In a patient with abdominal pain, what is the most helpful piece of information when trying to determine the cause of the pain?
Location of the pain
A patient with right upper quadrant pain may have which of the following conditions?
Gallbladder pain
In a patient with upper abdominal pain, which of the following is a relevant consideration?
Any female 45 years or older needs a 12-lead ECG
What is a potential complication in patients taking ACE-inhibitors?
Localized angioedema
A patient with left upper quadrant pain may have which of the following conditions?
Pancreatitis
What is a potential complication that may develop over time in patients who have had gastric bypass surgery?
Abdominal pain
What should be observed in patients taking ACE-inhibitors during transport?
Developing or increasing respiratory difficulty and/or changes in their voices
In a patient with lower abdominal pain, which of the following is a relevant consideration?
Females of childbearing years should be treated as a possible ectopic pregnancy
What is NOT an allergic reaction in patients taking ACE-inhibitors?
Localized angioedema
A patient with right lower quadrant pain may have which of the following conditions?
Classic appendicitis pain
What medication may be administered to patients taking ACE-inhibitors who experience angioedema?
Diphenhydramine (Benadryl)
What is the primary concern in a patient with abdominal pain?
Determining the cause of the pain
What is the dose of epinephrine administered to patients taking ACE-inhibitors who experience angioedema?
0.3 mg (0.3 mL) IM
What is the duration of action of diphenhydramine (Benadryl) compared to epinephrine?
Longer
Why is diphenhydramine (Benadryl) administered to patients taking ACE-inhibitors who experience angioedema?
To prolong the duration of epinephrine's effects
What is the severity of angioedema that can occur in patients taking ACE-inhibitors?
Severe, potentially blocking the upper airway
What is the primary goal of the initial treatment for unstable bradycardia?
Raise the patient's heart rate above 60 bpm
When should external pacing be initiated in a patient with unstable bradycardia?
As soon as possible, without delaying for vascular access or atropine to take effect
What is the recommended dose of atropine sulfate for a patient with unstable bradycardia?
1.0 mg IVP/IO, repeated every 5 minutes as needed
What is the primary concern in a patient with unstable bradycardia who is experiencing respiratory distress?
Hypoxia and inadequate ventilations
What is the indication for administering a fluid bolus of normal saline to a patient with unstable bradycardia?
The patient's blood pressure is below 90 mmHg
What is the maximum dose of atropine sulfate that can be administered to a patient with unstable bradycardia?
0.04 mg/kg (3 mg for the average adult)
Why is atropine sulfate unlikely to be effective in treating bradycardias with a wide QRS complex?
Because the QRS complex is not affected by atropine sulfate
What is the primary goal of pain management in a patient with unstable bradycardia who is conscious and not tolerating the pain from pacing?
To alleviate the patient's discomfort and pain
Study Notes
Medical Directors and Fire Chiefs
- Paul J. Adams, Medical Director for Coral Gables, Hialeah, and Miami Beach
- Dr. Armando Clift, Associate Medical Director for City of Miami and Village of Key Biscayne
- Marcos DelaRosa, Fire Chief for Coral Gables Fire Department
- Zahralban, Fire Chief for Miami Fire Rescue
- Virgernandez, Fire Chief for Miami Beach Fire Rescue
Acknowledgements
- Protocol Review Committee members:
- Frederick M. Keroff, Medical Director
- Emmanuel Louis, Lieutenant, MFR
- Raydel Castellanos, Firefighter, MFR
- Jose Siut, EMS Training Instructor, MFR
- Dan Feeney, EMS Captain, KBFR
- Nicholas Johnson, EMS Lieutenant, KBFR
- Robert Campos, Special Projects Coordinator, KBFR
Medical Director Overrides
- The following EMS protocols/procedures and medications will not be used by personnel from the City of Miami Fire Department until available for use:
- Ativan
- Cardene
- Nitrous Oxide
- Racemic Epinephrine
- Tetracaine Eye Drops
- Scoop Stretcher's
- T- Pod
- Oral Gastric tubes
Adult Protocols
Back Pain
- If patient is hemodynamically unstable (has a low blood pressure), administer normal saline, 500 mL IV bolus
- Re-evaluate vital signs after patient has received fluids
- May repeat once if needed
- Consider Pain Management as indicated
- With acute upper back pain:
- Any male 35 years or older needs a 12-lead ECG
- Any female 45 years or older needs a 12-lead ECG
