Practice Parameters - User contributions [en]

Maitland Fire Rescue Department Practice Parameters

2025-12-17T16:24:10Z

Mfrdmanager: /* Section 2 - Primary Care */

__NOTOC__
==TABLE OF CONTENTS==

[[Medical Director Authorization]]

===Section 1 - Administrative Policies===

{| class="wikitable"
|-
! Section !! Description !! Revision Date
|-
| 1.01 || [[General Measures]] || April-16
|-
| 1.02 || [[Radio Report Format]] || March-16
|-
| 1.03 || [[Refusal of Service]] || October-17
|-
| 1.04 || [[Physician or Nurse on Scene]] || March-09
|-
| 1.05 || [[Initiation of CPR and Determination of Death]] || July-16
|-
| 1.06|| [[Determination of Death in Trauma]]|| March-09
|-
| 1.07|| [[Crime or Unattended Death Scene]] || March-09
|-
| 1.08|| [[Medical Evaluation of Person in Police Custody]]|| March-09
|-
| 1.09|| [[Trauma Transport Protocol]]|| Dec-19
|-
| 1.10|| [[Emergency Transport]]|| March-09
|-
| 1.11|| [[Criteria for Helicopter Transport]]|| March-09
|-
| 1.12|| [[Medical Patient Transport Decision]]|| April-14
|-
| 1.13|| [[Obstetrical Patient Transport Decision]]|| Feb-15
|-
| 1.14|| [[Emergency Inter Facility Transport]]|| March-09
|-
| 1.15|| [[EMS Disaster Response Level]]|| March-09
|-
| 1.16|| [[EMS Offload Policy]]|| March-09
|-
| 1.17|| [[EMS Quality Improvement Program]]|| March-09
|-
| 1.18|| [[Scope of Practice]]|| March-09
|-
| 1.19|| [[Freestanding ED Transport Criteria]]|| October-13
|-
| 1.20|| [[Hospital Capability Chart]]|| May-18
|-
| 1.21|| [[Documentation Guidance]]|| June-17
|}

===Section 2 - Primary Care===

{| class="wikitable"
|-
! Section !! Description !! Revision Date
|-
| 2.01 ||[[Initial Medical Assessment and Care]]||March-09
|-
|2.02 ||[[Initial Trauma Assessment and Care]]||September-17
|-
||2.03 ||[[Rapid Trauma Assessment, Focused History and Physical Exam]]||Sept-15
|-
||2.04||[[Analgesia and Sedation]]||November-17
|-
||2.05||[[Drug Assisted Intubation]]||December-16
|-
|2.06||[[DISSOCIATIVE ANESTHETIC]]||September-24
|-
|||[[Patient Assist]]||January-25
|}

===Section 3 - Respiratory===

{| class="wikitable"
|-
! Section !! Description !! Revision Date
|-
| 3.01|| [[Acute Asthma or COPD with Wheezing]]|| February-19
|-
| 3.02|| [[Carbon Monoxide Inhalation]]|| March-09
|-
| 3.03|| [[Foreign Body Airway Obstruction]]|| March-09
|-
| 3.04|| [[Infectious Upper Airway Obstruction - Croup or Epiglottitis]]|| April-16
|-
| 3.05|| [[Severe Respiratory Pathogens]]|| November-10
|-
| 3.06|| [[Anxiety / Hyperventilation]]|| February-11
|}

===Section 4 - Cardiac===
{| class="wikitable"
|-
! Section !! Description !! Revision Date
|-
|4.01 || [[Chest Pain Acute Coronary Syndrome]]||Sept-17
|-
|4.02 || [[Asystole]]||April-16
|-
|4.03 || [[Atrial Fibrillation Atrial Flutter]]||June-17
|-
|4.04||[[Pulseless Electrical Activity (PEA)]]||January-16
|-
|4.05||[[Premature Ventricular Contractions (PVC)]]||May-12
|-
|4.06||[[Supraventricular Bradycardia and AV Blocks]]||March-09
|-
|4.07||[[Supraventricular Tachycardia]]||April-12
|-
|4.08||[[Ventricular Fibrillation Pulseless Ventricular Tachycardia]]||December-16
|-
|4.09||[[Ventricular Tachycardia with a Palpable Pulse]]||July-12
|-
|4.10||[[Wide Complex Tachycardia Uncertain Origin]]||May-12
|-
|4.11||[[Acute Cardiogenic Pulmonary Edema Pneumonia]]||March-09
|-
|4.12||[[Code Cool Post ROSC Induced Hypothermia]]||March-09
|-
|4.13||[[Adult Immediate Post-Cardiac Arrest Care]]||April-12
|-
|4.14||[[Ventricular Assist Devices]]||August-18
|}

===Section 5 - Medical===

{| class="wikitable"
|-
! Section !! Description !! Revision Date
|-
|5.01||[[Acute Abdominal Pain]]||April-16
|-
|5.02||[[Allergic Reaction Anaphylactic Shock]]||April-16
|-
|5.03||[[Altered Mental Status (AMS)]]||April-17
|-
|5.04||[[Suspected Stroke Transient Ischemic Attack TIA|Suspected Stroke or Transient Ischemic Attack]]||May-18
|-
|5.05||[[Drug Overdose Poisoning]]||March-09
|-
|5.06||[[Cold Emergencies]]||April-12
|-
|5.07||[[Heat Emergencies]]||August-15
|-
|5.08||[[Hazardous Materials]]||March-09
|-
|5.09||[[Severe Hypertension]]||March-09
|-
|5.10||[[Hypo or Hyperglycemia]]||April-16
|-
|5.11||[[Psychological Behavioral Emergencies]]||March-09
|-
|5.12||[[Seizure]]||April-16
|-
|5.13||[[Shock]]||March-09
|-
|5.14||[[Sickle Cell Anemia Crisis]]||March-09
|-
|5.15||[[Syncope]]||March-09
|-
|5.16||[[Vertigo]]||March-09
|-
|5.17||[[Sepsis Septic Shock]]||September-17
|-
|5.18||[[Suspected Kidney Stone]]||April-16
|-
|5.19||[[Cyanide Poisoning]]||April-16
|-
|5.20||[[Excited Delirium or Drug Induced Agitation]]||November-17
|-
|5.21||[[Ebola Virus Disease Patient Management]]||October-14
|-
|5.22||[[Acute Adrenal Insufficiency]]||June-18
|}

===Section 6 - Trauma===
{| class="wikitable"
|-
! Section !! Description !! Revision Date
|-
|6.01||[[Animal Bites Stings]]||March-09
|-
|6.02||[[Burns - Thermal, Electrical, Chemical]]||March-09
|-
|6.03||[[Selective Spinal Immobilization]]||August-14
|-
|6.04||[[Chest Injuries]]||March-09
|-
|6.05||[[Decompression Sickness or Dysbarism]]||March-09
|-
|6.06||[[Extremity Injuries]]||Feb-15
|-
|6.07||[[Head Injuries]]||November-17
|-
|6.08||[[Near Drowning]]||March-09
|-
|6.09||[[Ophthalmic Injuries]]||March-09
|-
|6.10||[[Suspected Abuse Neglect]]||March-09
|-
|6.11||[[Suspected Sexual Assault]]||March-09
|-
|6.12||[[Trunk Penetrating Injuries]]||April-12
|-
|6.13||[[Hemorrhagic Shock]]||October-18
|}

===Section 7 - Pediatric and Obstetrical===
{| class="wikitable"
|-
! Section !! Description !! Revision Date
|-
|7.01||[[Pediatric Asystole]]||April-16
|-
|7.02||[[Pediatric Pulseless Electrical Activity PEA]]||April-16
|-
|7.03||[[Pediatric Tachycardia, Ventricular Fibrillation or Pulseless Ventricular Tachycardia]]||April-16
|-
|7.04||[[Pregnancy Induced Hypertension (PIH)]]||March-09
|-
|7.05||[[Preterm Labor]]||November-17
|-
|7.06||[[Emergency Childbirth]]||November-17
|-
|7.07||[[Childbirth Complications]]||November-17
|-
|7.08||[[Newborn Care]]||April-16
|-
|7.09||[[Post Partum Care]]||November-17
|-
|7.10||[[Pediatric Febrile Emergency]]||April-16
|-
|7.11||[[Vaginal Bleeding]]||March-09
|-
|7.12||[[Trauma In Pregnancy]]||March-09
|}

===Section 8 - Medication Guidelines===
INTRODUCTION
The following pages contain guidelines for the medications commonly encountered by the Paramedic. They identify the name and class of the drug, a short description, indications, contraindications, precautions, and dosages. This is only a guideline to medication administration and shall not circumvent the need to refer to the appropriate Standing Order or to contact Medical Control for orders and consultation. For detailed and extensive information on each drug, refer to the Physician's Desk Reference, the Advanced Cardiac Life Support text or an emergency pre-hospital pharmacology reference.

Certain medications listed have various dosages depending on the patient's condition. Refer to the appropriate Standing Order or contact Medical Control for specific dosage information. All IV piggyback medications must be placed on a micro-gtt. solution set for field administration and if available, an infusion pump or infusion regulator MUST BE UTILIZED.

The following medications are authorized to be administered by Maitland Fire Rescue EMS:

{| class="wikitable"
|-
! Medication Name!! Revision Date
|-
|[[Acetaminophen]]||March-09
|-
|[[Adenosine]]||January-20
|-
|[[Albuterol]]||April-16
|-
|[[Aspirin]]||March-09
|-
|[[Ativan]]||April-16
|-
|[[Atropine]]||July-17
|-
|[[Atrovent]]||April-16
|-
|[[Calcium Chloride]]||April-16
|-
|[[Cardizem]]||July-17
|-
|[[Cyanokit]]||April-16
|-
|[[Dextrose 10%]]||April-16
|-
|[[Dextrose 50%]]||April-16
|-
|[[Diphenhydramine]]||April-16
|-
|[[Dopamine]]||April-16
|-
|[[Epinephrine]]||April-16
|-
|[[Etomidate]]||April-16
|-
|[[Fentanyl]]||November-16
|-
|[[Flumazenil]]||April-16
|-
|[[Glucagon]]||April-16
|-
|[[Hypertonic Saline|Hypertonic (3%) Saline]]||September-24
|-
|[[Keppra]]||September-24
|-
|[[Ketamine]]||November-17
|-
|[[Lasix]]||April-16
|-
|[[Lidocaine]]||July-17
|-
|[[Magnesium Sulfate]]||November-25
|-
|[[Morphine Sulfate]]||November-16
|-
|[[Naloxone]]||April-16
|-
|[[Nitro Drip]]||April-17
|-
|[[Nitro Spray]]||April-17
|-
|[[Nitro Tablets]]||April-17
|-
|[[Nitrous Oxide]]||November-16
|-
|[[Oxygen]]||March-09
|-
|[[Pepcid]]||April-16
|-
|[[Pontocaine]]||November-17
|-
|[[Promethazine]]||April-16
|-
|[[Racemic Epinephrine]]||April-16
|-
|[[Sodium Bicarbonate]]||April-16
|-
|[[Solu-Medrol]]||January-17
|-
|[[Toradol]]||March-09
|-
|[[TXA]]||October-20
|-
|[[Xopenex]]||April-16
|-
|[[Vasopressin]]||October-13
|-
|[[Valium]]||April-16
|-
|[[Versed]]||April-16
|-
|[[Zofran]]||April-16
|-
|[[Medication Infusion Tables]]||
|}

===Section 9 - Procedure Guidelines===
{| class="wikitable"
|-
! Section !! Description !! Revision Date
|-
|9.00||[[LUCAS Device]]||July-16
|-
|9.01||[[Pneupac VR1 Ventilator]]||March-09
|-
|9.02||[[Blood Alcohol Draw on Scene]]||March-09
|-
|9.03||[[Blood Draw using Vacutainer]]||March-09
|-
|9.04||[[Blood Glucose Test]]||March-09
|-
|9.05||[[Buretrol Usage]]||March-09
|-
|9.06||[[Cardiac Monitor]]||April-12
|-
|9.07||[[Cardioversion]]||March-09
|-
|9.08||[[Continuous Positive Airway Pressure Device]]||March-09
|-
|9.09||[[Cricothyrotomy Needle]]||March-09
|-
|9.10||[[Cricothyrotomy Surgical]]||March-09
|-
|9.11||[[Defibrillation]]||March-09
|-
|9.12||[[Defibrillation Pediatric]]||March-09
|-
|9.13||[[End Tidal CO2 Monitoring / Capnography]]||March-09
|-
|9.14.1||[[Intraosseous Infusion - Femoral]]||February-15
|-
|9.14.2||[[Intraosseous Infusion - Humeral Head]]||December-16
|-
|9.15||[[Intubation Endotracheal]]||March-09
|-
|9.16||[[Intubation Nasotracheal]]||March-09
|-
|9.17||[[Braun Syringe Infusion Pump]]||March-14
|-
|9.18||[[King Tube]]||March-09
|-
|9.19||[[Medication Administration Intramuscular]]||March-09
|-
|9.20||[[Medication Administration Nasal Atomizer]]||March-09
|-
|9.21||[[Medication Administration Nebulizer]]||March-09
|-
|9.22||[[Medication Administration Subcutaneous]]||March-09
|-
|9.23||[[Nasogastric/Orogastric Tube]]||March-09
|-
|9.24||[[Oxygen Administration]]||March-09
|-
|9.25||[[Peripheral IV Administration]]||March-09
|-
|9.26||[[Pleural Decompression]]||March-09
|-
|9.27||[[Removal of Taser Probes]]||March-09
|-
|9.28||[[Reconstitution of Medications]]||March-09
|-
|9.29||[[Transcutaneous Pacing Procedure]]||March-09
|-
|9.30||[[Emergency Escharotomy|Emergency Chest Wall Escharotomy]]||April-11
|-
|9.31||[[Central Venous Access Devices]]||June-12
|-
|9.32||[[Medication Administration Cross Check]]||Jun-12
|-
|9.33||[[Combat Application Tourniquet]]||Jan-14
|-
|9.34||[http://lifevest.zoll.com/medical-professionals/first-responder-resources Zoll LifeVest Wearable Defibrillator]||Dec-14
|-
|9.35||[[Medication Temperature Monitoring]]||Feb-19
|}

===Section 10 - References===
{| class="wikitable"
|-
! Section !! Description !! Revision Date
|-
|10.01||[[Abbreviations]]||March-09
|-
|10.02||[[Apgar Score]]||March-09
|-
|10.03||[[Glasgow Coma Score]]||March-09
|-
|10.04||[[Pediatric Vital Signs]]||March-09
|-
|10.05||[[Adult Trauma Alert Criteria]]||March-09
|-
|10.06||[[Pediatric Trauma Alert Criteria]]||March-09
|-
|10.07||[[Pediatric Trauma Score]]||March-09
|-
|10.08||[[Nitroglycerin Drip]]||March-09
|-
|10.09||[[Checking Range of Motion]]||March-09
|-
|10.10||[[Rules of Nine]]||March-09
|-
|10.11||[[Florida Statutes]]||March-09
|-
|10.12||[[Evaluation and Treatment Flow Chart]]||March-09
|-
|10.13||[[Spinal Injury Assessment Critical Criteria]]||March-09
|}

===Section 11 - Medical Director Memos===
{| class="wikitable sortable"
|-
! Subject !! Effective Date
|-
| [[Memo - Opening of Oviedo Medical Center|Opening of Oviedo Medical Center]] || 2017-01-29
|-
| [[Memo - Blood Draws - Florida Hospital|Blood Draws - Florida Hospital]] || 2017-01-25
|-
| [[Memo - Medical Alerts|Medical Alerts]] || 2016-04-27
|-
| [[Memo - Discontinuation of Central Venous Access|Discontinuation of Central Venous Access]] || 2013-08-03
|-
| [[Memo - Shortage of Atropine|Shortage of Atropine]] || 2013-04-11
|-
| [[Memo - EMS Blood Draws for SSCH|EMS Blood Draws for SSCH]] || 2013-03-07
|-
| [[Memo - Respiratory Breathing Treatments|Respiratory/Breathing Treatments]] || 2012-12-19
|-
| [[Memo - OB Transports|OB Transports]] || 2011-01-14
|-
| [[Memo - Aspirin Administration Documentation|Aspirin Administration Documentation]] || 2010-12-01
|-
| [[Memo - Alert Terminology|Alert Terminology]] || 2010-05-06
|}

Head Injuries

2025-12-17T16:23:04Z

Mfrdmanager:

==Section 6 - TRAUMA==
===6.07 HEAD INJURIES===

[[Initial Trauma Assessment and Care|INITIAL TRAUMA CARE]], (2.02) [[Oxygen|OXYGEN]] @ 100% via NRB mask or hyperventilate with BVM.
* Elevate head and shoulders 15 - 30 degrees if systolic BP > 90 mm Hg.
* Refer to [[Altered Mental Status (AMS)|ALTERED MENTAL STATUS PRACTICE PARAMETER]] (5.03).
* If '''Combative''' refer to [[DISSOCIATIVE ANESTHETIC]] (2.06)
* [[Morphine_Sulfate|MORPHINE]] - Initial dose 2-5 mg IVP, IM or IN followed by 2 mg doses. (Max 15 mg)
::'''AND / OR'''
* [[Ketamine|KETAMINE (KETALAR)]] Titrate to effect, starting dose of 0.5 mg/kg slow IVP or 1 mg/kg IM.
* Maintain ETCO2 between 30-35 mmHg and Oxygen saturation >95%

'''TRAUMATIC BRAIN INJURY MANAGEMENT'''
* If the following criteria have been met:
** GCS < 8 (Consider airway management with an i-gel if no gag reflex)
** AND Any one of the following:
*** Unilateral fixed or dilated pupil
*** Unilateral paralysis
*** Posturing
*** Seizure after injury
*** Skull deformity
''ADULT''
* [[Hypertonic Saline|3% Saline]] bolus, 250 ml IV or IO
* [[Keppra]] 1 gram IV or IO
''PEDIATRIC''
* [[Hypertonic Saline|3% Saline]] bolus at 5 ml/kg (max of 250 ml) IV/IO drip utilizing 10ggts drip set
* [[Keppra]] 20mg/kg (not to exceed 1g) IV/IO (may be repeated once at 40mg/kg if seizure continues)
* Transport patient to nearest Pediatric Trauma Center via appropriate method

 
'''OTHER OPTIONS'''
* [[Versed|MIDAZOLAM (Versed)]] - Initial dose 2-5mg IV or IN then 2 mg every 30 seconds to 1 minute.
** (Max dose 15 mg) in the intubated patient. IM .07-.08 mg/kg with onset in approximately 15 minutes. IM injection requires immediate IV access upon sedation.
* [[Ativan|LORAZAPAM (Ativan)]] 1-2 mg Slow IVP for adults titrated to effect. Max dose of 8mg. If no IV access or Agitated/Violent behavioral patient, administer 1-2 mg IM up to a total of 2 ml per large muscle injection site or 1 ml per small muscle injection site.
* These drugs may be given in combination for maximum effectiveness.
* Ensure that Pulse Oximeter is in place.
* Ensure that BVM and [[Flumazenil|ROMAZICON]] and/or [[Naloxone|NARCAN]] are readily available.

[[Category:Trauma|0607]

Hypertonic Saline

2025-12-17T16:21:15Z

Mfrdmanager: Created page with "==Section 8 - MEDICATION GUIDELINES== ===ELECTROLYTE=== ====Hypertonic Saline / 3% Saline==== '''DESCRIPTION''' *Strong saline solution used to shift fluid out of the cells a..."

