Suffolk County Protocols Flashcards

On-Line Medical Control Physician

• Authorized by the Medical Director and REMAC to provide advice at out-of-hospital medical emergencies.
• Provides direction to ALS Providers during out-of-hospital medical care.

Disaster Medical Response Team (DMRT) Physician

• Holds additional authority as a Deputy Fire Coordinator-Medical.
• Acts as an agent of the county when specifically called upon.

Designated EMS Field Physician

• Authorized to provide advice and direction at the scene of out-of-hospital medical emergencies by the Medical Director and REMAC.

Voice Contact with Medical Control Protocol

• Required to establish voice contact within 20 minutes after technician-patient contact.

Refusal of Medical Assistance (RMA)

• Consultations must be conducted via telephone.

ALS Provider Rights

• Has the right to question orders believed to be contraindicated or for which they are unqualified.

Protocol Adherence

• If an order is clarified and not retracted, the ALS Provider must execute it unless uncredentialed or untrained in the intervention.

Procedure Attempts

• Limited to 2 attempts per patient.

Standing Orders

• Written based on the assumption of a single ALS Provider; must be performed in order.

Obligations to Protocols

• Once standing orders are initiated, ALS Providers must adhere to that protocol.

Standing Orders Authority

• Medical Control physician assumes all treatment decisions, including transport, once contact is made; with exceptions for certain cases like defibrillation in specific rhythms.

Physician Extender Responsibilities

• A Physician Extender cannot provide on-scene direction outside their usual employment context.

On-Scene Treatment Responsibilities

• A Physician Extender in their usual setting may assume responsibility for patient care under their supervising physician's license.

Patient Responsibility Documentations

• On-scene physicians assuming care must document it and accompany the patient to the hospital.

Psychiatric Emergencies

• Transport to the nearest emergency department for medical evaluation is essential.

Hyperbaric Therapy Transport

• Patients requiring hyperbaric therapy should be taken to the nearest emergency department for evaluation.

Sexual Assault Victims

• Must have transportation to hospitals with a Sexual Assault Nurse Examiner (SANE) Program, barring unstable conditions.

Trauma Center Transport Protocol

• If transport time exceeds 30 minutes, Medical Control must be contacted for guidance.

Nitrous Oxide Usage

• Not permitted on medevac aircraft.

Endotracheal Intubation Requirements

• Must use End-Tidal CO2 waveform capnography and commercially available tube holders, along with head immobilization techniques.

RES-Q Pod™ Usage

• Required for all cardiac arrest patients; contraindicated for traumatic arrests with chest injury.

DNR Orders

• Specify not to perform certain resuscitation procedures in the event of cardiac or respiratory arrest.

Dispute of DNR Orders

• If a DNR or MOLST Form is contested, initiation of CPR is permissible to avoid confrontation.

Termination of Resuscitation

• Classified as a standing order.

Adult Definition

• An individual is classified as an adult if aged 15 years or older and weighing over 36 kg.

Patient Treatment Guidelines

• Patients over 12 years old and over 36 kg may be treated as adults.

Criteria for Unstable Patients

• Includes various vital sign threshold markers indicating instability, such as pulse irregularities and blood pressure extremes.

Ventricular Fibrillation / Pulseless Ventricular Tachycardia Treatment

• Includes specific dosages for defibrillation and medications like Epinephrine and Amiodarone.

Sodium Bicarbonate in Specific Situations

• Administered at 1 mEq/kg if renal failure, TCA overdose, or hyperkalemia is suspected.

Magnesium Sulfate Administration

• 2 g IV/IO/EJ for Torsade de Pointes during arrhythmias like Ventricular Fibrillation.

H's & T's of ASYSTOLE / PEA

• Conditions such as Hypoglycemia, Hypovolemia, Hypoxia, and others must be assessed.

Fluid Bolus Guidelines in ASYSTOLE / PEA

• Administer 20 ml/kg, repeatable to a maximum of 40 ml/kg.

Shock / Hypoperfusion After ROSC

• Specifically for patients in shock from post-cardiac arrest.

Dopamine Dosage During Shock

• Infusion of 10 mcg/kg/min if Systolic B/P is below 90 mmHg.

Exclusion Criteria for Therapeutic Hypothermia

• Certain conditions including pregnancy, trauma, and others preclude treatment.

Therapeutic Hypothermia Protocols

• Aimed at patients following cardiac arrest.

Chilled Normal Saline Infusion Limit

• Maximum infusion is 30 ml/kg or 2 L.

VENTRICULAR TACHYCARDIA WITH PULSE Protocols

• Differentiations between stable and unstable patients dictate treatment pathways including medications and cardioversion specifics.

Supraventricular Tachycardia Management

• Requires specific medication administration and follow-up with Medical Control as needed.

Atrial Fibrillation / Flutter Treatment

• Protocols are determined by stability and specific rates, including medication dosages and cardioversion strategies.### Acute Coronary Syndrome Entry Protocol

• Aspirin Dosage:

  • 2 x 81mg if patient has previously taken aspirin.
  • 324mg if patient is symptomatic and has taken aspirin.
  • 324mg if patient did not take aspirin this episode.

• STEMI Management:

  • Administer Nitroglycerin 0.4 mg SL, repeat every 5 minutes, maximum 3 doses with SBP > 120.
  • Morphine Sulfate up to 10 mg IVP required if SBP drops below 90.

IV Access and Procedures

• Maximum attempts for IV access: 2.
• If failed attempts reach the maximum, switch to intraosseous (IO) access.

Medical Shock / Hypoperfusion

• If SBP < 90 with inadequate tissue perfusion and respiratory distress:

  • Discontinue fluid bolus and initiate Dopamine Infusion at 10 mcg/kg/min.

• If blood pressure remains < 90 after initial treatment:

  • Must contact Medical Control.

Pulmonary Edema Management

• Maintain cautious observation when systolic BP is 120 or higher during transport.

• If BP suddenly drops below 120, contact Medical Control for further instructions.

• For congestive heart failure suspected cases:

  • Perform continuous monitoring and oxygen saturation checks.
  • Administer Nitroglycerin 0.4 mg SL before applying CPAP.
  • Morphine Sulfate may be given up to 10 mg IVP.

Asthma Protocol

• In cases without imminent respiratory failure:

  • Administer Albuterol and Ipratropium Bromide via nebulizer; repeat once.
  • Provide Methylprednisolone 125 mg IV.

• For patients with respiratory failure:

  • Administer Epinephrine 0.3 mg (0.3 ml of 1:1,000 solution) IM.
  • Magnesium Sulfate IV infusion at 2 grams in 100 ml over 10 minutes can follow.

COPD / Exacerbation Management

• Administer combination of Albuterol and Ipratropium Bromide via nebulizer.
• Utilize CPAP titration up to 10 cmH2O with continuous capnography monitoring, if SBP > 120.
• Include Methylprednisolone 125 mg IV in the treatment regimen.

Anaphylactic Shock

• Anaphylactic Shock characterized by respiratory failure and low SBP must be closely monitored and treated promptly with appropriate protocols.