- With acute lower back pain, perform a neurological exam evaluating motor and sensory function in the lower extremities
- If back pain is a result of traumatic injury, follow the appropriate trauma protocol
Baker Act / Marchman Act
- Fire Rescue personnel may examine, treat, and/or transport a patient without their informed consent under certain conditions where the patient is incapacitated
- Involuntary Examination, Florida Mental Health Act (“The Baker Act", FS 394.463)
- A person may be taken to a receiving facility for involuntary examination if there is reason to believe that the person has a mental illness and because of their mental illness:
- The person has refused voluntary examination after conscientious explanation and disclosure of the purpose of the examination
- The person is unable to determine for himself or herself whether examination is necessary
Coral Snake Bites
- Patients who have been bitten by a Coral Snake may not have any symptoms for a few hours
- If there is a reliable history of a possible Coral Snake bite, the patient should be transported to the hospital for further observation and evaluation
- Coral snakes do not have fangs but have small milk teeth
- Typical story is that a patient is bitten on the finger or toe and the patient has to shake the snake off
- "Red next to yellow can kill a fellow" (Coral Snake) vs. "Red next to black is a friend of Jack" (King Snake, non-poisonous)
Bites & Stings
- For any known or suspected Coral Snake bite, alert Venom 1
- Evaluate for specific signs/symptoms:
- Most signs and/or symptoms may be delayed up to 12 hours and are related to the type of venom, which is a neurotoxin
- CNS disturbances may be observed
- Stroke-like signs and/or symptoms
- Respiratory paralysis may develop
- Be prepared to manage respiratory distress and provide ventilation assistance
- Wrap an ace bandage snugly around the affected limb starting at the site of the bite and working towards the heart (proximal), wrapping the entire extremity
- Monitor distal circulation by capillary refill and/or pulse to ensure the wrap does not become a tourniquet
Abdominal Pain
- Abdominal pain may be associated with nausea and/or vomiting, diarrhea or constipation, urinary symptoms, difficulty breathing, cough, fever.
- Patients who have had gastric bypass surgery are at increased risk for having complications.
- Complications can occur shortly after surgery to many years following the surgical procedure.
Evaluation
- Questions to ask the patient:
- Onset of pain: sudden or gradual?
- Is the pain constant or intermittent?
- Has the pain moved since it started?
- Have you had this type of pain before?
- Are there any associated symptoms or clinical findings, such as nausea, vomiting, diarrhea, urinary symptoms, and/or shortness of breath?
- On a scale of 1 to 10, how bad is the pain now?
- Have you taken any medications to make yourself feel better? If so, did it make a difference?
- When was the timing of last menses?
Treatment
- Universal Initial Adult Patient Assessment / Care.
- Hypotension:
- Administer normal saline, 500 mL IV bolus. May repeat once if needed.
- Administer epinephrine 1:1,000, 0.3 mg IM (0.3 mL) for asthma or allergic reactions.
Allergic / Systemic Reactions
- Signs and symptoms:
- Protrusion of the tongue
- Jaw/teeth clenching
- Facial grimacing
- Deviation of the head to one side
- Sustained upward deviation of the eyes
- Extreme arching of the back
- Or rarely, laryngospasm
- Suspect possible dystonia in patients exhibiting these signs and who have taken certain medications.
- Treatment:
- Administer diphenhydramine (Benadryl), 50 mg slow IVP or IM.
Back Pain
- Localized edema-swelling usually of the lips, tongue, and/or throat.
- If the patient is hemodynamically unstable, administer normal saline, 500 mL IV bolus.
- Consider Pain Management as indicated.
- With acute upper back pain:
- Any male 35 years or older needs a 12-lead ECG.
- Any female 45 years or older needs a 12-lead ECG.
Bites & Stings
- Marine Animal Envenomations:
- Immerse the puncture(s) in non-scalding hot water as warm as tolerable (110-113°F) to achieve pain relief.
- Consider Pain Management in the conscious patient.
- Marine Animal Stings:
- Evaluate ABCs for evidence of an allergic reaction, severe inflammation and swelling that might compromise airway and breathing.
- Remove visible tentacles using 4x4s with a double-gloved hand.
- Apply a vinegar (acetic acid) soaked gauze to the affected areas for 30 minutes.
- Consider Pain Management in the conscious patient.
- After pain relief, attempt to remove any remaining tentacles by using shaving cream and gentle scraping action with a wooden tongue depressor.