==Section 8 - MEDICATION GUIDELINES==
===ELECTROLYTE===

====Hypertonic Saline / 3% Saline====
'''DESCRIPTION'''
*Strong saline solution used to shift fluid out of the cells and decrease intercranial pressure

'''INDICATIONS'''
*Traumatic Brain Injury

'''CONTRAINDICATIONS'''
*None found

'''PRECAUTIONS'''
*None found

'''DOSAGE'''
* Pediatrics - 5 ml/kg IV/IO utilizing 10 gtts drip set.
* Max dose 250 ml

[[Category:Medication Guidelines|Hypertonic Saline]]

Maitland Fire Rescue Department Practice Parameters

2025-12-17T16:20:49Z

Mfrdmanager: /* Section 8 - Medication Guidelines */

__NOTOC__
==TABLE OF CONTENTS==

[[Medical Director Authorization]]

===Section 1 - Administrative Policies===

{| class="wikitable"
|-
! Section !! Description !! Revision Date
|-
| 1.01 || [[General Measures]] || April-16
|-
| 1.02 || [[Radio Report Format]] || March-16
|-
| 1.03 || [[Refusal of Service]] || October-17
|-
| 1.04 || [[Physician or Nurse on Scene]] || March-09
|-
| 1.05 || [[Initiation of CPR and Determination of Death]] || July-16
|-
| 1.06|| [[Determination of Death in Trauma]]|| March-09
|-
| 1.07|| [[Crime or Unattended Death Scene]] || March-09
|-
| 1.08|| [[Medical Evaluation of Person in Police Custody]]|| March-09
|-
| 1.09|| [[Trauma Transport Protocol]]|| Dec-19
|-
| 1.10|| [[Emergency Transport]]|| March-09
|-
| 1.11|| [[Criteria for Helicopter Transport]]|| March-09
|-
| 1.12|| [[Medical Patient Transport Decision]]|| April-14
|-
| 1.13|| [[Obstetrical Patient Transport Decision]]|| Feb-15
|-
| 1.14|| [[Emergency Inter Facility Transport]]|| March-09
|-
| 1.15|| [[EMS Disaster Response Level]]|| March-09
|-
| 1.16|| [[EMS Offload Policy]]|| March-09
|-
| 1.17|| [[EMS Quality Improvement Program]]|| March-09
|-
| 1.18|| [[Scope of Practice]]|| March-09
|-
| 1.19|| [[Freestanding ED Transport Criteria]]|| October-13
|-
| 1.20|| [[Hospital Capability Chart]]|| May-18
|-
| 1.21|| [[Documentation Guidance]]|| June-17
|}

===Section 2 - Primary Care===

{| class="wikitable"
|-
! Section !! Description !! Revision Date
|-
| 2.01 ||[[Initial Medical Assessment and Care]]||March-09
|-
|2.02 ||[[Initial Trauma Assessment and Care]]||September-17
|-
||2.03 ||[[Rapid Trauma Assessment, Focused History and Physical Exam]]||Sept-15
|-
||2.04||[[Analgesia and Sedation]]||November-2017
|-
||2.05||[[Drug Assisted Intubation]]||December-2016
|-
|2.06||[[DISSOCIATIVE ANESTHETIC]]||
|-
|||[[Patient Assist]]||January-25
|}

===Section 3 - Respiratory===

{| class="wikitable"
|-
! Section !! Description !! Revision Date
|-
| 3.01|| [[Acute Asthma or COPD with Wheezing]]|| February-19
|-
| 3.02|| [[Carbon Monoxide Inhalation]]|| March-09
|-
| 3.03|| [[Foreign Body Airway Obstruction]]|| March-09
|-
| 3.04|| [[Infectious Upper Airway Obstruction - Croup or Epiglottitis]]|| April-16
|-
| 3.05|| [[Severe Respiratory Pathogens]]|| November-10
|-
| 3.06|| [[Anxiety / Hyperventilation]]|| February-11
|}

===Section 4 - Cardiac===
{| class="wikitable"
|-
! Section !! Description !! Revision Date
|-
|4.01 || [[Chest Pain Acute Coronary Syndrome]]||Sept-17
|-
|4.02 || [[Asystole]]||April-16
|-
|4.03 || [[Atrial Fibrillation Atrial Flutter]]||June-17
|-
|4.04||[[Pulseless Electrical Activity (PEA)]]||January-16
|-
|4.05||[[Premature Ventricular Contractions (PVC)]]||May-12
|-
|4.06||[[Supraventricular Bradycardia and AV Blocks]]||March-09
|-
|4.07||[[Supraventricular Tachycardia]]||April-12
|-
|4.08||[[Ventricular Fibrillation Pulseless Ventricular Tachycardia]]||December-16
|-
|4.09||[[Ventricular Tachycardia with a Palpable Pulse]]||July-12
|-
|4.10||[[Wide Complex Tachycardia Uncertain Origin]]||May-12
|-
|4.11||[[Acute Cardiogenic Pulmonary Edema Pneumonia]]||March-09
|-
|4.12||[[Code Cool Post ROSC Induced Hypothermia]]||March-09
|-
|4.13||[[Adult Immediate Post-Cardiac Arrest Care]]||April-12
|-
|4.14||[[Ventricular Assist Devices]]||August-18
|}

===Section 5 - Medical===

{| class="wikitable"
|-
! Section !! Description !! Revision Date
|-
|5.01||[[Acute Abdominal Pain]]||April-16
|-
|5.02||[[Allergic Reaction Anaphylactic Shock]]||April-16
|-
|5.03||[[Altered Mental Status (AMS)]]||April-17
|-
|5.04||[[Suspected Stroke Transient Ischemic Attack TIA|Suspected Stroke or Transient Ischemic Attack]]||May-18
|-
|5.05||[[Drug Overdose Poisoning]]||March-09
|-
|5.06||[[Cold Emergencies]]||April-12
|-
|5.07||[[Heat Emergencies]]||August-15
|-
|5.08||[[Hazardous Materials]]||March-09
|-
|5.09||[[Severe Hypertension]]||March-09
|-
|5.10||[[Hypo or Hyperglycemia]]||April-16
|-
|5.11||[[Psychological Behavioral Emergencies]]||March-09
|-
|5.12||[[Seizure]]||April-16
|-
|5.13||[[Shock]]||March-09
|-
|5.14||[[Sickle Cell Anemia Crisis]]||March-09
|-
|5.15||[[Syncope]]||March-09
|-
|5.16||[[Vertigo]]||March-09
|-
|5.17||[[Sepsis Septic Shock]]||September-17
|-
|5.18||[[Suspected Kidney Stone]]||April-16
|-
|5.19||[[Cyanide Poisoning]]||April-16
|-
|5.20||[[Excited Delirium or Drug Induced Agitation]]||November-17
|-
|5.21||[[Ebola Virus Disease Patient Management]]||October-14
|-
|5.22||[[Acute Adrenal Insufficiency]]||June-18
|}

===Section 6 - Trauma===
{| class="wikitable"
|-
! Section !! Description !! Revision Date
|-
|6.01||[[Animal Bites Stings]]||March-09
|-
|6.02||[[Burns - Thermal, Electrical, Chemical]]||March-09
|-
|6.03||[[Selective Spinal Immobilization]]||August-14
|-
|6.04||[[Chest Injuries]]||March-09
|-
|6.05||[[Decompression Sickness or Dysbarism]]||March-09
|-
|6.06||[[Extremity Injuries]]||Feb-15
|-
|6.07||[[Head Injuries]]||November-17
|-
|6.08||[[Near Drowning]]||March-09
|-
|6.09||[[Ophthalmic Injuries]]||March-09
|-
|6.10||[[Suspected Abuse Neglect]]||March-09
|-
|6.11||[[Suspected Sexual Assault]]||March-09
|-
|6.12||[[Trunk Penetrating Injuries]]||April-12
|-
|6.13||[[Hemorrhagic Shock]]||October-18
|}

===Section 7 - Pediatric and Obstetrical===
{| class="wikitable"
|-
! Section !! Description !! Revision Date
|-
|7.01||[[Pediatric Asystole]]||April-16
|-
|7.02||[[Pediatric Pulseless Electrical Activity PEA]]||April-16
|-
|7.03||[[Pediatric Tachycardia, Ventricular Fibrillation or Pulseless Ventricular Tachycardia]]||April-16
|-
|7.04||[[Pregnancy Induced Hypertension (PIH)]]||March-09
|-
|7.05||[[Preterm Labor]]||November-17
|-
|7.06||[[Emergency Childbirth]]||November-17
|-
|7.07||[[Childbirth Complications]]||November-17
|-
|7.08||[[Newborn Care]]||April-16
|-
|7.09||[[Post Partum Care]]||November-17
|-
|7.10||[[Pediatric Febrile Emergency]]||April-16
|-
|7.11||[[Vaginal Bleeding]]||March-09
|-
|7.12||[[Trauma In Pregnancy]]||March-09
|}

===Section 8 - Medication Guidelines===
INTRODUCTION
The following pages contain guidelines for the medications commonly encountered by the Paramedic. They identify the name and class of the drug, a short description, indications, contraindications, precautions, and dosages. This is only a guideline to medication administration and shall not circumvent the need to refer to the appropriate Standing Order or to contact Medical Control for orders and consultation. For detailed and extensive information on each drug, refer to the Physician's Desk Reference, the Advanced Cardiac Life Support text or an emergency pre-hospital pharmacology reference.

Certain medications listed have various dosages depending on the patient's condition. Refer to the appropriate Standing Order or contact Medical Control for specific dosage information. All IV piggyback medications must be placed on a micro-gtt. solution set for field administration and if available, an infusion pump or infusion regulator MUST BE UTILIZED.

The following medications are authorized to be administered by Maitland Fire Rescue EMS:

{| class="wikitable"
|-
! Medication Name!! Revision Date
|-
|[[Acetaminophen]]||March-09
|-
|[[Adenosine]]||January-20
|-
|[[Albuterol]]||April-16
|-
|[[Aspirin]]||March-09
|-
|[[Ativan]]||April-16
|-
|[[Atropine]]||July-17
|-
|[[Atrovent]]||April-16
|-
|[[Calcium Chloride]]||April-16
|-
|[[Cardizem]]||July-17
|-
|[[Cyanokit]]||April-16
|-
|[[Dextrose 10%]]||April-16
|-
|[[Dextrose 50%]]||April-16
|-
|[[Diphenhydramine]]||April-16
|-
|[[Dopamine]]||April-16
|-
|[[Epinephrine]]||April-16
|-
|[[Etomidate]]||April-16
|-
|[[Fentanyl]]||November-16
|-
|[[Flumazenil]]||April-16
|-
|[[Glucagon]]||April-16
|-
|[[Hypertonic Saline|Hypertonic (3%) Saline]]||September-24
|-
|[[Keppra]]||September-24
|-
|[[Ketamine]]||November-17
|-
|[[Lasix]]||April-16
|-
|[[Lidocaine]]||July-17
|-
|[[Magnesium Sulfate]]||November-25
|-
|[[Morphine Sulfate]]||November-16
|-
|[[Naloxone]]||April-16
|-
|[[Nitro Drip]]||April-17
|-
|[[Nitro Spray]]||April-17
|-
|[[Nitro Tablets]]||April-17
|-
|[[Nitrous Oxide]]||November-16
|-
|[[Oxygen]]||March-09
|-
|[[Pepcid]]||April-16
|-
|[[Pontocaine]]||November-17
|-
|[[Promethazine]]||April-16
|-
|[[Racemic Epinephrine]]||April-16
|-
|[[Sodium Bicarbonate]]||April-16
|-
|[[Solu-Medrol]]||January-17
|-
|[[Toradol]]||March-09
|-
|[[TXA]]||October-20
|-
|[[Xopenex]]||April-16
|-
|[[Vasopressin]]||October-13
|-
|[[Valium]]||April-16
|-
|[[Versed]]||April-16
|-
|[[Zofran]]||April-16
|-
|[[Medication Infusion Tables]]||
|}

===Section 9 - Procedure Guidelines===
{| class="wikitable"
|-
! Section !! Description !! Revision Date
|-
|9.00||[[LUCAS Device]]||July-16
|-
|9.01||[[Pneupac VR1 Ventilator]]||March-09
|-
|9.02||[[Blood Alcohol Draw on Scene]]||March-09
|-
|9.03||[[Blood Draw using Vacutainer]]||March-09
|-
|9.04||[[Blood Glucose Test]]||March-09
|-
|9.05||[[Buretrol Usage]]||March-09
|-
|9.06||[[Cardiac Monitor]]||April-12
|-
|9.07||[[Cardioversion]]||March-09
|-
|9.08||[[Continuous Positive Airway Pressure Device]]||March-09
|-
|9.09||[[Cricothyrotomy Needle]]||March-09
|-
|9.10||[[Cricothyrotomy Surgical]]||March-09
|-
|9.11||[[Defibrillation]]||March-09
|-
|9.12||[[Defibrillation Pediatric]]||March-09
|-
|9.13||[[End Tidal CO2 Monitoring / Capnography]]||March-09
|-
|9.14.1||[[Intraosseous Infusion - Femoral]]||February-15
|-
|9.14.2||[[Intraosseous Infusion - Humeral Head]]||December-16
|-
|9.15||[[Intubation Endotracheal]]||March-09
|-
|9.16||[[Intubation Nasotracheal]]||March-09
|-
|9.17||[[Braun Syringe Infusion Pump]]||March-14
|-
|9.18||[[King Tube]]||March-09
|-
|9.19||[[Medication Administration Intramuscular]]||March-09
|-
|9.20||[[Medication Administration Nasal Atomizer]]||March-09
|-
|9.21||[[Medication Administration Nebulizer]]||March-09
|-
|9.22||[[Medication Administration Subcutaneous]]||March-09
|-
|9.23||[[Nasogastric/Orogastric Tube]]||March-09
|-
|9.24||[[Oxygen Administration]]||March-09
|-
|9.25||[[Peripheral IV Administration]]||March-09
|-
|9.26||[[Pleural Decompression]]||March-09
|-
|9.27||[[Removal of Taser Probes]]||March-09
|-
|9.28||[[Reconstitution of Medications]]||March-09
|-
|9.29||[[Transcutaneous Pacing Procedure]]||March-09
|-
|9.30||[[Emergency Escharotomy|Emergency Chest Wall Escharotomy]]||April-11
|-
|9.31||[[Central Venous Access Devices]]||June-12
|-
|9.32||[[Medication Administration Cross Check]]||Jun-12
|-
|9.33||[[Combat Application Tourniquet]]||Jan-14
|-
|9.34||[http://lifevest.zoll.com/medical-professionals/first-responder-resources Zoll LifeVest Wearable Defibrillator]||Dec-14
|-
|9.35||[[Medication Temperature Monitoring]]||Feb-19
|}

===Section 10 - References===
{| class="wikitable"
|-
! Section !! Description !! Revision Date
|-
|10.01||[[Abbreviations]]||March-09
|-
|10.02||[[Apgar Score]]||March-09
|-
|10.03||[[Glasgow Coma Score]]||March-09
|-
|10.04||[[Pediatric Vital Signs]]||March-09
|-
|10.05||[[Adult Trauma Alert Criteria]]||March-09
|-
|10.06||[[Pediatric Trauma Alert Criteria]]||March-09
|-
|10.07||[[Pediatric Trauma Score]]||March-09
|-
|10.08||[[Nitroglycerin Drip]]||March-09
|-
|10.09||[[Checking Range of Motion]]||March-09
|-
|10.10||[[Rules of Nine]]||March-09
|-
|10.11||[[Florida Statutes]]||March-09
|-
|10.12||[[Evaluation and Treatment Flow Chart]]||March-09
|-
|10.13||[[Spinal Injury Assessment Critical Criteria]]||March-09
|}

===Section 11 - Medical Director Memos===
{| class="wikitable sortable"
|-
! Subject !! Effective Date
|-
| [[Memo - Opening of Oviedo Medical Center|Opening of Oviedo Medical Center]] || 2017-01-29
|-
| [[Memo - Blood Draws - Florida Hospital|Blood Draws - Florida Hospital]] || 2017-01-25
|-
| [[Memo - Medical Alerts|Medical Alerts]] || 2016-04-27
|-
| [[Memo - Discontinuation of Central Venous Access|Discontinuation of Central Venous Access]] || 2013-08-03
|-
| [[Memo - Shortage of Atropine|Shortage of Atropine]] || 2013-04-11
|-
| [[Memo - EMS Blood Draws for SSCH|EMS Blood Draws for SSCH]] || 2013-03-07
|-
| [[Memo - Respiratory Breathing Treatments|Respiratory/Breathing Treatments]] || 2012-12-19
|-
| [[Memo - OB Transports|OB Transports]] || 2011-01-14
|-
| [[Memo - Aspirin Administration Documentation|Aspirin Administration Documentation]] || 2010-12-01
|-
| [[Memo - Alert Terminology|Alert Terminology]] || 2010-05-06
|}

Patient Assist

2025-12-17T16:17:47Z

Mfrdmanager: Created page with "For all patient assist calls the following protocol guidelines are to be followed and documented: {| class="wikitable" |+ |Manual Vitals | *Obtain a full set of vitals signs t..."

For all patient assist calls the following protocol guidelines are to be followed and documented:
{| class="wikitable"
|+
|Manual Vitals
|
*Obtain a full set of vitals signs to include blood pressure (palpable systolic is acceptable), pulse, respiratory rate and effort, GCS, AVPU, pain score and scale, and SaO2.
*Assess AVPU/GCS and compare to normal baseline if possible.
*Tachycardia (HR>100) or relative hypotension (SBP<110) is concerning for sepsis.
*Assess skin color, condition, and temp.
*Assess blood sugar level.
*Perform second set of vitals after movement
|-
|Events leading to fall or patient assist
|
*Any new symptoms?
*Generalized weakness?
*Poor appetite?
*Shortness of breath?
*Syncope?
*Any LOC?
*Assess living conditions, trip hazards, etc.
|-
|Medications
|
*Any new medications?
*Blood thinners?
*Anti-platelet agents?
*Proper dose taken for the day?
*Compliant with prescribed medications?'''
|-
|Assessment (Including Stroke)
|Head-to-toe assessment - not just for trauma but for medical illness such as stroke, CHF, acute MI, or infection
|-
|Walk
|ALWAYS determine if able to ambulate at baseline prior to refusal. If possible confer with family, caretaker, spouse on scene.
|-
|...and document what you find! Be sure to include the information gathered into your report.
|Involve family and caregivers
Be specific about your concerns when discussing refusal.
Always advocate in the patients' best interest
If necessary and applicable refer the patient to local community paramedicince programs.
|}

DISSOCIATIVE ANESTHETIC

2025-12-17T16:17:02Z

Mfrdmanager: Created page with "==Section 2 - PRIMARY CARE== ===2.06 DISSOCIATIVE ANESTHETIC=== ''"THE BELOW MEDICATION MAY CAUSE A DECREASED LOC AND COULD COMPROMISE A PATIENT’S AIRWAY. JUDICIOUS USE IS A..."

==Section 2 - PRIMARY CARE==
===2.06 DISSOCIATIVE ANESTHETIC===
''"THE BELOW MEDICATION MAY CAUSE A DECREASED LOC AND COULD COMPROMISE A PATIENT’S AIRWAY. JUDICIOUS USE IS A MUST! ALLOW AMPLE TIME FOR DOSE TO TAKE EFFECT."'' 
 

===Procedure===
Ketamine is a dissociative anesthetic which temporarily takes over chemical receptors in the brain blocking pain receptors causing sedation and easing pain.

===Excited Delirium Syndrome===
[[Ketamine|KETAMINE (KETALAR)]] 4 mg/kg IM x 1 dose (2 mg/kg IVP)

===Combative Head Injury===
[[Ketamine|KETAMINE (KETALAR)]] 2 mg/kg IVP or IN OR 4 mg/kg IM x 1 dose 

[[Morphine_Sulfate|MORPHINE SULFATE]] 2 - 20 mg IV, IM or IN, titrated to effect.

