EMS Procedures PDF

EMS Procedures Bag Valve Mask BVM Indications RR less than Bradycardia Bag size Adult 8 60 1000 - 12 Adolescent (13 - 18) 12 60 1000 - 12 Chi...

EMS Procedures Bag Valve Mask BVM Indications RR less than Bradycardia Bag size Adult 8 60 1000 - 12 Adolescent (13 - 18) 12 60 1000 - 12 Child (1 - 12) 16 80 750 Infant/ Toddler (lees than 1) 20 100 450 - 500 Absent or diminished breath sounds Less than 90% on O2 Paradoxical Breathing Cardiac arrest GCS Less than 8 Procedure Suction ready Adjunct used - position tongue Proper sized mask to prevent vagal stimulation (pediatrics) Treat gastric dissension manually or open existing GI tube E-C clamp for seal and use jaw lift to adjust airway Electrical Therapy: Automated Mated External De brillator (AED) Contraindicated Less than 1 hour old Pad Choices Neonate (1 hr - 28 days) - 1yr manual preferred, pediatric pads preferred over adult pads Child 1 - 8 pediatric pads preferred over adult pads 8 and older Adult Pads Post Shock 5 cycles of CPR fi  Go Team Activation Go team Pt report completed by team and submitted to MIEMSS EMS Medical Command Communicates with go team in route Attending Physician and Anesthetist - go team members Extrications greater than 1 hour Syscom makes all noti cations to scene Reasons anesthesia, amputation, advance uid resuscitation (blood), chest tubes, GI tubes, catheters Transportation Air - Syscom - Shock trauma center (STC) Land - Maryland Express Care High Performance CPR (HPCPR) Contraindications Pronouncement of Death in Field Less than 24 hrs old Dispatcher Telephone CPR (T-CPR) Pt is more responsive to EMS interventions after T-CPR is initiated High Performance CPR Hover over chest during shock/ pulse check Advanced Airway 500CC - 3 nger or end of bag squeeze 13 - adult - 1 breath/ 6 seconds Neonate - 13 - 1 breath/ 3 seconds Without Advanced Airway 1 breath/ 10 seconds Manual CPR 30:2 single rescuer 15:2 2 rescuer with breaths on 14th and 15th recoil fi fi fl  Quality Improvement/ Metrics Time to CPR - fraction of 80%, improved survival Time to de brillation. Quality of CPR Code Resource Management (inverted triangle) highest - lowest priority 1. Chest compressions Less than 1 - 1.5” depth Greater than 1 - 2”depth 2. De brillation 3. BLS Airway. Adjunct 4. IV/ IO 5. Meds 6. ALS Airway Crew Roles HPCPR 1st and 2nd clinicians perform CPR and Ventilations alternating every 2 mins 3 clinicians 3rd becomes crew leader and doesn’t switch Monitors Assigns roles ALS Verbal announcement @ 1:30, 1:45 and 10 second count down 4 Clinicians 1 and 2 same 3rd attach and control AED 4th crew leader Greater than 4 Crew leader assigns roles Medevac All trauma, consult for C, D and hand Medical - Stroke, STEMI, Hyperbaric Greater than 30 min travel by ground priority 1 or 2 fi fi  Greater than 60 min travel by ground specialty centers or would deplete resources Dispatcher can call for based on info prior to EMS arrival Contraindication MOLST/ DNR B Landing Zone 150’ x 150’ - min 175’ X 175’ - preferred 45* test with full 360 - LZ o cer 10* or less slope 200’ stopped tra c in all directions No cones or ares 4 People Load Team Debris in eye take a knee wait for help Do not light LZ Emergency lights on until helicopter overhead PT Refusal PT = Person with potential for injury or illness, encountered on duty Who is a minor Not married, a parent, not self supporting or seeking treatment for rape (contact police or social services), drugs or STI Patient Assessment Includes 1. Visual Assessment 2. Primary Survey 3. Vitals (O2 sat, Hr, RR, Bp) 4. Secondary Survey 5. Capability to make decisions Allowed to Refuse Understand and discusses 18 or parent of child No to answers 1,2,3a,3b and 4 Yes to answers 5-8 “high risk for medical Illness” - second opinion/ consult Not Allowed to refuse 1. ALOC 2. Suicide, danger to self or others 3. Impaired judgment by illness or injury fl ffi ffi  4. Emergency petition Consult Required Clinician unsure/ disagrees with patient Pt involved in trauma Minor PT Yes, to questions 6-10 Document “At Risk” if medical care maybe needed Contact supervisor if Pt refuses to sign Restraints Do Not Hog Tie Document vitals q 15 mins Reasons to Restrain Danger to self and others Rules Greater than 1 year old Face up or on side Adults 4 points 1 arm up 1 arm down or cover with sheet and apply reeves Children 3 points 2 arms and a leg or cover with sheet and apply Reeves Be prepared to log roll any restrained Pt with additional