AICD (Automatic Implantable Cardioverter/Defibrillator)
- AICD is a device implanted in the soft tissues of the patient's chest wall.
- It consists of a lead system, computer circuitry, power supply, and capacitor.
- The device stores and delivers shocks to the heart when indicated.
AICD Discharges
- Universal Initial Adult Patient Assessment/Care is the first step.
- Airway management is crucial.
- Monitor ECG and SpO2, maintaining SpO2 at 94% or greater.
- Establish vascular access and treat dysrhythmias per appropriate protocol.
- Transport the patient to the closest appropriate hospital.
AICD Confirmed by ECG to be Discharging Inappropriately
- Monitor ECG, verify rhythm, and identify any inappropriate defibrillator discharges.
- For repetitive discharges, consider pain management in the conscious patient.
Airway Management
- Assessment of a patient's respiratory status is divided into two categories: upper airway and lower airway evaluation.
- The upper airway includes the tongue, soft palate, throat, oropharynx, and vocal cords.
- The lower airway includes the trachea, bronchi, and lungs.
- Evaluation of the upper airway involves assessing the openness or patency of the upper airway.
- Evaluation of the lower airway involves assessing ventilation and oxygenation.
Airway Management Protocol
- Deliver 1 breath every 6 seconds (10-12 breaths per minute) in respiratory/cardiac arrest.
- If the patient's breathing improves, continue with current airway management and transport.
- If not, insert a Supraglottic Airway device or intubate the patient with an appropriate sized ETT, if indicated.
- Confirm and monitor proper placement with capnography.
Baker Act / Marchman Act
- The Baker Act is a Florida law that allows for the involuntary examination of a person suspected of having a mental illness.
- The Act can only be imposed by a judge, sworn law enforcement officer, or certain medical professionals.
- Reasonable force (restraint) may be applied, but the patient should not be placed in a prone (face down) position.
Coral Snake Bites
- Coral snakes do not have fangs, but have small milk teeth.
- The typical story is that a patient is bitten on the finger or toe and has to shake the snake off.
- Patients who have been bitten may not have any symptoms for a few hours.
- If there is a reliable history of a possible Coral Snake bite, the patient should be transported to the hospital for further observation and evaluation.
General Snake Bites
- For any known or suspected bite, alert Venom 1.
- Evaluate for specific signs/symptoms, including delayed CNS disturbances and stroke-like signs.
- Respiratory paralysis may develop, so be prepared to manage respiratory distress and provide ventilation assistance.
- Wrap an ace bandage snugly around the affected limb to minimize movement and monitor distal circulation.
Common EMS Protocols
- The protocols are applicable in Coral Gables, Hialeah, Miami, Miami Beach, and Key Biscayne.
Adult Protocols
- AICD (Automatic Implantable Cardioverter/Defibrillator) is a device implanted in the patient's chest wall, consisting of a lead system, computer circuitry, power supply, and capacitor.
- AICD discharges require Universal Initial Adult Patient Assessment/Care, airway management, ECG and SpO2 monitoring, vascular access, and treatment of dysrhythmias.
Airway Management
- Assessment of a patient's respiratory status is divided into upper and lower airway evaluation.
- Appropriate management includes transport to the closest appropriate facility for further observation.
Allergic/ Systemic Reactions
- Mild allergic reactions involve making the patient comfortable and assessing for respiratory distress and anaphylaxis.
- Treatment includes diphenhydramine (Benadryl) administration, ipratropium/albuterol (DuoNeb) for bronchospasm, and transport.
- Anaphylaxis is a severe allergic reaction resulting in circulatory shock and respiratory distress, requiring Universal Initial Adult Patient Assessment/Care and treatment.
Bites and Stings
- For any reptile or spider bite, request the Miami-Dade County Venom 1 Unit.
- General treatment includes Universal Initial Adult Patient Assessment/Care, ECG and SpO2 monitoring, pain management, and rapid transport if symptomatic.
- Marine animal envenomations involve immersion in non-scalding hot water for pain relief, and avoiding removal of embedded spines.
- Marine animal stings require evaluation of ABCs, removal of tentacles, vinegar (acetic acid) soaked gauze application, and pain management.
EMS Protocols
- The 2022-24 Common EMS Protocols involve the collaboration of multiple medical directors and fire chiefs from Coral Gables, Hialeah, Miami, Miami Beach, and Key Biscayne.
- The protocol review committee consists of individuals who have worked tirelessly to produce a state-of-the-art protocol manual.