Maitland Fire Rescue Department Practice Parameters

2025-12-17T16:16:35Z

Mfrdmanager: /* Section 2 - Primary Care */

__NOTOC__
==TABLE OF CONTENTS==

[[Medical Director Authorization]]

===Section 1 - Administrative Policies===

{| class="wikitable"
|-
! Section !! Description !! Revision Date
|-
| 1.01 || [[General Measures]] || April-16
|-
| 1.02 || [[Radio Report Format]] || March-16
|-
| 1.03 || [[Refusal of Service]] || October-17
|-
| 1.04 || [[Physician or Nurse on Scene]] || March-09
|-
| 1.05 || [[Initiation of CPR and Determination of Death]] || July-16
|-
| 1.06|| [[Determination of Death in Trauma]]|| March-09
|-
| 1.07|| [[Crime or Unattended Death Scene]] || March-09
|-
| 1.08|| [[Medical Evaluation of Person in Police Custody]]|| March-09
|-
| 1.09|| [[Trauma Transport Protocol]]|| Dec-19
|-
| 1.10|| [[Emergency Transport]]|| March-09
|-
| 1.11|| [[Criteria for Helicopter Transport]]|| March-09
|-
| 1.12|| [[Medical Patient Transport Decision]]|| April-14
|-
| 1.13|| [[Obstetrical Patient Transport Decision]]|| Feb-15
|-
| 1.14|| [[Emergency Inter Facility Transport]]|| March-09
|-
| 1.15|| [[EMS Disaster Response Level]]|| March-09
|-
| 1.16|| [[EMS Offload Policy]]|| March-09
|-
| 1.17|| [[EMS Quality Improvement Program]]|| March-09
|-
| 1.18|| [[Scope of Practice]]|| March-09
|-
| 1.19|| [[Freestanding ED Transport Criteria]]|| October-13
|-
| 1.20|| [[Hospital Capability Chart]]|| May-18
|-
| 1.21|| [[Documentation Guidance]]|| June-17
|}

===Section 2 - Primary Care===

{| class="wikitable"
|-
! Section !! Description !! Revision Date
|-
| 2.01 ||[[Initial Medical Assessment and Care]]||March-09
|-
|2.02 ||[[Initial Trauma Assessment and Care]]||September-17
|-
||2.03 ||[[Rapid Trauma Assessment, Focused History and Physical Exam]]||Sept-15
|-
||2.04||[[Analgesia and Sedation]]||November-2017
|-
||2.05||[[Drug Assisted Intubation]]||December-2016
|-
|2.06||[[DISSOCIATIVE ANESTHETIC]]||
|-
|||[[Patient Assist]]||January-25
|}

===Section 3 - Respiratory===

{| class="wikitable"
|-
! Section !! Description !! Revision Date
|-
| 3.01|| [[Acute Asthma or COPD with Wheezing]]|| February-19
|-
| 3.02|| [[Carbon Monoxide Inhalation]]|| March-09
|-
| 3.03|| [[Foreign Body Airway Obstruction]]|| March-09
|-
| 3.04|| [[Infectious Upper Airway Obstruction - Croup or Epiglottitis]]|| April-16
|-
| 3.05|| [[Severe Respiratory Pathogens]]|| November-10
|-
| 3.06|| [[Anxiety / Hyperventilation]]|| February-11
|}

===Section 4 - Cardiac===
{| class="wikitable"
|-
! Section !! Description !! Revision Date
|-
|4.01 || [[Chest Pain Acute Coronary Syndrome]]||Sept-17
|-
|4.02 || [[Asystole]]||April-16
|-
|4.03 || [[Atrial Fibrillation Atrial Flutter]]||June-17
|-
|4.04||[[Pulseless Electrical Activity (PEA)]]||January-16
|-
|4.05||[[Premature Ventricular Contractions (PVC)]]||May-12
|-
|4.06||[[Supraventricular Bradycardia and AV Blocks]]||March-09
|-
|4.07||[[Supraventricular Tachycardia]]||April-12
|-
|4.08||[[Ventricular Fibrillation Pulseless Ventricular Tachycardia]]||December-16
|-
|4.09||[[Ventricular Tachycardia with a Palpable Pulse]]||July-12
|-
|4.10||[[Wide Complex Tachycardia Uncertain Origin]]||May-12
|-
|4.11||[[Acute Cardiogenic Pulmonary Edema Pneumonia]]||March-09
|-
|4.12||[[Code Cool Post ROSC Induced Hypothermia]]||March-09
|-
|4.13||[[Adult Immediate Post-Cardiac Arrest Care]]||April-12
|-
|4.14||[[Ventricular Assist Devices]]||August-18
|}

===Section 5 - Medical===

{| class="wikitable"
|-
! Section !! Description !! Revision Date
|-
|5.01||[[Acute Abdominal Pain]]||April-16
|-
|5.02||[[Allergic Reaction Anaphylactic Shock]]||April-16
|-
|5.03||[[Altered Mental Status (AMS)]]||April-17
|-
|5.04||[[Suspected Stroke Transient Ischemic Attack TIA|Suspected Stroke or Transient Ischemic Attack]]||May-18
|-
|5.05||[[Drug Overdose Poisoning]]||March-09
|-
|5.06||[[Cold Emergencies]]||April-12
|-
|5.07||[[Heat Emergencies]]||August-15
|-
|5.08||[[Hazardous Materials]]||March-09
|-
|5.09||[[Severe Hypertension]]||March-09
|-
|5.10||[[Hypo or Hyperglycemia]]||April-16
|-
|5.11||[[Psychological Behavioral Emergencies]]||March-09
|-
|5.12||[[Seizure]]||April-16
|-
|5.13||[[Shock]]||March-09
|-
|5.14||[[Sickle Cell Anemia Crisis]]||March-09
|-
|5.15||[[Syncope]]||March-09
|-
|5.16||[[Vertigo]]||March-09
|-
|5.17||[[Sepsis Septic Shock]]||September-17
|-
|5.18||[[Suspected Kidney Stone]]||April-16
|-
|5.19||[[Cyanide Poisoning]]||April-16
|-
|5.20||[[Excited Delirium or Drug Induced Agitation]]||November-17
|-
|5.21||[[Ebola Virus Disease Patient Management]]||October-14
|-
|5.22||[[Acute Adrenal Insufficiency]]||June-18
|}

===Section 6 - Trauma===
{| class="wikitable"
|-
! Section !! Description !! Revision Date
|-
|6.01||[[Animal Bites Stings]]||March-09
|-
|6.02||[[Burns - Thermal, Electrical, Chemical]]||March-09
|-
|6.03||[[Selective Spinal Immobilization]]||August-14
|-
|6.04||[[Chest Injuries]]||March-09
|-
|6.05||[[Decompression Sickness or Dysbarism]]||March-09
|-
|6.06||[[Extremity Injuries]]||Feb-15
|-
|6.07||[[Head Injuries]]||November-17
|-
|6.08||[[Near Drowning]]||March-09
|-
|6.09||[[Ophthalmic Injuries]]||March-09
|-
|6.10||[[Suspected Abuse Neglect]]||March-09
|-
|6.11||[[Suspected Sexual Assault]]||March-09
|-
|6.12||[[Trunk Penetrating Injuries]]||April-12
|-
|6.13||[[Hemorrhagic Shock]]||October-18
|}

===Section 7 - Pediatric and Obstetrical===
{| class="wikitable"
|-
! Section !! Description !! Revision Date
|-
|7.01||[[Pediatric Asystole]]||April-16
|-
|7.02||[[Pediatric Pulseless Electrical Activity PEA]]||April-16
|-
|7.03||[[Pediatric Tachycardia, Ventricular Fibrillation or Pulseless Ventricular Tachycardia]]||April-16
|-
|7.04||[[Pregnancy Induced Hypertension (PIH)]]||March-09
|-
|7.05||[[Preterm Labor]]||November-17
|-
|7.06||[[Emergency Childbirth]]||November-17
|-
|7.07||[[Childbirth Complications]]||November-17
|-
|7.08||[[Newborn Care]]||April-16
|-
|7.09||[[Post Partum Care]]||November-17
|-
|7.10||[[Pediatric Febrile Emergency]]||April-16
|-
|7.11||[[Vaginal Bleeding]]||March-09
|-
|7.12||[[Trauma In Pregnancy]]||March-09
|}

===Section 8 - Medication Guidelines===
INTRODUCTION
The following pages contain guidelines for the medications commonly encountered by the Paramedic. They identify the name and class of the drug, a short description, indications, contraindications, precautions, and dosages. This is only a guideline to medication administration and shall not circumvent the need to refer to the appropriate Standing Order or to contact Medical Control for orders and consultation. For detailed and extensive information on each drug, refer to the Physician's Desk Reference, the Advanced Cardiac Life Support text or an emergency pre-hospital pharmacology reference.

Certain medications listed have various dosages depending on the patient's condition. Refer to the appropriate Standing Order or contact Medical Control for specific dosage information. All IV piggyback medications must be placed on a micro-gtt. solution set for field administration and if available, an infusion pump or infusion regulator MUST BE UTILIZED.

The following medications are authorized to be administered by Maitland Fire Rescue EMS:

{| class="wikitable"
|-
! Medication Name!! Revision Date
|-
|[[Acetaminophen]]||March-09
|-
|[[Adenosine]]||January-20
|-
|[[Albuterol]]||April-16
|-
|[[Aspirin]]||March-09
|-
|[[Ativan]]||April-16
|-
|[[Atropine]]||July-17
|-
|[[Atrovent]]||April-16
|-
|[[Calcium Chloride]]||April-16
|-
|[[Cardizem]]||July-17
|-
|[[Cyanokit]]||April-16
|-
|[[Dextrose 10%]]||April-16
|-
|[[Dextrose 50%]]||April-16
|-
|[[Diphenhydramine]]||April-16
|-
|[[Dopamine]]||April-16
|-
|[[Epinephrine]]||April-16
|-
|[[Etomidate]]||April-16
|-
|[[Fentanyl]]||November-16
|-
|[[Flumazenil]]||April-16
|-
|[[Glucagon]]||April-16
|-
|[[Keppra]]||September-24
|-
|[[Ketamine]]||November-17
|-
|[[Lasix]]||April-16
|-
|[[Lidocaine]]||July-17
|-
|[[Magnesium Sulfate]]||November-25
|-
|[[Morphine Sulfate]]||November-16
|-
|[[Naloxone]]||April-16
|-
|[[Nitro Drip]]||April-17
|-
|[[Nitro Spray]]||April-17
|-
|[[Nitro Tablets]]||April-17
|-
|[[Nitrous Oxide]]||November-16
|-
|[[Oxygen]]||March-09
|-
|[[Pepcid]]||April-16
|-
|[[Pontocaine]]||November-17
|-
|[[Promethazine]]||April-16
|-
|[[Racemic Epinephrine]]||April-16
|-
|[[Sodium Bicarbonate]]||April-16
|-
|[[Solu-Medrol]]||January-17
|-
|[[Toradol]]||March-09
|-
|[[TXA]]||October-20
|-
|[[Xopenex]]||April-16
|-
|[[Vasopressin]]||October-13
|-
|[[Valium]]||April-16
|-
|[[Versed]]||April-16
|-
|[[Zofran]]||April-16
|-
|[[Medication Infusion Tables]]||
|}

===Section 9 - Procedure Guidelines===
{| class="wikitable"
|-
! Section !! Description !! Revision Date
|-
|9.00||[[LUCAS Device]]||July-16
|-
|9.01||[[Pneupac VR1 Ventilator]]||March-09
|-
|9.02||[[Blood Alcohol Draw on Scene]]||March-09
|-
|9.03||[[Blood Draw using Vacutainer]]||March-09
|-
|9.04||[[Blood Glucose Test]]||March-09
|-
|9.05||[[Buretrol Usage]]||March-09
|-
|9.06||[[Cardiac Monitor]]||April-12
|-
|9.07||[[Cardioversion]]||March-09
|-
|9.08||[[Continuous Positive Airway Pressure Device]]||March-09
|-
|9.09||[[Cricothyrotomy Needle]]||March-09
|-
|9.10||[[Cricothyrotomy Surgical]]||March-09
|-
|9.11||[[Defibrillation]]||March-09
|-
|9.12||[[Defibrillation Pediatric]]||March-09
|-
|9.13||[[End Tidal CO2 Monitoring / Capnography]]||March-09
|-
|9.14.1||[[Intraosseous Infusion - Femoral]]||February-15
|-
|9.14.2||[[Intraosseous Infusion - Humeral Head]]||December-16
|-
|9.15||[[Intubation Endotracheal]]||March-09
|-
|9.16||[[Intubation Nasotracheal]]||March-09
|-
|9.17||[[Braun Syringe Infusion Pump]]||March-14
|-
|9.18||[[King Tube]]||March-09
|-
|9.19||[[Medication Administration Intramuscular]]||March-09
|-
|9.20||[[Medication Administration Nasal Atomizer]]||March-09
|-
|9.21||[[Medication Administration Nebulizer]]||March-09
|-
|9.22||[[Medication Administration Subcutaneous]]||March-09
|-
|9.23||[[Nasogastric/Orogastric Tube]]||March-09
|-
|9.24||[[Oxygen Administration]]||March-09
|-
|9.25||[[Peripheral IV Administration]]||March-09
|-
|9.26||[[Pleural Decompression]]||March-09
|-
|9.27||[[Removal of Taser Probes]]||March-09
|-
|9.28||[[Reconstitution of Medications]]||March-09
|-
|9.29||[[Transcutaneous Pacing Procedure]]||March-09
|-
|9.30||[[Emergency Escharotomy|Emergency Chest Wall Escharotomy]]||April-11
|-
|9.31||[[Central Venous Access Devices]]||June-12
|-
|9.32||[[Medication Administration Cross Check]]||Jun-12
|-
|9.33||[[Combat Application Tourniquet]]||Jan-14
|-
|9.34||[http://lifevest.zoll.com/medical-professionals/first-responder-resources Zoll LifeVest Wearable Defibrillator]||Dec-14
|-
|9.35||[[Medication Temperature Monitoring]]||Feb-19
|}

===Section 10 - References===
{| class="wikitable"
|-
! Section !! Description !! Revision Date
|-
|10.01||[[Abbreviations]]||March-09
|-
|10.02||[[Apgar Score]]||March-09
|-
|10.03||[[Glasgow Coma Score]]||March-09
|-
|10.04||[[Pediatric Vital Signs]]||March-09
|-
|10.05||[[Adult Trauma Alert Criteria]]||March-09
|-
|10.06||[[Pediatric Trauma Alert Criteria]]||March-09
|-
|10.07||[[Pediatric Trauma Score]]||March-09
|-
|10.08||[[Nitroglycerin Drip]]||March-09
|-
|10.09||[[Checking Range of Motion]]||March-09
|-
|10.10||[[Rules of Nine]]||March-09
|-
|10.11||[[Florida Statutes]]||March-09
|-
|10.12||[[Evaluation and Treatment Flow Chart]]||March-09
|-
|10.13||[[Spinal Injury Assessment Critical Criteria]]||March-09
|}

===Section 11 - Medical Director Memos===
{| class="wikitable sortable"
|-
! Subject !! Effective Date
|-
| [[Memo - Opening of Oviedo Medical Center|Opening of Oviedo Medical Center]] || 2017-01-29
|-
| [[Memo - Blood Draws - Florida Hospital|Blood Draws - Florida Hospital]] || 2017-01-25
|-
| [[Memo - Medical Alerts|Medical Alerts]] || 2016-04-27
|-
| [[Memo - Discontinuation of Central Venous Access|Discontinuation of Central Venous Access]] || 2013-08-03
|-
| [[Memo - Shortage of Atropine|Shortage of Atropine]] || 2013-04-11
|-
| [[Memo - EMS Blood Draws for SSCH|EMS Blood Draws for SSCH]] || 2013-03-07
|-
| [[Memo - Respiratory Breathing Treatments|Respiratory/Breathing Treatments]] || 2012-12-19
|-
| [[Memo - OB Transports|OB Transports]] || 2011-01-14
|-
| [[Memo - Aspirin Administration Documentation|Aspirin Administration Documentation]] || 2010-12-01
|-
| [[Memo - Alert Terminology|Alert Terminology]] || 2010-05-06
|}

Maitland Fire Rescue Department Practice Parameters

2025-12-17T16:16:08Z

Mfrdmanager: /* Section 2 - Primary Care */

__NOTOC__
==TABLE OF CONTENTS==

[[Medical Director Authorization]]

===Section 1 - Administrative Policies===

{| class="wikitable"
|-
! Section !! Description !! Revision Date
|-
| 1.01 || [[General Measures]] || April-16
|-
| 1.02 || [[Radio Report Format]] || March-16
|-
| 1.03 || [[Refusal of Service]] || October-17
|-
| 1.04 || [[Physician or Nurse on Scene]] || March-09
|-
| 1.05 || [[Initiation of CPR and Determination of Death]] || July-16
|-
| 1.06|| [[Determination of Death in Trauma]]|| March-09
|-
| 1.07|| [[Crime or Unattended Death Scene]] || March-09
|-
| 1.08|| [[Medical Evaluation of Person in Police Custody]]|| March-09
|-
| 1.09|| [[Trauma Transport Protocol]]|| Dec-19
|-
| 1.10|| [[Emergency Transport]]|| March-09
|-
| 1.11|| [[Criteria for Helicopter Transport]]|| March-09
|-
| 1.12|| [[Medical Patient Transport Decision]]|| April-14
|-
| 1.13|| [[Obstetrical Patient Transport Decision]]|| Feb-15
|-
| 1.14|| [[Emergency Inter Facility Transport]]|| March-09
|-
| 1.15|| [[EMS Disaster Response Level]]|| March-09
|-
| 1.16|| [[EMS Offload Policy]]|| March-09
|-
| 1.17|| [[EMS Quality Improvement Program]]|| March-09
|-
| 1.18|| [[Scope of Practice]]|| March-09
|-
| 1.19|| [[Freestanding ED Transport Criteria]]|| October-13
|-
| 1.20|| [[Hospital Capability Chart]]|| May-18
|-
| 1.21|| [[Documentation Guidance]]|| June-17
|}

===Section 2 - Primary Care===

{| class="wikitable"
|-
! Section !! Description !! Revision Date
|-
| 2.01 ||[[Initial Medical Assessment and Care]]||March-09
|-
|2.02 ||[[Initial Trauma Assessment and Care]]||September-17
|-
||2.03 ||[[Rapid Trauma Assessment, Focused History and Physical Exam]]||Sept-15
|-
||2.04||[[Analgesia and Sedation]]||November-2017
|-
||2.05||[[Drug Assisted Intubation]]||December-2016
|-
|2.06||[[DISSOCIATIVE ANESTHETIC]]||
|-
|[[Patient Assist]]||January-25
|}

===Section 3 - Respiratory===

{| class="wikitable"
|-
! Section !! Description !! Revision Date
|-
| 3.01|| [[Acute Asthma or COPD with Wheezing]]|| February-19
|-
| 3.02|| [[Carbon Monoxide Inhalation]]|| March-09
|-
| 3.03|| [[Foreign Body Airway Obstruction]]|| March-09
|-
| 3.04|| [[Infectious Upper Airway Obstruction - Croup or Epiglottitis]]|| April-16
|-
| 3.05|| [[Severe Respiratory Pathogens]]|| November-10
|-
| 3.06|| [[Anxiety / Hyperventilation]]|| February-11
|}