personnel Police Hand cu ed - face up, hands anterior MCI or Unusual Event Procedure does not supersede SOP’s Indications 5 or more PT encounters or decontamination’s from 1 or more related events Specialized rescue 3 or more priority 1 PT More than 1 PT burned requiring burn center ff  2 medevacs or the MAB WMD Multiple PT with unusual signs and symptoms Evacuation of a health care facility EMRC ASAP noti cation of MCI or Unusual Event Dispatchers may notify while units are in route Required Info: 1. Type of Incident 2. Address 3. Age Range 4. Estimated # PT by Priority 5. # of PT total 6. Hazardous Agent involved Transportation Group Super/ Medical Communication supervisor Final check point before transport EMRC will communicate # of available beds and where Communicate # and reason to receiving hospital Notify EMRC/ dispatch center of last PT transported Cannot Establish Supervisor: Each unit go through EMRC Volatile Environment - Active or Potentially Active Shooter By not entering scene = additional loss of life Law Enforcement escorts for FD Zones Hot Zone - Direct Threat Mitigation of direct threat Tactical medic Only operate here (TEMS) Commercial tourniquet - control severe hemorrhage applied over clothing as high on limb as possible No CPR in Hot Zone NAAK/ MARK1 if indicated Warm Zone - Potential Threat Primary Objective - Evacuation, don’t delay for interventions fi  Care at injury location or casualty collection point (CCP) May have multiple CCP’s in warm zone CCP concealed/ covered/ protected Label casualties with appropriate ribbons or markers to prevent reassessment MARCHED Massive Hemorrhage Greatest threat to life is trauma Reassess hot zone tourniquets Tourniquets DC by ALS with medical consult Hemostatic Dressing - vascular neck, groin and axilla injuries with 5 mins direct pressure Airway High priority for evacuation Casualty Unconscious with, without or potential obstruction 1. Jaw thrust/ chin lift 2. NPA 3. Recovery position or position of comfort for PT 4. Time/ Environment permitting - advanced airway Respiration Chest wound assessment Tension pneumon - common cause of preventable death 3.25”/ 14ga needle or kit Circulation Hypotension - IV, 90mmHg Hypovolemic shock - 500CC 1x bolus Trauma Arrest - No CPR Hypothermia Increased mortality Easier to prevent than treat Move/ Minimize heat loss Everything Else Mark/ Duodote - organophosphate or nerve agent Burns, eye, acute per protocol Document  Massive Hemorrhage Airway Respirations Circulation Hypothermia Everything Else Document Cold Zone - traditional PT Care Evacuation corridor - transition between cold and warm zone Retriage Readdress hemorrhage Care dictated by resources CPR larger role for: electrocution, hypothermia, non-traumatic arrest, near drowning Emerging Infectious Disease (EID) Increased last 2 decades New, old, unknown infection spreading Ex. Ebola Viral Disease, ue is not Case speci c signs and symptoms Informations from CDC about PUI Transmission Modes: Direct - direct contact droplet spread Indirect - air particles, vehicles, vectors Don PPE Never use N95 on PT 3 Categories of Hospitals 1. Frontline - all hospitals with ED’s 2. Assessment - 4-5 day stay and then transported to a treatment hospital 3. Treatment - CDC approved, stay until death or no longer ill Transport no Helicopter Less than 45 mins to assessment otherwise frontline for priority 1 and 2 and pediatrics under 15 fi fl  Communication “PUI” used Refusal Remove yourself from the environment Hospice/ Palliative Care Must be enrolling or enrolled Valid MOLST-B Contraindicated Less than 18 BLS Transport Portable xed or CAAD Pump ALS Transport Chest Tube Ventilator Not on xed pump Direct To Triage Priority 3 18 or older Able to communicate and understand Able to sit in a wheel chair Vitals 10-20 - RR 60-100 - HR 92%+ - on room air 96-101 - temp 71+ - glucose 110 - 180 - systolic 60-100 - diastolic Do Not Use High risk conditions Time dependent needs fi fi  Mechanical CPR Cardiac arrest with established resuscitation Contraindications Younger than 13 LVADs PT’s Procedure Use after 2 - 2 min cycles of manual CPR 10 sec brake max Stand bye mode for transport of ROSC De brillate while device is operating Free Standing Medical Facility MIEMSS designated Priority 2,3,4 in need of non-critical interventions Priority 1 needing airway or in extremis Contraindicated pregnant, specialty center, time critical needs to hospital Consult With designated base station fi