Airway Management
- There are three adjuncts for Positive Pressure Ventilation (PPV):
- CPAP (Continuous Positive Airway Pressure): best for Acute Pulmonary Edema, and can be used for respiratory distress that does not respond to medication.
- Automatic Ventilator: used for PPV in demand, manual, or automatic mode.
- BVM (Bag-Valve-Mask): used when CPAP or Automatic Ventilator is indicated but not available, and can be used with an advanced airway.
- Advanced Airway options include Supraglottic Airway or oral Endotracheal Tube, and should be properly placed in cases of respiratory arrest or prolonged PPV.
Adult Protocols
Alcohol Intoxication
- Patients can be categorized into Green, Yellow, and Red categories based on their level of intoxication.
- Green category patients can be transported BLS when appropriate, while Yellow category patients should be transported via an ALS unit to the closest appropriate facility.
- Red Category patients shall be transported via an ALS unit to the closest appropriate facility.
- Treatment options include:
- Establishing baseline vitals, level of consciousness, and glucose testing.
- Ruling out possible drug ingestion/overdose.
- Trying to persuade the patient to go to an appropriate hospital.
Allergic / Systemic Reactions
- Treatment for allergic reactions includes:
- Administering epinephrine 1:1,000, 0.3 mg (0.3 mL) IM.
- Administering diphenhydramine (Benadryl), 50 mg slow IVP or IM.
Bites and Stings
- Exotic snake bites require rapid transport and identification of the snake's scientific name or common name.
- Brown Recluse Spider bites have signs and symptoms including:
- Small bleb (blister) surrounded by a white ring.
- Localized pain, redness, and swelling.
- Localized tissue necrosis.
- Black Widow Spider bites have signs and symptoms including:
- Immediate localized pain.
- Progressive muscle spasms.
- Rigid abdomen.
- Seizures.
- Paralysis.
- Treatment for Black Widow Spider bites includes:
- Alerting Venom 1.
- Evaluating for specific signs and symptoms.
- Administering midazolam (Versed) to reduce severe muscle spasms.
- Administering morphine sulfate to reduce severe muscle spasms.
- Considering pain management in the conscious patient.
Abdominal Pain
- Traumatic damage to solid organs (spleen, kidney, liver) can cause gastrointestinal bleeding
- Important signs and symptoms:
- Upper abdominal pain (above umbilicus)
- Nausea and/or vomiting
- Bleeding from the mouth or rectum
- Evaluation considerations:
- Age and gender: males ≥35 years and females ≥45 years require a 12-lead ECG
- Location of pain:
- Right upper quadrant pain: gallbladder pain, kidney stones
- Right lower quadrant pain: kidney stones, ectopic pregnancy, classic appendicitis
- Left upper quadrant pain: pancreatitis
- Left lower quadrant pain: diverticulitis
Airway Management
- Clinical assessment of the lower airway:
- Mental status
- Skin assessment (warm/dry, pink, ashen, or cyanotic)
- Chest wall and accessory muscle assessment (retractions, abdominal breathing)
- Lung sounds (wheezing, rhonchi, rales, absent breath sounds)
- Management options:
- Blow-by
- Nasal cannula
- Nebulizer
- NRB mask
- BVM with reservoir
- CPAP
- Invasive advanced airways (supraglottic devices, oral ETT, cricothyrotomy)
- Monitoring:
- Level of consciousness
- SpO2 levels
- Capnography waveforms
Angioedema
- Patients taking ACE-inhibitors may present with:
- Localized angioedema (lips, tongue, throat)
- Partial upper airway obstruction with stridor
- Treatment:
- Epinephrine 1:1,000, 0.3 mg (0.3 mL) IM
- Diphenhydramine (Benadryl), 50 mg slow IVP or IM
- Observation during transport for developing or increasing respiratory difficulty and/or changes in voice
Bradycardia
- Unstable bradycardia signs and symptoms:
- New onset of altered mental status
- Syncope
- Respiratory distress/CHF
- Chest pain
- Low blood pressure
- Signs/symptoms of shock
- STEMI
- Treatment:
- Universal initial adult patient assessment/care
- External pacing as soon as possible
- Atropine sulfate, 1.0 mg IVP/IO (may be repeated every 5 minutes until maximum dose reached)
- Ensure adequate ventilations
- Fluid bolus of normal saline, 500 mL IV/IO (may repeat once as needed) if BP remains <90 mmHg
EMS Protocols
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