===Section 4 - Cardiac===
{| class="wikitable"
|-
! Section !! Description !! Revision Date
|-
|4.01 || [[Chest Pain Acute Coronary Syndrome]]||Sept-17
|-
|4.02 || [[Asystole]]||April-16
|-
|4.03 || [[Atrial Fibrillation Atrial Flutter]]||June-17
|-
|4.04||[[Pulseless Electrical Activity (PEA)]]||January-16
|-
|4.05||[[Premature Ventricular Contractions (PVC)]]||May-12
|-
|4.06||[[Supraventricular Bradycardia and AV Blocks]]||March-09
|-
|4.07||[[Supraventricular Tachycardia]]||April-12
|-
|4.08||[[Ventricular Fibrillation Pulseless Ventricular Tachycardia]]||December-16
|-
|4.09||[[Ventricular Tachycardia with a Palpable Pulse]]||July-12
|-
|4.10||[[Wide Complex Tachycardia Uncertain Origin]]||May-12
|-
|4.11||[[Acute Cardiogenic Pulmonary Edema Pneumonia]]||March-09
|-
|4.12||[[Code Cool Post ROSC Induced Hypothermia]]||March-09
|-
|4.13||[[Adult Immediate Post-Cardiac Arrest Care]]||April-12
|-
|4.14||[[Ventricular Assist Devices]]||August-18
|}

===Section 5 - Medical===

{| class="wikitable"
|-
! Section !! Description !! Revision Date
|-
|5.01||[[Acute Abdominal Pain]]||April-16
|-
|5.02||[[Allergic Reaction Anaphylactic Shock]]||April-16
|-
|5.03||[[Altered Mental Status (AMS)]]||April-17
|-
|5.04||[[Suspected Stroke Transient Ischemic Attack TIA|Suspected Stroke or Transient Ischemic Attack]]||May-18
|-
|5.05||[[Drug Overdose Poisoning]]||March-09
|-
|5.06||[[Cold Emergencies]]||April-12
|-
|5.07||[[Heat Emergencies]]||August-15
|-
|5.08||[[Hazardous Materials]]||March-09
|-
|5.09||[[Severe Hypertension]]||March-09
|-
|5.10||[[Hypo or Hyperglycemia]]||April-16
|-
|5.11||[[Psychological Behavioral Emergencies]]||March-09
|-
|5.12||[[Seizure]]||April-16
|-
|5.13||[[Shock]]||March-09
|-
|5.14||[[Sickle Cell Anemia Crisis]]||March-09
|-
|5.15||[[Syncope]]||March-09
|-
|5.16||[[Vertigo]]||March-09
|-
|5.17||[[Sepsis Septic Shock]]||September-17
|-
|5.18||[[Suspected Kidney Stone]]||April-16
|-
|5.19||[[Cyanide Poisoning]]||April-16
|-
|5.20||[[Excited Delirium or Drug Induced Agitation]]||November-17
|-
|5.21||[[Ebola Virus Disease Patient Management]]||October-14
|-
|5.22||[[Acute Adrenal Insufficiency]]||June-18
|}

===Section 6 - Trauma===
{| class="wikitable"
|-
! Section !! Description !! Revision Date
|-
|6.01||[[Animal Bites Stings]]||March-09
|-
|6.02||[[Burns - Thermal, Electrical, Chemical]]||March-09
|-
|6.03||[[Selective Spinal Immobilization]]||August-14
|-
|6.04||[[Chest Injuries]]||March-09
|-
|6.05||[[Decompression Sickness or Dysbarism]]||March-09
|-
|6.06||[[Extremity Injuries]]||Feb-15
|-
|6.07||[[Head Injuries]]||November-17
|-
|6.08||[[Near Drowning]]||March-09
|-
|6.09||[[Ophthalmic Injuries]]||March-09
|-
|6.10||[[Suspected Abuse Neglect]]||March-09
|-
|6.11||[[Suspected Sexual Assault]]||March-09
|-
|6.12||[[Trunk Penetrating Injuries]]||April-12
|-
|6.13||[[Hemorrhagic Shock]]||October-18
|}

===Section 7 - Pediatric and Obstetrical===
{| class="wikitable"
|-
! Section !! Description !! Revision Date
|-
|7.01||[[Pediatric Asystole]]||April-16
|-
|7.02||[[Pediatric Pulseless Electrical Activity PEA]]||April-16
|-
|7.03||[[Pediatric Tachycardia, Ventricular Fibrillation or Pulseless Ventricular Tachycardia]]||April-16
|-
|7.04||[[Pregnancy Induced Hypertension (PIH)]]||March-09
|-
|7.05||[[Preterm Labor]]||November-17
|-
|7.06||[[Emergency Childbirth]]||November-17
|-
|7.07||[[Childbirth Complications]]||November-17
|-
|7.08||[[Newborn Care]]||April-16
|-
|7.09||[[Post Partum Care]]||November-17
|-
|7.10||[[Pediatric Febrile Emergency]]||April-16
|-
|7.11||[[Vaginal Bleeding]]||March-09
|-
|7.12||[[Trauma In Pregnancy]]||March-09
|}

===Section 8 - Medication Guidelines===
INTRODUCTION
The following pages contain guidelines for the medications commonly encountered by the Paramedic. They identify the name and class of the drug, a short description, indications, contraindications, precautions, and dosages. This is only a guideline to medication administration and shall not circumvent the need to refer to the appropriate Standing Order or to contact Medical Control for orders and consultation. For detailed and extensive information on each drug, refer to the Physician's Desk Reference, the Advanced Cardiac Life Support text or an emergency pre-hospital pharmacology reference.

Certain medications listed have various dosages depending on the patient's condition. Refer to the appropriate Standing Order or contact Medical Control for specific dosage information. All IV piggyback medications must be placed on a micro-gtt. solution set for field administration and if available, an infusion pump or infusion regulator MUST BE UTILIZED.

The following medications are authorized to be administered by Maitland Fire Rescue EMS:

{| class="wikitable"
|-
! Medication Name!! Revision Date
|-
|[[Acetaminophen]]||March-09
|-
|[[Adenosine]]||January-20
|-
|[[Albuterol]]||April-16
|-
|[[Aspirin]]||March-09
|-
|[[Ativan]]||April-16
|-
|[[Atropine]]||July-17
|-
|[[Atrovent]]||April-16
|-
|[[Calcium Chloride]]||April-16
|-
|[[Cardizem]]||July-17
|-
|[[Cyanokit]]||April-16
|-
|[[Dextrose 10%]]||April-16
|-
|[[Dextrose 50%]]||April-16
|-
|[[Diphenhydramine]]||April-16
|-
|[[Dopamine]]||April-16
|-
|[[Epinephrine]]||April-16
|-
|[[Etomidate]]||April-16
|-
|[[Fentanyl]]||November-16
|-
|[[Flumazenil]]||April-16
|-
|[[Glucagon]]||April-16
|-
|[[Keppra]]||September-24
|-
|[[Ketamine]]||November-17
|-
|[[Lasix]]||April-16
|-
|[[Lidocaine]]||July-17
|-
|[[Magnesium Sulfate]]||November-25
|-
|[[Morphine Sulfate]]||November-16
|-
|[[Naloxone]]||April-16
|-
|[[Nitro Drip]]||April-17
|-
|[[Nitro Spray]]||April-17
|-
|[[Nitro Tablets]]||April-17
|-
|[[Nitrous Oxide]]||November-16
|-
|[[Oxygen]]||March-09
|-
|[[Pepcid]]||April-16
|-
|[[Pontocaine]]||November-17
|-
|[[Promethazine]]||April-16
|-
|[[Racemic Epinephrine]]||April-16
|-
|[[Sodium Bicarbonate]]||April-16
|-
|[[Solu-Medrol]]||January-17
|-
|[[Toradol]]||March-09
|-
|[[TXA]]||October-20
|-
|[[Xopenex]]||April-16
|-
|[[Vasopressin]]||October-13
|-
|[[Valium]]||April-16
|-
|[[Versed]]||April-16
|-
|[[Zofran]]||April-16
|-
|[[Medication Infusion Tables]]||
|}

===Section 9 - Procedure Guidelines===
{| class="wikitable"
|-
! Section !! Description !! Revision Date
|-
|9.00||[[LUCAS Device]]||July-16
|-
|9.01||[[Pneupac VR1 Ventilator]]||March-09
|-
|9.02||[[Blood Alcohol Draw on Scene]]||March-09
|-
|9.03||[[Blood Draw using Vacutainer]]||March-09
|-
|9.04||[[Blood Glucose Test]]||March-09
|-
|9.05||[[Buretrol Usage]]||March-09
|-
|9.06||[[Cardiac Monitor]]||April-12
|-
|9.07||[[Cardioversion]]||March-09
|-
|9.08||[[Continuous Positive Airway Pressure Device]]||March-09
|-
|9.09||[[Cricothyrotomy Needle]]||March-09
|-
|9.10||[[Cricothyrotomy Surgical]]||March-09
|-
|9.11||[[Defibrillation]]||March-09
|-
|9.12||[[Defibrillation Pediatric]]||March-09
|-
|9.13||[[End Tidal CO2 Monitoring / Capnography]]||March-09
|-
|9.14.1||[[Intraosseous Infusion - Femoral]]||February-15
|-
|9.14.2||[[Intraosseous Infusion - Humeral Head]]||December-16
|-
|9.15||[[Intubation Endotracheal]]||March-09
|-
|9.16||[[Intubation Nasotracheal]]||March-09
|-
|9.17||[[Braun Syringe Infusion Pump]]||March-14
|-
|9.18||[[King Tube]]||March-09
|-
|9.19||[[Medication Administration Intramuscular]]||March-09
|-
|9.20||[[Medication Administration Nasal Atomizer]]||March-09
|-
|9.21||[[Medication Administration Nebulizer]]||March-09
|-
|9.22||[[Medication Administration Subcutaneous]]||March-09
|-
|9.23||[[Nasogastric/Orogastric Tube]]||March-09
|-
|9.24||[[Oxygen Administration]]||March-09
|-
|9.25||[[Peripheral IV Administration]]||March-09
|-
|9.26||[[Pleural Decompression]]||March-09
|-
|9.27||[[Removal of Taser Probes]]||March-09
|-
|9.28||[[Reconstitution of Medications]]||March-09
|-
|9.29||[[Transcutaneous Pacing Procedure]]||March-09
|-
|9.30||[[Emergency Escharotomy|Emergency Chest Wall Escharotomy]]||April-11
|-
|9.31||[[Central Venous Access Devices]]||June-12
|-
|9.32||[[Medication Administration Cross Check]]||Jun-12
|-
|9.33||[[Combat Application Tourniquet]]||Jan-14
|-
|9.34||[http://lifevest.zoll.com/medical-professionals/first-responder-resources Zoll LifeVest Wearable Defibrillator]||Dec-14
|-
|9.35||[[Medication Temperature Monitoring]]||Feb-19
|}

===Section 10 - References===
{| class="wikitable"
|-
! Section !! Description !! Revision Date
|-
|10.01||[[Abbreviations]]||March-09
|-
|10.02||[[Apgar Score]]||March-09
|-
|10.03||[[Glasgow Coma Score]]||March-09
|-
|10.04||[[Pediatric Vital Signs]]||March-09
|-
|10.05||[[Adult Trauma Alert Criteria]]||March-09
|-
|10.06||[[Pediatric Trauma Alert Criteria]]||March-09
|-
|10.07||[[Pediatric Trauma Score]]||March-09
|-
|10.08||[[Nitroglycerin Drip]]||March-09
|-
|10.09||[[Checking Range of Motion]]||March-09
|-
|10.10||[[Rules of Nine]]||March-09
|-
|10.11||[[Florida Statutes]]||March-09
|-
|10.12||[[Evaluation and Treatment Flow Chart]]||March-09
|-
|10.13||[[Spinal Injury Assessment Critical Criteria]]||March-09
|}

===Section 11 - Medical Director Memos===
{| class="wikitable sortable"
|-
! Subject !! Effective Date
|-
| [[Memo - Opening of Oviedo Medical Center|Opening of Oviedo Medical Center]] || 2017-01-29
|-
| [[Memo - Blood Draws - Florida Hospital|Blood Draws - Florida Hospital]] || 2017-01-25
|-
| [[Memo - Medical Alerts|Medical Alerts]] || 2016-04-27
|-
| [[Memo - Discontinuation of Central Venous Access|Discontinuation of Central Venous Access]] || 2013-08-03
|-
| [[Memo - Shortage of Atropine|Shortage of Atropine]] || 2013-04-11
|-
| [[Memo - EMS Blood Draws for SSCH|EMS Blood Draws for SSCH]] || 2013-03-07
|-
| [[Memo - Respiratory Breathing Treatments|Respiratory/Breathing Treatments]] || 2012-12-19
|-
| [[Memo - OB Transports|OB Transports]] || 2011-01-14
|-
| [[Memo - Aspirin Administration Documentation|Aspirin Administration Documentation]] || 2010-12-01
|-
| [[Memo - Alert Terminology|Alert Terminology]] || 2010-05-06
|}

Head Injuries

2025-12-17T16:10:13Z

Mfrdmanager:

==Section 6 - TRAUMA==
===6.07 HEAD INJURIES===

[[Initial Trauma Assessment and Care|INITIAL TRAUMA CARE]], (2.02) [[Oxygen|OXYGEN]] @ 100% via NRB mask or hyperventilate with BVM.
* Elevate head and shoulders 15 - 30 degrees if systolic BP > 90 mm Hg.
* Refer to [[Altered Mental Status (AMS)|ALTERED MENTAL STATUS PRACTICE PARAMETER]] (5.03).
* If '''Combative''' refer to [[Dissociative Anesthetic|DISSOCIATIVE ANESTHETIC]] (2.05)
* [[Morphine_Sulfate|MORPHINE]] - Initial dose 2-5 mg IVP, IM or IN followed by 2 mg doses. (Max 15 mg)
::'''AND / OR'''
* [[Ketamine|KETAMINE (KETALAR)]] Titrate to effect, starting dose of 0.5 mg/kg slow IVP or 1 mg/kg IM.
* Maintain ETCO2 between 30-35 mmHg and Oxygen saturation >95%

'''TRAUMATIC BRAIN INJURY MANAGEMENT'''
* If the following criteria have been met:
** GCS < 8 (Consider airway management with an i-gel if no gag reflex)
** AND Any one of the following:
*** Unilateral fixed or dilated pupil
*** Unilateral paralysis
*** Posturing
*** Seizure after injury
*** Skull deformity
''ADULT''
* [[Hypertonic Saline|3% Saline]] bolus, 250 ml IV or IO
* [[Keppra]] 1 gram IV or IO
''PEDIATRIC''
* [[Hypertonic Saline|3% Saline]] bolus at 5 ml/kg (max of 250 ml) IV/IO drip utilizing 10ggts drip set
* [[Keppra]] 20mg/kg (not to exceed 1g) IV/IO (may be repeated once at 40mg/kg if seizure continues)
* Transport patient to nearest Pediatric Trauma Center via appropriate method

 
'''OTHER OPTIONS'''
* [[Versed|MIDAZOLAM (Versed)]] - Initial dose 2-5mg IV or IN then 2 mg every 30 seconds to 1 minute.
** (Max dose 15 mg) in the intubated patient. IM .07-.08 mg/kg with onset in approximately 15 minutes. IM injection requires immediate IV access upon sedation.
* [[Ativan|LORAZAPAM (Ativan)]] 1-2 mg Slow IVP for adults titrated to effect. Max dose of 8mg. If no IV access or Agitated/Violent behavioral patient, administer 1-2 mg IM up to a total of 2 ml per large muscle injection site or 1 ml per small muscle injection site.
* These drugs may be given in combination for maximum effectiveness.
* Ensure that Pulse Oximeter is in place.
* Ensure that BVM and [[Flumazenil|ROMAZICON]] and/or [[Naloxone|NARCAN]] are readily available.

[[Category:Trauma|0607]

Head Injuries

2025-12-17T16:09:19Z

Mfrdmanager:

==Section 6 - TRAUMA==
===6.07 HEAD INJURIES===

[[Initial Trauma Assessment and Care|INITIAL TRAUMA CARE]], (2.02) [[Oxygen|OXYGEN]] @ 100% via NRB mask or hyperventilate with BVM.
* Elevate head and shoulders 15 - 30 degrees if systolic BP > 90 mm Hg.
* Refer to [[Altered Mental Status (AMS)|ALTERED MENTAL STATUS PRACTICE PARAMETER]] (5.03).
* If '''Combative''' refer to [[Dissociative Anesthetic|DISSOCIATIVE ANESTHETIC]] (2.05)
* [[Morphine_Sulfate|MORPHINE]] - Initial dose 2-5 mg IVP, IM or IN followed by 2 mg doses. (Max 15 mg)
::'''AND / OR'''
* [[Ketamine|KETAMINE (KETALAR)]] Titrate to effect, starting dose of 0.5 mg/kg slow IVP or 1 mg/kg IM.
* Maintain ETCO2 between 30-35 mmHg and Oxygen saturation >95%

'''TRAUMATIC BRAIN INJURY MANAGEMENT'''
* If the following criteria have been met:
** GCS < 8 (Consider airway management with an i-gel if no gag reflex)
** AND Any one of the following:
*** Unilateral fixed or dilated pupil
*** Unilateral paralysis
*** Posturing
*** Seizure after injury
*** Skull deformity
''ADULT''
* [[Hypertonic Saline|3% Saline]] bolus, 250 ml IV or IO
* [[Keppra]] 1 gram IV or IO
''PEDIATRIC''
* [[Hypertonic Saline|3% Saline]] bolus at 5 ml/kg (max of 250 ml) IV/IO drip utilizing 10ggts drip set
* [[Keppra]] 20mg/kg (not to exceed 1g) IV/IO (may be repeated once at 40mg/kg if seizure continues)
* Transport patient to nearest Pediatric Trauma Center via appropriate method

 
'''OTHER OPTIONS'''
* [[Versed|MIDAZOLAM (Versed)]] - Initial dose 2-5mg IV or IN then 2 mg every 30 seconds to 1 minute.
** (Max dose 15 mg) in the intubated patient. IM .07-.08 mg/kg with onset in approximately 15 minutes. IM injection requires immediate IV access upon sedation.
* [[Ativan|LORAZAPAM (VALIUM)]] 1-2 mg Slow IVP for adults titrated to effect. Max dose of 8mg. If no IV access or Agitated/Violent behavioral patient, administer 1-2 mg IM up to a total of 2 ml per large muscle injection site or 1 ml per small muscle injection site.
* These drugs may be given in combination for maximum effectiveness.
* Ensure that Pulse Oximeter is in place.
* Ensure that BVM and [[Flumazenil|ROMAZICON]] and/or [[Naloxone|NARCAN]] are readily available.

[[Category:Trauma|0607]

Keppra

2025-12-09T13:53:58Z

Mfrdmanager: Created page with "==Section 8 - MEDICATION GUIDELINES== ===ANTICONVULSANT=== ====Keppra / Levetiracetam==== '''DESCRIPTION / ACTION:''' * Anticonvulsant for Traumatic Brain Injury patients. ''..."

==Section 8 - MEDICATION GUIDELINES==
===ANTICONVULSANT===

====Keppra / Levetiracetam====
'''DESCRIPTION / ACTION:'''
* Anticonvulsant for Traumatic Brain Injury patients.
'''INDICATIONS:'''
* [[Head Injuries|TBI]] in the Adult or Pediatric Patient
'''CONTRAINDICATIONS:'''
* Hypersensitivity or allergy
'''DOSE:'''
* For adults, 1 gram IV or IO push
* For pediatrics, 20 mg/kg IV or IO push. May repeat at 40 mg/kg
* Max dose of 1 gram.

[[Category:Medication Guidelines|Keppra]]

Maitland Fire Rescue Department Practice Parameters

2025-12-09T13:53:34Z

Mfrdmanager: /* Section 8 - Medication Guidelines */

__NOTOC__
==TABLE OF CONTENTS==

[[Medical Director Authorization]]

===Section 1 - Administrative Policies===

{| class="wikitable"
|-
! Section !! Description !! Revision Date
|-
| 1.01 || [[General Measures]] || April-16
|-
| 1.02 || [[Radio Report Format]] || March-16
|-
| 1.03 || [[Refusal of Service]] || October-17
|-
| 1.04 || [[Physician or Nurse on Scene]] || March-09
|-
| 1.05 || [[Initiation of CPR and Determination of Death]] || July-16
|-
| 1.06|| [[Determination of Death in Trauma]]|| March-09
|-
| 1.07|| [[Crime or Unattended Death Scene]] || March-09
|-
| 1.08|| [[Medical Evaluation of Person in Police Custody]]|| March-09
|-
| 1.09|| [[Trauma Transport Protocol]]|| Dec-19
|-
| 1.10|| [[Emergency Transport]]|| March-09
|-
| 1.11|| [[Criteria for Helicopter Transport]]|| March-09
|-
| 1.12|| [[Medical Patient Transport Decision]]|| April-14
|-
| 1.13|| [[Obstetrical Patient Transport Decision]]|| Feb-15
|-
| 1.14|| [[Emergency Inter Facility Transport]]|| March-09
|-
| 1.15|| [[EMS Disaster Response Level]]|| March-09
|-
| 1.16|| [[EMS Offload Policy]]|| March-09
|-
| 1.17|| [[EMS Quality Improvement Program]]|| March-09
|-
| 1.18|| [[Scope of Practice]]|| March-09
|-
| 1.19|| [[Freestanding ED Transport Criteria]]|| October-13
|-
| 1.20|| [[Hospital Capability Chart]]|| May-18
|-
| 1.21|| [[Documentation Guidance]]|| June-17
|}

===Section 2 - Primary Care===

{| class="wikitable"
|-
! Section !! Description !! Revision Date
|-
| 2.01 ||[[Initial Medical Assessment and Care]]||March-09
|-
|2.02 ||[[Initial Trauma Assessment and Care]]||September-17
|-
||2.03 ||[[Rapid Trauma Assessment, Focused History and Physical Exam]]||Sept-15
|-
||2.04||[[Analgesia and Sedation]]||November-2017
|-
||2.05||[[Drug Assisted Intubation]]||December-2016
|}

===Section 3 - Respiratory===

{| class="wikitable"
|-
! Section !! Description !! Revision Date
|-
| 3.01|| [[Acute Asthma or COPD with Wheezing]]|| February-19
|-
| 3.02|| [[Carbon Monoxide Inhalation]]|| March-09
|-
| 3.03|| [[Foreign Body Airway Obstruction]]|| March-09
|-
| 3.04|| [[Infectious Upper Airway Obstruction - Croup or Epiglottitis]]|| April-16
|-
| 3.05|| [[Severe Respiratory Pathogens]]|| November-10
|-
| 3.06|| [[Anxiety / Hyperventilation]]|| February-11
|}

===Section 4 - Cardiac===
{| class="wikitable"
|-
! Section !! Description !! Revision Date
|-
|4.01 || [[Chest Pain Acute Coronary Syndrome]]||Sept-17
|-
|4.02 || [[Asystole]]||April-16
|-
|4.03 || [[Atrial Fibrillation Atrial Flutter]]||June-17
|-
|4.04||[[Pulseless Electrical Activity (PEA)]]||January-16
|-
|4.05||[[Premature Ventricular Contractions (PVC)]]||May-12
|-
|4.06||[[Supraventricular Bradycardia and AV Blocks]]||March-09
|-
|4.07||[[Supraventricular Tachycardia]]||April-12
|-
|4.08||[[Ventricular Fibrillation Pulseless Ventricular Tachycardia]]||December-16
|-
|4.09||[[Ventricular Tachycardia with a Palpable Pulse]]||July-12
|-
|4.10||[[Wide Complex Tachycardia Uncertain Origin]]||May-12
|-
|4.11||[[Acute Cardiogenic Pulmonary Edema Pneumonia]]||March-09
|-
|4.12||[[Code Cool Post ROSC Induced Hypothermia]]||March-09
|-
|4.13||[[Adult Immediate Post-Cardiac Arrest Care]]||April-12
|-
|4.14||[[Ventricular Assist Devices]]||August-18
|}

===Section 5 - Medical===

{| class="wikitable"
|-
! Section !! Description !! Revision Date
|-
|5.01||[[Acute Abdominal Pain]]||April-16
|-
|5.02||[[Allergic Reaction Anaphylactic Shock]]||April-16
|-
|5.03||[[Altered Mental Status (AMS)]]||April-17
|-
|5.04||[[Suspected Stroke Transient Ischemic Attack TIA|Suspected Stroke or Transient Ischemic Attack]]||May-18
|-
|5.05||[[Drug Overdose Poisoning]]||March-09
|-
|5.06||[[Cold Emergencies]]||April-12
|-
|5.07||[[Heat Emergencies]]||August-15
|-
|5.08||[[Hazardous Materials]]||March-09
|-
|5.09||[[Severe Hypertension]]||March-09
|-
|5.10||[[Hypo or Hyperglycemia]]||April-16
|-
|5.11||[[Psychological Behavioral Emergencies]]||March-09
|-
|5.12||[[Seizure]]||April-16
|-
|5.13||[[Shock]]||March-09
|-
|5.14||[[Sickle Cell Anemia Crisis]]||March-09
|-
|5.15||[[Syncope]]||March-09
|-
|5.16||[[Vertigo]]||March-09
|-
|5.17||[[Sepsis Septic Shock]]||September-17
|-
|5.18||[[Suspected Kidney Stone]]||April-16
|-
|5.19||[[Cyanide Poisoning]]||April-16
|-
|5.20||[[Excited Delirium or Drug Induced Agitation]]||November-17
|-
|5.21||[[Ebola Virus Disease Patient Management]]||October-14
|-
|5.22||[[Acute Adrenal Insufficiency]]||June-18
|}

===Section 6 - Trauma===
{| class="wikitable"
|-
! Section !! Description !! Revision Date
|-
|6.01||[[Animal Bites Stings]]||March-09
|-
|6.02||[[Burns - Thermal, Electrical, Chemical]]||March-09
|-
|6.03||[[Selective Spinal Immobilization]]||August-14
|-
|6.04||[[Chest Injuries]]||March-09
|-
|6.05||[[Decompression Sickness or Dysbarism]]||March-09
|-
|6.06||[[Extremity Injuries]]||Feb-15
|-
|6.07||[[Head Injuries]]||November-17
|-
|6.08||[[Near Drowning]]||March-09
|-
|6.09||[[Ophthalmic Injuries]]||March-09
|-
|6.10||[[Suspected Abuse Neglect]]||March-09
|-
|6.11||[[Suspected Sexual Assault]]||March-09
|-
|6.12||[[Trunk Penetrating Injuries]]||April-12
|-
|6.13||[[Hemorrhagic Shock]]||October-18
|}

===Section 7 - Pediatric and Obstetrical===
{| class="wikitable"
|-
! Section !! Description !! Revision Date
|-
|7.01||[[Pediatric Asystole]]||April-16
|-
|7.02||[[Pediatric Pulseless Electrical Activity PEA]]||April-16
|-
|7.03||[[Pediatric Tachycardia, Ventricular Fibrillation or Pulseless Ventricular Tachycardia]]||April-16
|-
|7.04||[[Pregnancy Induced Hypertension (PIH)]]||March-09
|-
|7.05||[[Preterm Labor]]||November-17
|-
|7.06||[[Emergency Childbirth]]||November-17
|-
|7.07||[[Childbirth Complications]]||November-17
|-
|7.08||[[Newborn Care]]||April-16
|-
|7.09||[[Post Partum Care]]||November-17
|-
|7.10||[[Pediatric Febrile Emergency]]||April-16
|-
|7.11||[[Vaginal Bleeding]]||March-09
|-
|7.12||[[Trauma In Pregnancy]]||March-09
|}

===Section 8 - Medication Guidelines===
INTRODUCTION
The following pages contain guidelines for the medications commonly encountered by the Paramedic. They identify the name and class of the drug, a short description, indications, contraindications, precautions, and dosages. This is only a guideline to medication administration and shall not circumvent the need to refer to the appropriate Standing Order or to contact Medical Control for orders and consultation. For detailed and extensive information on each drug, refer to the Physician's Desk Reference, the Advanced Cardiac Life Support text or an emergency pre-hospital pharmacology reference.

Certain medications listed have various dosages depending on the patient's condition. Refer to the appropriate Standing Order or contact Medical Control for specific dosage information. All IV piggyback medications must be placed on a micro-gtt. solution set for field administration and if available, an infusion pump or infusion regulator MUST BE UTILIZED.

The following medications are authorized to be administered by Maitland Fire Rescue EMS:

{| class="wikitable"
|-
! Medication Name!! Revision Date
|-
|[[Acetaminophen]]||March-09
|-
|[[Adenosine]]||January-20
|-
|[[Albuterol]]||April-16
|-
|[[Aspirin]]||March-09
|-
|[[Ativan]]||April-16
|-
|[[Atropine]]||July-17
|-
|[[Atrovent]]||April-16
|-
|[[Calcium Chloride]]||April-16
|-
|[[Cardizem]]||July-17
|-
|[[Cyanokit]]||April-16
|-
|[[Dextrose 10%]]||April-16
|-
|[[Dextrose 50%]]||April-16
|-
|[[Diphenhydramine]]||April-16
|-
|[[Dopamine]]||April-16
|-
|[[Epinephrine]]||April-16
|-
|[[Etomidate]]||April-16
|-
|[[Fentanyl]]||November-16
|-
|[[Flumazenil]]||April-16
|-
|[[Glucagon]]||April-16
|-
|[[Keppra]]||September-24
|-
|[[Ketamine]]||November-17
|-
|[[Lasix]]||April-16
|-
|[[Lidocaine]]||July-17
|-
|[[Magnesium Sulfate]]||November-25
|-
|[[Morphine Sulfate]]||November-16
|-
|[[Naloxone]]||April-16
|-
|[[Nitro Drip]]||April-17
|-
|[[Nitro Spray]]||April-17
|-
|[[Nitro Tablets]]||April-17
|-
|[[Nitrous Oxide]]||November-16
|-
|[[Oxygen]]||March-09
|-
|[[Pepcid]]||April-16
|-
|[[Pontocaine]]||November-17
|-
|[[Promethazine]]||April-16
|-
|[[Racemic Epinephrine]]||April-16
|-
|[[Sodium Bicarbonate]]||April-16
|-
|[[Solu-Medrol]]||January-17
|-
|[[Toradol]]||March-09
|-
|[[TXA]]||October-20
|-
|[[Xopenex]]||April-16
|-
|[[Vasopressin]]||October-13
|-
|[[Valium]]||April-16
|-
|[[Versed]]||April-16
|-
|[[Zofran]]||April-16
|-
|[[Medication Infusion Tables]]||
|}

===Section 9 - Procedure Guidelines===
{| class="wikitable"
|-
! Section !! Description !! Revision Date
|-
|9.00||[[LUCAS Device]]||July-16
|-
|9.01||[[Pneupac VR1 Ventilator]]||March-09
|-
|9.02||[[Blood Alcohol Draw on Scene]]||March-09
|-
|9.03||[[Blood Draw using Vacutainer]]||March-09
|-
|9.04||[[Blood Glucose Test]]||March-09
|-
|9.05||[[Buretrol Usage]]||March-09
|-
|9.06||[[Cardiac Monitor]]||April-12
|-
|9.07||[[Cardioversion]]||March-09
|-
|9.08||[[Continuous Positive Airway Pressure Device]]||March-09
|-
|9.09||[[Cricothyrotomy Needle]]||March-09
|-
|9.10||[[Cricothyrotomy Surgical]]||March-09
|-
|9.11||[[Defibrillation]]||March-09
|-
|9.12||[[Defibrillation Pediatric]]||March-09
|-
|9.13||[[End Tidal CO2 Monitoring / Capnography]]||March-09
|-
|9.14.1||[[Intraosseous Infusion - Femoral]]||February-15
|-
|9.14.2||[[Intraosseous Infusion - Humeral Head]]||December-16
|-
|9.15||[[Intubation Endotracheal]]||March-09
|-
|9.16||[[Intubation Nasotracheal]]||March-09
|-
|9.17||[[Braun Syringe Infusion Pump]]||March-14
|-
|9.18||[[King Tube]]||March-09
|-
|9.19||[[Medication Administration Intramuscular]]||March-09
|-
|9.20||[[Medication Administration Nasal Atomizer]]||March-09
|-
|9.21||[[Medication Administration Nebulizer]]||March-09
|-
|9.22||[[Medication Administration Subcutaneous]]||March-09
|-
|9.23||[[Nasogastric/Orogastric Tube]]||March-09
|-
|9.24||[[Oxygen Administration]]||March-09
|-
|9.25||[[Peripheral IV Administration]]||March-09
|-
|9.26||[[Pleural Decompression]]||March-09
|-
|9.27||[[Removal of Taser Probes]]||March-09
|-
|9.28||[[Reconstitution of Medications]]||March-09
|-
|9.29||[[Transcutaneous Pacing Procedure]]||March-09
|-
|9.30||[[Emergency Escharotomy|Emergency Chest Wall Escharotomy]]||April-11
|-
|9.31||[[Central Venous Access Devices]]||June-12
|-
|9.32||[[Medication Administration Cross Check]]||Jun-12
|-
|9.33||[[Combat Application Tourniquet]]||Jan-14
|-
|9.34||[http://lifevest.zoll.com/medical-professionals/first-responder-resources Zoll LifeVest Wearable Defibrillator]||Dec-14
|-
|9.35||[[Medication Temperature Monitoring]]||Feb-19
|}

===Section 10 - References===
{| class="wikitable"
|-
! Section !! Description !! Revision Date
|-
|10.01||[[Abbreviations]]||March-09
|-
|10.02||[[Apgar Score]]||March-09
|-
|10.03||[[Glasgow Coma Score]]||March-09
|-
|10.04||[[Pediatric Vital Signs]]||March-09
|-
|10.05||[[Adult Trauma Alert Criteria]]||March-09
|-
|10.06||[[Pediatric Trauma Alert Criteria]]||March-09
|-
|10.07||[[Pediatric Trauma Score]]||March-09
|-
|10.08||[[Nitroglycerin Drip]]||March-09
|-
|10.09||[[Checking Range of Motion]]||March-09
|-
|10.10||[[Rules of Nine]]||March-09
|-
|10.11||[[Florida Statutes]]||March-09
|-
|10.12||[[Evaluation and Treatment Flow Chart]]||March-09
|-
|10.13||[[Spinal Injury Assessment Critical Criteria]]||March-09
|}

===Section 11 - Medical Director Memos===
{| class="wikitable sortable"
|-
! Subject !! Effective Date
|-
| [[Memo - Opening of Oviedo Medical Center|Opening of Oviedo Medical Center]] || 2017-01-29
|-
| [[Memo - Blood Draws - Florida Hospital|Blood Draws - Florida Hospital]] || 2017-01-25
|-
| [[Memo - Medical Alerts|Medical Alerts]] || 2016-04-27
|-
| [[Memo - Discontinuation of Central Venous Access|Discontinuation of Central Venous Access]] || 2013-08-03
|-
| [[Memo - Shortage of Atropine|Shortage of Atropine]] || 2013-04-11
|-
| [[Memo - EMS Blood Draws for SSCH|EMS Blood Draws for SSCH]] || 2013-03-07
|-
| [[Memo - Respiratory Breathing Treatments|Respiratory/Breathing Treatments]] || 2012-12-19
|-
| [[Memo - OB Transports|OB Transports]] || 2011-01-14
|-
| [[Memo - Aspirin Administration Documentation|Aspirin Administration Documentation]] || 2010-12-01
|-
| [[Memo - Alert Terminology|Alert Terminology]] || 2010-05-06
|}

Suspected Stroke Transient Ischemic Attack TIA

2025-10-29T18:16:33Z

Mfrdmanager: /* TRANSPORT DESTINATION (Determined ONLY by VAN Assessment Results) */

==Section 5 -MEDICAL==
===5.04 SUSPECTED STROKE/TRANSIENT ISCHEMIC ATTACK (T.I.A.)===

==== PRINCIPLES ====

*Rapidly identify patients with suspected stroke
*Minimize scene time & safe, expediate transport to the appropriate facility
*Continuous review and improvement on the stroke management process
*[[Initial Medical Assessment and Care|INITIAL MEDICAL CARE]] 2.01
*Differential Diagnosis
**[[Altered_Mental_Status_(AMS)|ALTERED MENTAL STATUS (AMS)]] 5.03
**[[Sepsis_Septic_Shock|SEPSIS]] 5.17
*Establish a definitive last known well (LKW) time
*Complete a Cincinnati Pre-Hospital Stroke Exam

==== BE FAST Exam ====

*BE FAST and VAN assessments can be performed simultaneously

{| class="wikitable"
|Balance
|Is the person suddenly having trouble with balance or coordination?
|-
|Eyes
|Is the person experiencing suddenly blurred or double vision or a sudden loss of vision in one or both eyes without pain?
|-
|Face
|Face numbness or weakness, especially one side
“Smile”
|-
|Arm
|Arm numbness or weakness, especially on one side of the body
“Arms out like Superman”
|-
|colspan="2"|(VAN Positive or Negative?)
|-
|Speech 
|Slurred speech or difficulty speaking or understanding
“You can’t teach an old dog new tricks”
|-
|colspan="2"|(VAN Aphasic? Consider VAN Visual Disturbance and Neglect!))
|-
|Time 
|Time since – Last seen normal/Last Known Well (LKW)
|}

*Perform Blood Glucose
*Complete Stroke Checklist
**Identify any t-PA exclusions and document all findings
**Leave copy at hospital
**Forward or Fax the duplicate Stroke Checklist to County EMS QA office
**A copy of the completed stroke checklist must also accompany the abbreviated report for the agency.
*Obtain IV Access
**An 18 gauge is preferable.
**Avoid multiple attempts and IO's
**Notify ER staff and document location of any missed IV’s.
**'''Be conscientious of numerous IV attempts due to possibility of Fibrinolytic therapy and subsequent bleeding from both successful and attempted IV sites.'''
*Perform blood draw of all tubes.
**The crew shall hold onto the tubes at the hospital until a staff member is ready to label the blood tubes.
**Document that blood was drawn.
*HYPERTENSION - Do not treat hypertension.
*Elevate the head of the stretcher 15-30 degrees if systolic BP >100 mm Hg
*Do not allow aspiration
*Maintain head and neck in neutral alignment, without flexing the neck
*Protect paralyzed limbs from injury
*Obtain 12-lead EKG
*Nausea/vomiting - administer an antiemetic
*Have Patient hold both arms up for 10 seconds
**Is arm weakness present?
***YES - continue VAN assessment 
***NO - Patient is VAN negative.

====VAN Assessment====
{| class="wikitable"
|Visual 
|'''IS VISION GAZED IN ONE DIRECTION? NEW ONSET BLINDNESS?'''
Test: Ask the person to look up, then down then left, then right. Or have them follow your finger in those directions.

Normal: No preferred gaze and eyes move past midline upon request.

Abnormal: Gaze is deviated to one side and does not pass the midline upon request or new onset blindness.
|-
|Aphasia 
|'''CAN THE PERSON SPEAK & UNDERSTAND LANGUAGE?'''
Test: Ask them to name an ordinary object such as a pen. Or ask them to make a fist

Normal: The patient can understand language and name ordinary objects.

Abnormal: Inability to understand or express speech or name ordinary objects, does not follow simple commands such as “close your eyes” or make a fist

Slurred speech alone does not indicate a positive VAN test

|-
|Neglect 
|'''IS THE PATIENT IGNORING ONE SIDEOF THE BODY (Usually the left side)?'''
Test: Ask the patient to close their eyes and tell them that you will touch each arm individually and then both at the same time. Ask them to acknowledge each touch.

Normal: Patient acknowledges both individual touches and simultaneous touch.

Abnormal: Patient does not acknowledge simultaneous touch usually ignoring the left side

If the patient does not acknowledge individual touches this does not indicate a positive VAN test.

|}

'''ARM DRIFT PLUS ONE OF THE ABOVE IS VAN POSITIVE'''

Cincinnati and VAN assessments often are performed simultaneously

====TRANSPORT DESTINATION (Determined ONLY by VAN Assessment Results)====

If patient exhibits symptoms, regardless of time frame, call in as STROKE ALERT 

Stroke receiving center can determine acuity and level of aggressive action.

Transporting EMERGENCY or NON-EMERGENCY is determined by the crew but a LKW of <48 hours should receive EMERGENCY transportation.

Use of air medical resources is appropriate when the window for evaluation for Intra-arterial therapy is less than 1-hour and ground transport exceeds 30 minutes.

{| class="wikitable"
|+DESTINATION SELECTION
|-
|colspan="2"|All suspected stroke and TIA patients must be transported to a stroke-receiving facility, unless the patient is UNSTABLE.
|-
|VAN Negative
|PRIMARY STROKE CENTER
|-
|VAN Positive
|COMPREHENSIVE STROKE CENTER
|-
|VAN NEGATIVE or POSITIVE and tPA EXCLUSIONS
|COMPREHENSIVE STROKE CENTER
|}

=====COMPREHENSIVE STROKE DESTINATIONS=====
*Evaluation of suspected Large Vessel Occlusion (LVO) -or-
*Have contraindications for IV therapy such as Coumadin therapy, recent surgery, treatment of bleeding ulcer, etc.
{| class="wikitable"
|Advent Health Orlando
|Comprehensive Stroke Care
|-
|Orlando Regional Medical Center
|Comprehensive Stroke Care
|}

=====PRIMARY STROKE DESTINATIONS=====
The following hospitals have been approved by the Medical Director
{| class="wikitable"
|Advent Health Altamonte
|Primary Stroke Care
|-
|Advent Health Apopka
|Primary Stroke Care
|-
|Advent Health East
|Primary Stroke Care
|-
|Advent Health Orlando
|Comprehensive Stroke Care
|-
|HCA Lake Monroe
|Primary Stroke Care
|-
|Orlando Regional Medical Center
|Comprehensive Stroke Care
|-
|Oviedo Medical Center
|Primary Stroke Care
|-
|South Seminole Community Hospital
|Primary Stroke Care
|-
|Winter Park Memorial Hospital
|Primary Stroke Care
|}

Maitland Fire Rescue Department Practice Parameters

2025-10-29T18:13:35Z

Mfrdmanager: /* Section 8 - Medication Guidelines */

__NOTOC__
==TABLE OF CONTENTS==

[[Medical Director Authorization]]

===Section 1 - Administrative Policies===

{| class="wikitable"
|-
! Section !! Description !! Revision Date
|-
| 1.01 || [[General Measures]] || April-16
|-
| 1.02 || [[Radio Report Format]] || March-16
|-
| 1.03 || [[Refusal of Service]] || October-17
|-
| 1.04 || [[Physician or Nurse on Scene]] || March-09
|-
| 1.05 || [[Initiation of CPR and Determination of Death]] || July-16
|-
| 1.06|| [[Determination of Death in Trauma]]|| March-09
|-
| 1.07|| [[Crime or Unattended Death Scene]] || March-09
|-
| 1.08|| [[Medical Evaluation of Person in Police Custody]]|| March-09
|-
| 1.09|| [[Trauma Transport Protocol]]|| Dec-19
|-
| 1.10|| [[Emergency Transport]]|| March-09
|-
| 1.11|| [[Criteria for Helicopter Transport]]|| March-09
|-
| 1.12|| [[Medical Patient Transport Decision]]|| April-14
|-
| 1.13|| [[Obstetrical Patient Transport Decision]]|| Feb-15
|-
| 1.14|| [[Emergency Inter Facility Transport]]|| March-09
|-
| 1.15|| [[EMS Disaster Response Level]]|| March-09
|-
| 1.16|| [[EMS Offload Policy]]|| March-09
|-
| 1.17|| [[EMS Quality Improvement Program]]|| March-09
|-
| 1.18|| [[Scope of Practice]]|| March-09
|-
| 1.19|| [[Freestanding ED Transport Criteria]]|| October-13
|-
| 1.20|| [[Hospital Capability Chart]]|| May-18
|-
| 1.21|| [[Documentation Guidance]]|| June-17
|}

===Section 2 - Primary Care===

{| class="wikitable"
|-
! Section !! Description !! Revision Date
|-
| 2.01 ||[[Initial Medical Assessment and Care]]||March-09
|-
|2.02 ||[[Initial Trauma Assessment and Care]]||September-17
|-
||2.03 ||[[Rapid Trauma Assessment, Focused History and Physical Exam]]||Sept-15
|-
||2.04||[[Analgesia and Sedation]]||November-2017
|-
||2.05||[[Drug Assisted Intubation]]||December-2016
|}

===Section 3 - Respiratory===

{| class="wikitable"
|-
! Section !! Description !! Revision Date
|-
| 3.01|| [[Acute Asthma or COPD with Wheezing]]|| February-19
|-
| 3.02|| [[Carbon Monoxide Inhalation]]|| March-09
|-
| 3.03|| [[Foreign Body Airway Obstruction]]|| March-09
|-
| 3.04|| [[Infectious Upper Airway Obstruction - Croup or Epiglottitis]]|| April-16
|-
| 3.05|| [[Severe Respiratory Pathogens]]|| November-10
|-
| 3.06|| [[Anxiety / Hyperventilation]]|| February-11
|}

===Section 4 - Cardiac===
{| class="wikitable"
|-
! Section !! Description !! Revision Date
|-
|4.01 || [[Chest Pain Acute Coronary Syndrome]]||Sept-17
|-
|4.02 || [[Asystole]]||April-16
|-
|4.03 || [[Atrial Fibrillation Atrial Flutter]]||June-17
|-
|4.04||[[Pulseless Electrical Activity (PEA)]]||January-16
|-
|4.05||[[Premature Ventricular Contractions (PVC)]]||May-12
|-
|4.06||[[Supraventricular Bradycardia and AV Blocks]]||March-09
|-
|4.07||[[Supraventricular Tachycardia]]||April-12
|-
|4.08||[[Ventricular Fibrillation Pulseless Ventricular Tachycardia]]||December-16
|-
|4.09||[[Ventricular Tachycardia with a Palpable Pulse]]||July-12
|-
|4.10||[[Wide Complex Tachycardia Uncertain Origin]]||May-12
|-
|4.11||[[Acute Cardiogenic Pulmonary Edema Pneumonia]]||March-09
|-
|4.12||[[Code Cool Post ROSC Induced Hypothermia]]||March-09
|-
|4.13||[[Adult Immediate Post-Cardiac Arrest Care]]||April-12
|-
|4.14||[[Ventricular Assist Devices]]||August-18
|}

===Section 5 - Medical===

{| class="wikitable"
|-
! Section !! Description !! Revision Date
|-
|5.01||[[Acute Abdominal Pain]]||April-16
|-
|5.02||[[Allergic Reaction Anaphylactic Shock]]||April-16
|-
|5.03||[[Altered Mental Status (AMS)]]||April-17
|-
|5.04||[[Suspected Stroke Transient Ischemic Attack TIA|Suspected Stroke or Transient Ischemic Attack]]||May-18
|-
|5.05||[[Drug Overdose Poisoning]]||March-09
|-
|5.06||[[Cold Emergencies]]||April-12
|-
|5.07||[[Heat Emergencies]]||August-15
|-
|5.08||[[Hazardous Materials]]||March-09
|-
|5.09||[[Severe Hypertension]]||March-09
|-
|5.10||[[Hypo or Hyperglycemia]]||April-16
|-
|5.11||[[Psychological Behavioral Emergencies]]||March-09
|-
|5.12||[[Seizure]]||April-16
|-
|5.13||[[Shock]]||March-09
|-
|5.14||[[Sickle Cell Anemia Crisis]]||March-09
|-
|5.15||[[Syncope]]||March-09
|-
|5.16||[[Vertigo]]||March-09
|-
|5.17||[[Sepsis Septic Shock]]||September-17
|-
|5.18||[[Suspected Kidney Stone]]||April-16
|-
|5.19||[[Cyanide Poisoning]]||April-16
|-
|5.20||[[Excited Delirium or Drug Induced Agitation]]||November-17
|-
|5.21||[[Ebola Virus Disease Patient Management]]||October-14
|-
|5.22||[[Acute Adrenal Insufficiency]]||June-18
|}

===Section 6 - Trauma===
{| class="wikitable"
|-
! Section !! Description !! Revision Date
|-
|6.01||[[Animal Bites Stings]]||March-09
|-
|6.02||[[Burns - Thermal, Electrical, Chemical]]||March-09
|-
|6.03||[[Selective Spinal Immobilization]]||August-14
|-
|6.04||[[Chest Injuries]]||March-09
|-
|6.05||[[Decompression Sickness or Dysbarism]]||March-09
|-
|6.06||[[Extremity Injuries]]||Feb-15
|-
|6.07||[[Head Injuries]]||November-17
|-
|6.08||[[Near Drowning]]||March-09
|-
|6.09||[[Ophthalmic Injuries]]||March-09
|-
|6.10||[[Suspected Abuse Neglect]]||March-09
|-
|6.11||[[Suspected Sexual Assault]]||March-09
|-
|6.12||[[Trunk Penetrating Injuries]]||April-12
|-
|6.13||[[Hemorrhagic Shock]]||October-18
|}

===Section 7 - Pediatric and Obstetrical===
{| class="wikitable"
|-
! Section !! Description !! Revision Date
|-
|7.01||[[Pediatric Asystole]]||April-16
|-
|7.02||[[Pediatric Pulseless Electrical Activity PEA]]||April-16
|-
|7.03||[[Pediatric Tachycardia, Ventricular Fibrillation or Pulseless Ventricular Tachycardia]]||April-16
|-
|7.04||[[Pregnancy Induced Hypertension (PIH)]]||March-09
|-
|7.05||[[Preterm Labor]]||November-17
|-
|7.06||[[Emergency Childbirth]]||November-17
|-
|7.07||[[Childbirth Complications]]||November-17
|-
|7.08||[[Newborn Care]]||April-16
|-
|7.09||[[Post Partum Care]]||November-17
|-
|7.10||[[Pediatric Febrile Emergency]]||April-16
|-
|7.11||[[Vaginal Bleeding]]||March-09
|-
|7.12||[[Trauma In Pregnancy]]||March-09
|}

===Section 8 - Medication Guidelines===
INTRODUCTION
The following pages contain guidelines for the medications commonly encountered by the Paramedic. They identify the name and class of the drug, a short description, indications, contraindications, precautions, and dosages. This is only a guideline to medication administration and shall not circumvent the need to refer to the appropriate Standing Order or to contact Medical Control for orders and consultation. For detailed and extensive information on each drug, refer to the Physician's Desk Reference, the Advanced Cardiac Life Support text or an emergency pre-hospital pharmacology reference.

Certain medications listed have various dosages depending on the patient's condition. Refer to the appropriate Standing Order or contact Medical Control for specific dosage information. All IV piggyback medications must be placed on a micro-gtt. solution set for field administration and if available, an infusion pump or infusion regulator MUST BE UTILIZED.

The following medications are authorized to be administered by Maitland Fire Rescue EMS:

{| class="wikitable"
|-
! Medication Name!! Revision Date
|-
|[[Acetaminophen]]||March-09
|-
|[[Adenosine]]||January-20
|-
|[[Albuterol]]||April-16
|-
|[[Aspirin]]||March-09
|-
|[[Ativan]]||April-16
|-
|[[Atropine]]||July-17
|-
|[[Atrovent]]||April-16
|-
|[[Calcium Chloride]]||April-16
|-
|[[Cardizem]]||July-17
|-
|[[Cyanokit]]||April-16
|-
|[[Dextrose 10%]]||April-16
|-
|[[Dextrose 50%]]||April-16
|-
|[[Diphenhydramine]]||April-16
|-
|[[Dopamine]]||April-16
|-
|[[Epinephrine]]||April-16
|-
|[[Etomidate]]||April-16
|-
|[[Fentanyl]]||November-16
|-
|[[Flumazenil]]||April-16
|-
|[[Glucagon]]||April-16
|-
|[[Ketamine]]||November-17
|-
|[[Lasix]]||April-16
|-
|[[Lidocaine]]||July-17
|-
|[[Magnesium Sulfate]]||November-25
|-
|[[Morphine Sulfate]]||November-16
|-
|[[Naloxone]]||April-16
|-
|[[Nitro Drip]]||April-17
|-
|[[Nitro Spray]]||April-17
|-
|[[Nitro Tablets]]||April-17
|-
|[[Nitrous Oxide]]||November-16
|-
|[[Oxygen]]||March-09
|-
|[[Pepcid]]||April-16
|-
|[[Pontocaine]]||November-17
|-
|[[Promethazine]]||April-16
|-
|[[Racemic Epinephrine]]||April-16
|-
|[[Sodium Bicarbonate]]||April-16
|-
|[[Solu-Medrol]]||January-17
|-
|[[Toradol]]||March-09
|-
|[[TXA]]||October-20
|-
|[[Xopenex]]||April-16
|-
|[[Vasopressin]]||October-13
|-
|[[Valium]]||April-16
|-
|[[Versed]]||April-16
|-
|[[Zofran]]||April-16
|-
|[[Medication Infusion Tables]]||
|}

===Section 9 - Procedure Guidelines===
{| class="wikitable"
|-
! Section !! Description !! Revision Date
|-
|9.00||[[LUCAS Device]]||July-16
|-
|9.01||[[Pneupac VR1 Ventilator]]||March-09
|-
|9.02||[[Blood Alcohol Draw on Scene]]||March-09
|-
|9.03||[[Blood Draw using Vacutainer]]||March-09
|-
|9.04||[[Blood Glucose Test]]||March-09
|-
|9.05||[[Buretrol Usage]]||March-09
|-
|9.06||[[Cardiac Monitor]]||April-12
|-
|9.07||[[Cardioversion]]||March-09
|-
|9.08||[[Continuous Positive Airway Pressure Device]]||March-09
|-
|9.09||[[Cricothyrotomy Needle]]||March-09
|-
|9.10||[[Cricothyrotomy Surgical]]||March-09
|-
|9.11||[[Defibrillation]]||March-09
|-
|9.12||[[Defibrillation Pediatric]]||March-09
|-
|9.13||[[End Tidal CO2 Monitoring / Capnography]]||March-09
|-
|9.14.1||[[Intraosseous Infusion - Femoral]]||February-15
|-
|9.14.2||[[Intraosseous Infusion - Humeral Head]]||December-16
|-
|9.15||[[Intubation Endotracheal]]||March-09
|-
|9.16||[[Intubation Nasotracheal]]||March-09
|-
|9.17||[[Braun Syringe Infusion Pump]]||March-14
|-
|9.18||[[King Tube]]||March-09
|-
|9.19||[[Medication Administration Intramuscular]]||March-09
|-
|9.20||[[Medication Administration Nasal Atomizer]]||March-09
|-
|9.21||[[Medication Administration Nebulizer]]||March-09
|-
|9.22||[[Medication Administration Subcutaneous]]||March-09
|-
|9.23||[[Nasogastric/Orogastric Tube]]||March-09
|-
|9.24||[[Oxygen Administration]]||March-09
|-
|9.25||[[Peripheral IV Administration]]||March-09
|-
|9.26||[[Pleural Decompression]]||March-09
|-
|9.27||[[Removal of Taser Probes]]||March-09
|-
|9.28||[[Reconstitution of Medications]]||March-09
|-
|9.29||[[Transcutaneous Pacing Procedure]]||March-09
|-
|9.30||[[Emergency Escharotomy|Emergency Chest Wall Escharotomy]]||April-11
|-
|9.31||[[Central Venous Access Devices]]||June-12
|-
|9.32||[[Medication Administration Cross Check]]||Jun-12
|-
|9.33||[[Combat Application Tourniquet]]||Jan-14
|-
|9.34||[http://lifevest.zoll.com/medical-professionals/first-responder-resources Zoll LifeVest Wearable Defibrillator]||Dec-14
|-
|9.35||[[Medication Temperature Monitoring]]||Feb-19
|}

===Section 10 - References===
{| class="wikitable"
|-
! Section !! Description !! Revision Date
|-
|10.01||[[Abbreviations]]||March-09
|-
|10.02||[[Apgar Score]]||March-09
|-
|10.03||[[Glasgow Coma Score]]||March-09
|-
|10.04||[[Pediatric Vital Signs]]||March-09
|-
|10.05||[[Adult Trauma Alert Criteria]]||March-09
|-
|10.06||[[Pediatric Trauma Alert Criteria]]||March-09
|-
|10.07||[[Pediatric Trauma Score]]||March-09
|-
|10.08||[[Nitroglycerin Drip]]||March-09
|-
|10.09||[[Checking Range of Motion]]||March-09
|-
|10.10||[[Rules of Nine]]||March-09
|-
|10.11||[[Florida Statutes]]||March-09
|-
|10.12||[[Evaluation and Treatment Flow Chart]]||March-09
|-
|10.13||[[Spinal Injury Assessment Critical Criteria]]||March-09
|}

===Section 11 - Medical Director Memos===
{| class="wikitable sortable"
|-
! Subject !! Effective Date
|-
| [[Memo - Opening of Oviedo Medical Center|Opening of Oviedo Medical Center]] || 2017-01-29
|-
| [[Memo - Blood Draws - Florida Hospital|Blood Draws - Florida Hospital]] || 2017-01-25
|-
| [[Memo - Medical Alerts|Medical Alerts]] || 2016-04-27
|-
| [[Memo - Discontinuation of Central Venous Access|Discontinuation of Central Venous Access]] || 2013-08-03
|-
| [[Memo - Shortage of Atropine|Shortage of Atropine]] || 2013-04-11
|-
| [[Memo - EMS Blood Draws for SSCH|EMS Blood Draws for SSCH]] || 2013-03-07
|-
| [[Memo - Respiratory Breathing Treatments|Respiratory/Breathing Treatments]] || 2012-12-19
|-
| [[Memo - OB Transports|OB Transports]] || 2011-01-14
|-
| [[Memo - Aspirin Administration Documentation|Aspirin Administration Documentation]] || 2010-12-01
|-
| [[Memo - Alert Terminology|Alert Terminology]] || 2010-05-06
|}

Maitland Fire Rescue Department Practice Parameters

2025-10-29T18:13:10Z

Mfrdmanager: /* Section 8 - Medication Guidelines */

__NOTOC__
==TABLE OF CONTENTS==

[[Medical Director Authorization]]

===Section 1 - Administrative Policies===

{| class="wikitable"
|-
! Section !! Description !! Revision Date
|-
| 1.01 || [[General Measures]] || April-16
|-
| 1.02 || [[Radio Report Format]] || March-16
|-
| 1.03 || [[Refusal of Service]] || October-17
|-
| 1.04 || [[Physician or Nurse on Scene]] || March-09
|-
| 1.05 || [[Initiation of CPR and Determination of Death]] || July-16
|-
| 1.06|| [[Determination of Death in Trauma]]|| March-09
|-
| 1.07|| [[Crime or Unattended Death Scene]] || March-09
|-
| 1.08|| [[Medical Evaluation of Person in Police Custody]]|| March-09
|-
| 1.09|| [[Trauma Transport Protocol]]|| Dec-19
|-
| 1.10|| [[Emergency Transport]]|| March-09
|-
| 1.11|| [[Criteria for Helicopter Transport]]|| March-09
|-
| 1.12|| [[Medical Patient Transport Decision]]|| April-14
|-
| 1.13|| [[Obstetrical Patient Transport Decision]]|| Feb-15
|-
| 1.14|| [[Emergency Inter Facility Transport]]|| March-09
|-
| 1.15|| [[EMS Disaster Response Level]]|| March-09
|-
| 1.16|| [[EMS Offload Policy]]|| March-09
|-
| 1.17|| [[EMS Quality Improvement Program]]|| March-09
|-
| 1.18|| [[Scope of Practice]]|| March-09
|-
| 1.19|| [[Freestanding ED Transport Criteria]]|| October-13
|-
| 1.20|| [[Hospital Capability Chart]]|| May-18
|-
| 1.21|| [[Documentation Guidance]]|| June-17
|}

===Section 2 - Primary Care===

{| class="wikitable"
|-
! Section !! Description !! Revision Date
|-
| 2.01 ||[[Initial Medical Assessment and Care]]||March-09
|-
|2.02 ||[[Initial Trauma Assessment and Care]]||September-17
|-
||2.03 ||[[Rapid Trauma Assessment, Focused History and Physical Exam]]||Sept-15
|-
||2.04||[[Analgesia and Sedation]]||November-2017
|-
||2.05||[[Drug Assisted Intubation]]||December-2016
|}

===Section 3 - Respiratory===

{| class="wikitable"
|-
! Section !! Description !! Revision Date
|-
| 3.01|| [[Acute Asthma or COPD with Wheezing]]|| February-19
|-
| 3.02|| [[Carbon Monoxide Inhalation]]|| March-09
|-
| 3.03|| [[Foreign Body Airway Obstruction]]|| March-09
|-
| 3.04|| [[Infectious Upper Airway Obstruction - Croup or Epiglottitis]]|| April-16
|-
| 3.05|| [[Severe Respiratory Pathogens]]|| November-10
|-
| 3.06|| [[Anxiety / Hyperventilation]]|| February-11
|}

===Section 4 - Cardiac===
{| class="wikitable"
|-
! Section !! Description !! Revision Date
|-
|4.01 || [[Chest Pain Acute Coronary Syndrome]]||Sept-17
|-
|4.02 || [[Asystole]]||April-16
|-
|4.03 || [[Atrial Fibrillation Atrial Flutter]]||June-17
|-
|4.04||[[Pulseless Electrical Activity (PEA)]]||January-16
|-
|4.05||[[Premature Ventricular Contractions (PVC)]]||May-12
|-
|4.06||[[Supraventricular Bradycardia and AV Blocks]]||March-09
|-
|4.07||[[Supraventricular Tachycardia]]||April-12
|-
|4.08||[[Ventricular Fibrillation Pulseless Ventricular Tachycardia]]||December-16
|-
|4.09||[[Ventricular Tachycardia with a Palpable Pulse]]||July-12
|-
|4.10||[[Wide Complex Tachycardia Uncertain Origin]]||May-12
|-
|4.11||[[Acute Cardiogenic Pulmonary Edema Pneumonia]]||March-09
|-
|4.12||[[Code Cool Post ROSC Induced Hypothermia]]||March-09
|-
|4.13||[[Adult Immediate Post-Cardiac Arrest Care]]||April-12
|-
|4.14||[[Ventricular Assist Devices]]||August-18
|}

===Section 5 - Medical===

{| class="wikitable"
|-
! Section !! Description !! Revision Date
|-
|5.01||[[Acute Abdominal Pain]]||April-16
|-
|5.02||[[Allergic Reaction Anaphylactic Shock]]||April-16
|-
|5.03||[[Altered Mental Status (AMS)]]||April-17
|-
|5.04||[[Suspected Stroke Transient Ischemic Attack TIA|Suspected Stroke or Transient Ischemic Attack]]||May-18
|-
|5.05||[[Drug Overdose Poisoning]]||March-09
|-
|5.06||[[Cold Emergencies]]||April-12
|-
|5.07||[[Heat Emergencies]]||August-15
|-
|5.08||[[Hazardous Materials]]||March-09
|-
|5.09||[[Severe Hypertension]]||March-09
|-
|5.10||[[Hypo or Hyperglycemia]]||April-16
|-
|5.11||[[Psychological Behavioral Emergencies]]||March-09
|-
|5.12||[[Seizure]]||April-16
|-
|5.13||[[Shock]]||March-09
|-
|5.14||[[Sickle Cell Anemia Crisis]]||March-09
|-
|5.15||[[Syncope]]||March-09
|-
|5.16||[[Vertigo]]||March-09
|-
|5.17||[[Sepsis Septic Shock]]||September-17
|-
|5.18||[[Suspected Kidney Stone]]||April-16
|-
|5.19||[[Cyanide Poisoning]]||April-16
|-
|5.20||[[Excited Delirium or Drug Induced Agitation]]||November-17
|-
|5.21||[[Ebola Virus Disease Patient Management]]||October-14
|-
|5.22||[[Acute Adrenal Insufficiency]]||June-18
|}

===Section 6 - Trauma===
{| class="wikitable"
|-
! Section !! Description !! Revision Date
|-
|6.01||[[Animal Bites Stings]]||March-09
|-
|6.02||[[Burns - Thermal, Electrical, Chemical]]||March-09
|-
|6.03||[[Selective Spinal Immobilization]]||August-14
|-
|6.04||[[Chest Injuries]]||March-09
|-
|6.05||[[Decompression Sickness or Dysbarism]]||March-09
|-
|6.06||[[Extremity Injuries]]||Feb-15
|-
|6.07||[[Head Injuries]]||November-17
|-
|6.08||[[Near Drowning]]||March-09
|-
|6.09||[[Ophthalmic Injuries]]||March-09
|-
|6.10||[[Suspected Abuse Neglect]]||March-09
|-
|6.11||[[Suspected Sexual Assault]]||March-09
|-
|6.12||[[Trunk Penetrating Injuries]]||April-12
|-
|6.13||[[Hemorrhagic Shock]]||October-18
|}

===Section 7 - Pediatric and Obstetrical===
{| class="wikitable"
|-
! Section !! Description !! Revision Date
|-
|7.01||[[Pediatric Asystole]]||April-16
|-
|7.02||[[Pediatric Pulseless Electrical Activity PEA]]||April-16
|-
|7.03||[[Pediatric Tachycardia, Ventricular Fibrillation or Pulseless Ventricular Tachycardia]]||April-16
|-
|7.04||[[Pregnancy Induced Hypertension (PIH)]]||March-09
|-
|7.05||[[Preterm Labor]]||November-17
|-
|7.06||[[Emergency Childbirth]]||November-17
|-
|7.07||[[Childbirth Complications]]||November-17
|-
|7.08||[[Newborn Care]]||April-16
|-
|7.09||[[Post Partum Care]]||November-17
|-
|7.10||[[Pediatric Febrile Emergency]]||April-16
|-
|7.11||[[Vaginal Bleeding]]||March-09
|-
|7.12||[[Trauma In Pregnancy]]||March-09
|}

===Section 8 - Medication Guidelines===
INTRODUCTION
The following pages contain guidelines for the medications commonly encountered by the Paramedic. They identify the name and class of the drug, a short description, indications, contraindications, precautions, and dosages. This is only a guideline to medication administration and shall not circumvent the need to refer to the appropriate Standing Order or to contact Medical Control for orders and consultation. For detailed and extensive information on each drug, refer to the Physician's Desk Reference, the Advanced Cardiac Life Support text or an emergency pre-hospital pharmacology reference.

Certain medications listed have various dosages depending on the patient's condition. Refer to the appropriate Standing Order or contact Medical Control for specific dosage information. All IV piggyback medications must be placed on a micro-gtt. solution set for field administration and if available, an infusion pump or infusion regulator MUST BE UTILIZED.

The following medications are authorized to be administered by Maitland Fire Rescue EMS:

{| class="wikitable"
|-
! Medication Name!! Revision Date
|-
|[[Acetaminophen]]||March-09
|-
|[[Adenosine]]||January-20
|-
|[[Albuterol]]||April-16
|-
|[[Aspirin]]||March-09
|-
|[[Ativan]]||April-16
|-
|[[Atropine]]||July-17
|-
|[[Atrovent]]||April-16
|-
|[[Calcium Chloride]]||April-16
|-
|[[Cardizem]]||July-17
|-
|[[Cyanokit]]||April-16
|-
|[[Dextrose 10%]]||April-16
|-
|[[Dextrose 50%]]||April-16
|-
|[[Diphenhydramine]]||April-16
|-
|[[Dopamine]]||April-16
|-
|[[Epinephrine]]||April-16
|-
|[[Etomidate]]||April-16
|-
|[[Fentanyl]]||November-16
|-
|[[Flumazenil]]||April-16
|-
|[[Glucagon]]||April-16
|-
|[[Ketamine]]||November-17
|-
|[[Lasix]]||April-16
|-
|[[Lidocaine]]||July-17
|-
|[[Magnesium Sulfate]]||Nov-25
|-
|[[Morphine Sulfate]]||November-16
|-
|[[Naloxone]]||April-16
|-
|[[Nitro Drip]]||April-17
|-
|[[Nitro Spray]]||April-17
|-
|[[Nitro Tablets]]||April-17
|-
|[[Nitrous Oxide]]||November-16
|-
|[[Oxygen]]||March-09
|-
|[[Pepcid]]||April-16
|-
|[[Pontocaine]]||November-17
|-
|[[Promethazine]]||April-16
|-
|[[Racemic Epinephrine]]||April-16
|-
|[[Sodium Bicarbonate]]||April-16
|-
|[[Solu-Medrol]]||January-17
|-
|[[Toradol]]||March-09
|-
|[[TXA]]||October-20
|-
|[[Xopenex]]||April-16
|-
|[[Vasopressin]]||October-13
|-
|[[Valium]]||April-16
|-
|[[Versed]]||April-16
|-
|[[Zofran]]||April-16
|-
|[[Medication Infusion Tables]]||
|}

===Section 9 - Procedure Guidelines===
{| class="wikitable"
|-
! Section !! Description !! Revision Date
|-
|9.00||[[LUCAS Device]]||July-16
|-
|9.01||[[Pneupac VR1 Ventilator]]||March-09
|-
|9.02||[[Blood Alcohol Draw on Scene]]||March-09
|-
|9.03||[[Blood Draw using Vacutainer]]||March-09
|-
|9.04||[[Blood Glucose Test]]||March-09
|-
|9.05||[[Buretrol Usage]]||March-09
|-
|9.06||[[Cardiac Monitor]]||April-12
|-
|9.07||[[Cardioversion]]||March-09
|-
|9.08||[[Continuous Positive Airway Pressure Device]]||March-09
|-
|9.09||[[Cricothyrotomy Needle]]||March-09
|-
|9.10||[[Cricothyrotomy Surgical]]||March-09
|-
|9.11||[[Defibrillation]]||March-09
|-
|9.12||[[Defibrillation Pediatric]]||March-09
|-
|9.13||[[End Tidal CO2 Monitoring / Capnography]]||March-09
|-
|9.14.1||[[Intraosseous Infusion - Femoral]]||February-15
|-
|9.14.2||[[Intraosseous Infusion - Humeral Head]]||December-16
|-
|9.15||[[Intubation Endotracheal]]||March-09
|-
|9.16||[[Intubation Nasotracheal]]||March-09
|-
|9.17||[[Braun Syringe Infusion Pump]]||March-14
|-
|9.18||[[King Tube]]||March-09
|-
|9.19||[[Medication Administration Intramuscular]]||March-09
|-
|9.20||[[Medication Administration Nasal Atomizer]]||March-09
|-
|9.21||[[Medication Administration Nebulizer]]||March-09
|-
|9.22||[[Medication Administration Subcutaneous]]||March-09
|-
|9.23||[[Nasogastric/Orogastric Tube]]||March-09
|-
|9.24||[[Oxygen Administration]]||March-09
|-
|9.25||[[Peripheral IV Administration]]||March-09
|-
|9.26||[[Pleural Decompression]]||March-09
|-
|9.27||[[Removal of Taser Probes]]||March-09
|-
|9.28||[[Reconstitution of Medications]]||March-09
|-
|9.29||[[Transcutaneous Pacing Procedure]]||March-09
|-
|9.30||[[Emergency Escharotomy|Emergency Chest Wall Escharotomy]]||April-11
|-
|9.31||[[Central Venous Access Devices]]||June-12
|-
|9.32||[[Medication Administration Cross Check]]||Jun-12
|-
|9.33||[[Combat Application Tourniquet]]||Jan-14
|-
|9.34||[http://lifevest.zoll.com/medical-professionals/first-responder-resources Zoll LifeVest Wearable Defibrillator]||Dec-14
|-
|9.35||[[Medication Temperature Monitoring]]||Feb-19
|}

===Section 10 - References===
{| class="wikitable"
|-
! Section !! Description !! Revision Date
|-
|10.01||[[Abbreviations]]||March-09
|-
|10.02||[[Apgar Score]]||March-09
|-
|10.03||[[Glasgow Coma Score]]||March-09
|-
|10.04||[[Pediatric Vital Signs]]||March-09
|-
|10.05||[[Adult Trauma Alert Criteria]]||March-09
|-
|10.06||[[Pediatric Trauma Alert Criteria]]||March-09
|-
|10.07||[[Pediatric Trauma Score]]||March-09
|-
|10.08||[[Nitroglycerin Drip]]||March-09
|-
|10.09||[[Checking Range of Motion]]||March-09
|-
|10.10||[[Rules of Nine]]||March-09
|-
|10.11||[[Florida Statutes]]||March-09
|-
|10.12||[[Evaluation and Treatment Flow Chart]]||March-09
|-
|10.13||[[Spinal Injury Assessment Critical Criteria]]||March-09
|}

===Section 11 - Medical Director Memos===
{| class="wikitable sortable"
|-
! Subject !! Effective Date
|-
| [[Memo - Opening of Oviedo Medical Center|Opening of Oviedo Medical Center]] || 2017-01-29
|-
| [[Memo - Blood Draws - Florida Hospital|Blood Draws - Florida Hospital]] || 2017-01-25
|-
| [[Memo - Medical Alerts|Medical Alerts]] || 2016-04-27
|-
| [[Memo - Discontinuation of Central Venous Access|Discontinuation of Central Venous Access]] || 2013-08-03
|-
| [[Memo - Shortage of Atropine|Shortage of Atropine]] || 2013-04-11
|-
| [[Memo - EMS Blood Draws for SSCH|EMS Blood Draws for SSCH]] || 2013-03-07
|-
| [[Memo - Respiratory Breathing Treatments|Respiratory/Breathing Treatments]] || 2012-12-19
|-
| [[Memo - OB Transports|OB Transports]] || 2011-01-14
|-
| [[Memo - Aspirin Administration Documentation|Aspirin Administration Documentation]] || 2010-12-01
|-
| [[Memo - Alert Terminology|Alert Terminology]] || 2010-05-06
|}

Magnesium Sulfate

2025-10-29T18:12:35Z

Mfrdmanager:

==Section 8 - MEDICATION GUIDELINES==
===ELECTROLYTES===

====Magnesium Sulfate====
'''DESCRIPTION'''
* It is an anticonvulsant, especially effective in the control of seizures associated with eclampsia.
'''INDICATIONS'''
* Seizures due to [[Pregnancy Induced Hypertension (PIH)|eclampsia]] (toxemia of pregnancy)
'''CONTRAINDICATIONS'''
* Patients with heart block or recent myocardial infarction.
'''PRECAUTIONS'''
* May cause hypotension, circulatory collapse, or cardiac and respiratory depression. Calcium Chloride should be available to counteract the untoward effects of Magnesium.
'''DOSAGE'''
* Refer to appropriate PRACTICE PARAMETER for specific dosages.
* Refer to Handtevy System infusion instructions for dosage.

[[Category:Medication Guidelines|Magnesium Sulfate]]

Suspected Stroke Transient Ischemic Attack TIA

2023-04-13T18:25:51Z

Mfrdmanager: Created page with "==Section 5 -MEDICAL== ===5.04 SUSPECTED STROKE/TRANSIENT ISCHEMIC ATTACK (T.I.A.)=== ==== PRINCIPLES ==== *Rapidly identify patients with suspected stroke *Minimize scen..."

==Section 5 -MEDICAL==
===5.04 SUSPECTED STROKE/TRANSIENT ISCHEMIC ATTACK (T.I.A.)===

==== PRINCIPLES ====

*Rapidly identify patients with suspected stroke
*Minimize scene time & safe, expediate transport to the appropriate facility
*Continuous review and improvement on the stroke management process
*[[Initial Medical Assessment and Care|INITIAL MEDICAL CARE]] 2.01
*Differential Diagnosis
**[[Altered_Mental_Status_(AMS)|ALTERED MENTAL STATUS (AMS)]] 5.03
**[[Sepsis_Septic_Shock|SEPSIS]] 5.17
*Establish a definitive last known well (LKW) time
*Complete a Cincinnati Pre-Hospital Stroke Exam

==== BE FAST Exam ====

*BE FAST and VAN assessments can be performed simultaneously

{| class="wikitable"
|Balance
|Is the person suddenly having trouble with balance or coordination?
|-
|Eyes
|Is the person experiencing suddenly blurred or double vision or a sudden loss of vision in one or both eyes without pain?
|-
|Face
|Face numbness or weakness, especially one side
“Smile”
|-
|Arm
|Arm numbness or weakness, especially on one side of the body
“Arms out like Superman”
|-
|colspan="2"|(VAN Positive or Negative?)
|-
|Speech 
|Slurred speech or difficulty speaking or understanding
“You can’t teach an old dog new tricks”
|-
|colspan="2"|(VAN Aphasic? Consider VAN Visual Disturbance and Neglect!))
|-
|Time 
|Time since – Last seen normal/Last Known Well (LKW)
|}

*Perform Blood Glucose
*Complete Stroke Checklist
**Identify any t-PA exclusions and document all findings
**Leave copy at hospital
**Forward or Fax the duplicate Stroke Checklist to County EMS QA office
**A copy of the completed stroke checklist must also accompany the abbreviated report for the agency.
*Obtain IV Access
**An 18 gauge is preferable.
**Avoid multiple attempts and IO's
**Notify ER staff and document location of any missed IV’s.
**'''Be conscientious of numerous IV attempts due to possibility of Fibrinolytic therapy and subsequent bleeding from both successful and attempted IV sites.'''
*Perform blood draw of all tubes.
**The crew shall hold onto the tubes at the hospital until a staff member is ready to label the blood tubes.
**Document that blood was drawn.
*HYPERTENSION - Do not treat hypertension.
*Elevate the head of the stretcher 15-30 degrees if systolic BP >100 mm Hg
*Do not allow aspiration
*Maintain head and neck in neutral alignment, without flexing the neck
*Protect paralyzed limbs from injury
*Obtain 12-lead EKG
*Nausea/vomiting - administer an antiemetic
*Have Patient hold both arms up for 10 seconds
**Is arm weakness present?
***YES - continue VAN assessment 
***NO - Patient is VAN negative.

====VAN Assessment====
{| class="wikitable"
|Visual 
|'''IS VISION GAZED IN ONE DIRECTION? NEW ONSET BLINDNESS?'''
Test: Ask the person to look up, then down then left, then right. Or have them follow your finger in those directions.

Normal: No preferred gaze and eyes move past midline upon request.

Abnormal: Gaze is deviated to one side and does not pass the midline upon request or new onset blindness.
|-
|Aphasia 
|'''CAN THE PERSON SPEAK & UNDERSTAND LANGUAGE?'''
Test: Ask them to name an ordinary object such as a pen. Or ask them to make a fist

Normal: The patient can understand language and name ordinary objects.

Abnormal: Inability to understand or express speech or name ordinary objects, does not follow simple commands such as “close your eyes” or make a fist

Slurred speech alone does not indicate a positive VAN test

|-
|Neglect 
|'''IS THE PATIENT IGNORING ONE SIDEOF THE BODY (Usually the left side)?'''
Test: Ask the patient to close their eyes and tell them that you will touch each arm individually and then both at the same time. Ask them to acknowledge each touch.

Normal: Patient acknowledges both individual touches and simultaneous touch.

Abnormal: Patient does not acknowledge simultaneous touch usually ignoring the left side

If the patient does not acknowledge individual touches this does not indicate a positive VAN test.

|}

'''ARM DRIFT PLUS ONE OF THE ABOVE IS VAN POSITIVE'''

Cincinnati and VAN assessments often are performed simultaneously

====TRANSPORT DESTINATION (Determined ONLY by VAN Assessment Results)====

If patient exhibits symptoms, regardless of time frame, call in as STROKE ALERT 

Stroke receiving center can determine acuity and level of aggressive action.

Transporting EMERGENCY or NON-EMERGENCY is determined by the crew but a LKW of <24 should receive EMERGENCY transportation.

Use of air medical resources is appropriate when the window for evaluation for Intra-arterial therapy is less than 1-hour and ground transport exceeds 30 minutes.

{| class="wikitable"
|+DESTINATION SELECTION
|-
|colspan="2"|All suspected stroke and TIA patients must be transported to a stroke-receiving facility, unless the patient is UNSTABLE.
|-
|VAN Negative
|PRIMARY STROKE CENTER
|-
|VAN Positive
|COMPREHENSIVE STROKE CENTER
|-
|VAN NEGATIVE or POSITIVE and tPA EXCLUSIONS
|COMPREHENSIVE STROKE CENTER
|}

=====COMPREHENSIVE STROKE DESTINATIONS=====
*Evaluation of suspected Large Vessel Occlusion (LVO) -or-
*Have contraindications for IV therapy such as Coumadin therapy, recent surgery, treatment of bleeding ulcer, etc.
{| class="wikitable"
|Advent Health Orlando
|Comprehensive Stroke Care
|-
|Orlando Regional Medical Center
|Comprehensive Stroke Care
|}

=====PRIMARY STROKE DESTINATIONS=====
The following hospitals have been approved by the Medical Director
{| class="wikitable"
|Advent Health Altamonte
|Primary Stroke Care
|-
|Advent Health Apopka
|Primary Stroke Care
|-
|Advent Health East
|Primary Stroke Care
|-
|Advent Health Orlando
|Comprehensive Stroke Care
|-
|HCA Lake Monroe
|Primary Stroke Care
|-
|Orlando Regional Medical Center
|Comprehensive Stroke Care
|-
|Oviedo Medical Center
|Primary Stroke Care
|-
|South Seminole Community Hospital
|Primary Stroke Care
|-
|Winter Park Memorial Hospital
|Primary Stroke Care
|}

Maitland Fire Rescue Department Practice Parameters

2023-04-13T18:25:35Z

Mfrdmanager: /* Section 5 - Medical */

__NOTOC__
==TABLE OF CONTENTS==

[[Medical Director Authorization]]

===Section 1 - Administrative Policies===

{| class="wikitable"
|-
! Section !! Description !! Revision Date
|-
| 1.01 || [[General Measures]] || April-16
|-
| 1.02 || [[Radio Report Format]] || March-16
|-
| 1.03 || [[Refusal of Service]] || October-17
|-
| 1.04 || [[Physician or Nurse on Scene]] || March-09
|-
| 1.05 || [[Initiation of CPR and Determination of Death]] || July-16
|-
| 1.06|| [[Determination of Death in Trauma]]|| March-09
|-
| 1.07|| [[Crime or Unattended Death Scene]] || March-09
|-
| 1.08|| [[Medical Evaluation of Person in Police Custody]]|| March-09
|-
| 1.09|| [[Trauma Transport Protocol]]|| Dec-19
|-
| 1.10|| [[Emergency Transport]]|| March-09
|-
| 1.11|| [[Criteria for Helicopter Transport]]|| March-09
|-
| 1.12|| [[Medical Patient Transport Decision]]|| April-14
|-
| 1.13|| [[Obstetrical Patient Transport Decision]]|| Feb-15
|-
| 1.14|| [[Emergency Inter Facility Transport]]|| March-09
|-
| 1.15|| [[EMS Disaster Response Level]]|| March-09
|-
| 1.16|| [[EMS Offload Policy]]|| March-09
|-
| 1.17|| [[EMS Quality Improvement Program]]|| March-09
|-
| 1.18|| [[Scope of Practice]]|| March-09
|-
| 1.19|| [[Freestanding ED Transport Criteria]]|| October-13
|-
| 1.20|| [[Hospital Capability Chart]]|| May-18
|-
| 1.21|| [[Documentation Guidance]]|| June-17
|}

===Section 2 - Primary Care===

{| class="wikitable"
|-
! Section !! Description !! Revision Date
|-
| 2.01 ||[[Initial Medical Assessment and Care]]||March-09
|-
|2.02 ||[[Initial Trauma Assessment and Care]]||September-17
|-
||2.03 ||[[Rapid Trauma Assessment, Focused History and Physical Exam]]||Sept-15
|-
||2.04||[[Analgesia and Sedation]]||November-2017
|-
||2.05||[[Drug Assisted Intubation]]||December-2016
|}

===Section 3 - Respiratory===

{| class="wikitable"
|-
! Section !! Description !! Revision Date
|-
| 3.01|| [[Acute Asthma or COPD with Wheezing]]|| February-19
|-
| 3.02|| [[Carbon Monoxide Inhalation]]|| March-09
|-
| 3.03|| [[Foreign Body Airway Obstruction]]|| March-09
|-
| 3.04|| [[Infectious Upper Airway Obstruction - Croup or Epiglottitis]]|| April-16
|-
| 3.05|| [[Severe Respiratory Pathogens]]|| November-10
|-
| 3.06|| [[Anxiety / Hyperventilation]]|| February-11
|}

===Section 4 - Cardiac===
{| class="wikitable"
|-
! Section !! Description !! Revision Date
|-
|4.01 || [[Chest Pain Acute Coronary Syndrome]]||Sept-17
|-
|4.02 || [[Asystole]]||April-16
|-
|4.03 || [[Atrial Fibrillation Atrial Flutter]]||June-17
|-
|4.04||[[Pulseless Electrical Activity (PEA)]]||January-16
|-
|4.05||[[Premature Ventricular Contractions (PVC)]]||May-12
|-
|4.06||[[Supraventricular Bradycardia and AV Blocks]]||March-09
|-
|4.07||[[Supraventricular Tachycardia]]||April-12
|-
|4.08||[[Ventricular Fibrillation Pulseless Ventricular Tachycardia]]||December-16
|-
|4.09||[[Ventricular Tachycardia with a Palpable Pulse]]||July-12
|-
|4.10||[[Wide Complex Tachycardia Uncertain Origin]]||May-12
|-
|4.11||[[Acute Cardiogenic Pulmonary Edema Pneumonia]]||March-09
|-
|4.12||[[Code Cool Post ROSC Induced Hypothermia]]||March-09
|-
|4.13||[[Adult Immediate Post-Cardiac Arrest Care]]||April-12
|-
|4.14||[[Ventricular Assist Devices]]||August-18
|}

===Section 5 - Medical===

{| class="wikitable"
|-
! Section !! Description !! Revision Date
|-
|5.01||[[Acute Abdominal Pain]]||April-16
|-
|5.02||[[Allergic Reaction Anaphylactic Shock]]||April-16
|-
|5.03||[[Altered Mental Status (AMS)]]||April-17
|-
|5.04||[[Suspected Stroke Transient Ischemic Attack TIA|Suspected Stroke or Transient Ischemic Attack]]||May-18
|-
|5.05||[[Drug Overdose Poisoning]]||March-09
|-
|5.06||[[Cold Emergencies]]||April-12
|-
|5.07||[[Heat Emergencies]]||August-15
|-
|5.08||[[Hazardous Materials]]||March-09
|-
|5.09||[[Severe Hypertension]]||March-09
|-
|5.10||[[Hypo or Hyperglycemia]]||April-16
|-
|5.11||[[Psychological Behavioral Emergencies]]||March-09
|-
|5.12||[[Seizure]]||April-16
|-
|5.13||[[Shock]]||March-09
|-
|5.14||[[Sickle Cell Anemia Crisis]]||March-09
|-
|5.15||[[Syncope]]||March-09
|-
|5.16||[[Vertigo]]||March-09
|-
|5.17||[[Sepsis Septic Shock]]||September-17
|-
|5.18||[[Suspected Kidney Stone]]||April-16
|-
|5.19||[[Cyanide Poisoning]]||April-16
|-
|5.20||[[Excited Delirium or Drug Induced Agitation]]||November-17
|-
|5.21||[[Ebola Virus Disease Patient Management]]||October-14
|-
|5.22||[[Acute Adrenal Insufficiency]]||June-18
|}

===Section 6 - Trauma===
{| class="wikitable"
|-
! Section !! Description !! Revision Date
|-
|6.01||[[Animal Bites Stings]]||March-09
|-
|6.02||[[Burns - Thermal, Electrical, Chemical]]||March-09
|-
|6.03||[[Selective Spinal Immobilization]]||August-14
|-
|6.04||[[Chest Injuries]]||March-09
|-
|6.05||[[Decompression Sickness or Dysbarism]]||March-09
|-
|6.06||[[Extremity Injuries]]||Feb-15
|-
|6.07||[[Head Injuries]]||November-17
|-
|6.08||[[Near Drowning]]||March-09
|-
|6.09||[[Ophthalmic Injuries]]||March-09
|-
|6.10||[[Suspected Abuse Neglect]]||March-09
|-
|6.11||[[Suspected Sexual Assault]]||March-09
|-
|6.12||[[Trunk Penetrating Injuries]]||April-12
|-
|6.13||[[Hemorrhagic Shock]]||October-18
|}

===Section 7 - Pediatric and Obstetrical===
{| class="wikitable"
|-
! Section !! Description !! Revision Date
|-
|7.01||[[Pediatric Asystole]]||April-16
|-
|7.02||[[Pediatric Pulseless Electrical Activity PEA]]||April-16
|-
|7.03||[[Pediatric Tachycardia, Ventricular Fibrillation or Pulseless Ventricular Tachycardia]]||April-16
|-
|7.04||[[Pregnancy Induced Hypertension (PIH)]]||March-09
|-
|7.05||[[Preterm Labor]]||November-17
|-
|7.06||[[Emergency Childbirth]]||November-17
|-
|7.07||[[Childbirth Complications]]||November-17
|-
|7.08||[[Newborn Care]]||April-16
|-
|7.09||[[Post Partum Care]]||November-17
|-
|7.10||[[Pediatric Febrile Emergency]]||April-16
|-
|7.11||[[Vaginal Bleeding]]||March-09
|-
|7.12||[[Trauma In Pregnancy]]||March-09
|}

===Section 8 - Medication Guidelines===
INTRODUCTION
The following pages contain guidelines for the medications commonly encountered by the Paramedic. They identify the name and class of the drug, a short description, indications, contraindications, precautions, and dosages. This is only a guideline to medication administration and shall not circumvent the need to refer to the appropriate Standing Order or to contact Medical Control for orders and consultation. For detailed and extensive information on each drug, refer to the Physician's Desk Reference, the Advanced Cardiac Life Support text or an emergency pre-hospital pharmacology reference.

Certain medications listed have various dosages depending on the patient's condition. Refer to the appropriate Standing Order or contact Medical Control for specific dosage information. All IV piggyback medications must be placed on a micro-gtt. solution set for field administration and if available, an infusion pump or infusion regulator MUST BE UTILIZED.

The following medications are authorized to be administered by Maitland Fire Rescue EMS:

{| class="wikitable"
|-
! Medication Name!! Revision Date
|-
|[[Acetaminophen]]||March-09
|-
|[[Adenosine]]||January-20
|-
|[[Albuterol]]||April-16
|-
|[[Aspirin]]||March-09
|-
|[[Ativan]]||April-16
|-
|[[Atropine]]||July-17
|-
|[[Atrovent]]||April-16
|-
|[[Calcium Chloride]]||April-16
|-
|[[Cardizem]]||July-17
|-
|[[Cyanokit]]||April-16
|-
|[[Dextrose 10%]]||April-16
|-
|[[Dextrose 50%]]||April-16
|-
|[[Diphenhydramine]]||April-16
|-
|[[Dopamine]]||April-16
|-
|[[Epinephrine]]||April-16
|-
|[[Etomidate]]||April-16
|-
|[[Fentanyl]]||November-16
|-
|[[Flumazenil]]||April-16
|-
|[[Glucagon]]||April-16
|-
|[[Ketamine]]||November-17
|-
|[[Lasix]]||April-16
|-
|[[Lidocaine]]||July-17
|-
|[[Magnesium Sulfate]]||April-16
|-
|[[Morphine Sulfate]]||November-16
|-
|[[Naloxone]]||April-16
|-
|[[Nitro Drip]]||April-17
|-
|[[Nitro Spray]]||April-17
|-
|[[Nitro Tablets]]||April-17
|-
|[[Nitrous Oxide]]||November-16
|-
|[[Oxygen]]||March-09
|-
|[[Pepcid]]||April-16
|-
|[[Pontocaine]]||November-17
|-
|[[Promethazine]]||April-16
|-
|[[Racemic Epinephrine]]||April-16
|-
|[[Sodium Bicarbonate]]||April-16
|-
|[[Solu-Medrol]]||January-17
|-
|[[Toradol]]||March-09
|-
|[[TXA]]||October-20
|-
|[[Xopenex]]||April-16
|-
|[[Vasopressin]]||October-13
|-
|[[Valium]]||April-16
|-
|[[Versed]]||April-16
|-
|[[Zofran]]||April-16
|-
|[[Medication Infusion Tables]]||
|}

===Section 9 - Procedure Guidelines===
{| class="wikitable"
|-
! Section !! Description !! Revision Date
|-
|9.00||[[LUCAS Device]]||July-16
|-
|9.01||[[Pneupac VR1 Ventilator]]||March-09
|-
|9.02||[[Blood Alcohol Draw on Scene]]||March-09
|-
|9.03||[[Blood Draw using Vacutainer]]||March-09
|-
|9.04||[[Blood Glucose Test]]||March-09
|-
|9.05||[[Buretrol Usage]]||March-09
|-
|9.06||[[Cardiac Monitor]]||April-12
|-
|9.07||[[Cardioversion]]||March-09
|-
|9.08||[[Continuous Positive Airway Pressure Device]]||March-09
|-
|9.09||[[Cricothyrotomy Needle]]||March-09
|-
|9.10||[[Cricothyrotomy Surgical]]||March-09
|-
|9.11||[[Defibrillation]]||March-09
|-
|9.12||[[Defibrillation Pediatric]]||March-09
|-
|9.13||[[End Tidal CO2 Monitoring / Capnography]]||March-09
|-
|9.14.1||[[Intraosseous Infusion - Femoral]]||February-15
|-
|9.14.2||[[Intraosseous Infusion - Humeral Head]]||December-16
|-
|9.15||[[Intubation Endotracheal]]||March-09
|-
|9.16||[[Intubation Nasotracheal]]||March-09
|-
|9.17||[[Braun Syringe Infusion Pump]]||March-14
|-
|9.18||[[King Tube]]||March-09
|-
|9.19||[[Medication Administration Intramuscular]]||March-09
|-
|9.20||[[Medication Administration Nasal Atomizer]]||March-09
|-
|9.21||[[Medication Administration Nebulizer]]||March-09
|-
|9.22||[[Medication Administration Subcutaneous]]||March-09
|-
|9.23||[[Nasogastric/Orogastric Tube]]||March-09
|-
|9.24||[[Oxygen Administration]]||March-09
|-
|9.25||[[Peripheral IV Administration]]||March-09
|-
|9.26||[[Pleural Decompression]]||March-09
|-
|9.27||[[Removal of Taser Probes]]||March-09
|-
|9.28||[[Reconstitution of Medications]]||March-09
|-
|9.29||[[Transcutaneous Pacing Procedure]]||March-09
|-
|9.30||[[Emergency Escharotomy|Emergency Chest Wall Escharotomy]]||April-11
|-
|9.31||[[Central Venous Access Devices]]||June-12
|-
|9.32||[[Medication Administration Cross Check]]||Jun-12
|-
|9.33||[[Combat Application Tourniquet]]||Jan-14
|-
|9.34||[http://lifevest.zoll.com/medical-professionals/first-responder-resources Zoll LifeVest Wearable Defibrillator]||Dec-14
|-
|9.35||[[Medication Temperature Monitoring]]||Feb-19
|}

===Section 10 - References===
{| class="wikitable"
|-
! Section !! Description !! Revision Date
|-
|10.01||[[Abbreviations]]||March-09
|-
|10.02||[[Apgar Score]]||March-09
|-
|10.03||[[Glasgow Coma Score]]||March-09
|-
|10.04||[[Pediatric Vital Signs]]||March-09
|-
|10.05||[[Adult Trauma Alert Criteria]]||March-09
|-
|10.06||[[Pediatric Trauma Alert Criteria]]||March-09
|-
|10.07||[[Pediatric Trauma Score]]||March-09
|-
|10.08||[[Nitroglycerin Drip]]||March-09
|-
|10.09||[[Checking Range of Motion]]||March-09
|-
|10.10||[[Rules of Nine]]||March-09
|-
|10.11||[[Florida Statutes]]||March-09
|-
|10.12||[[Evaluation and Treatment Flow Chart]]||March-09
|-
|10.13||[[Spinal Injury Assessment Critical Criteria]]||March-09
|}

===Section 11 - Medical Director Memos===
{| class="wikitable sortable"
|-
! Subject !! Effective Date
|-
| [[Memo - Opening of Oviedo Medical Center|Opening of Oviedo Medical Center]] || 2017-01-29
|-
| [[Memo - Blood Draws - Florida Hospital|Blood Draws - Florida Hospital]] || 2017-01-25
|-
| [[Memo - Medical Alerts|Medical Alerts]] || 2016-04-27
|-
| [[Memo - Discontinuation of Central Venous Access|Discontinuation of Central Venous Access]] || 2013-08-03
|-
| [[Memo - Shortage of Atropine|Shortage of Atropine]] || 2013-04-11
|-
| [[Memo - EMS Blood Draws for SSCH|EMS Blood Draws for SSCH]] || 2013-03-07
|-
| [[Memo - Respiratory Breathing Treatments|Respiratory/Breathing Treatments]] || 2012-12-19
|-
| [[Memo - OB Transports|OB Transports]] || 2011-01-14
|-
| [[Memo - Aspirin Administration Documentation|Aspirin Administration Documentation]] || 2010-12-01
|-
| [[Memo - Alert Terminology|Alert Terminology]] || 2010-05-06
|}

Suspected Stroke Transcient Ischemic Attack TIA

2023-04-13T18:24:52Z

Mfrdmanager:

==Section 5 -MEDICAL==
===5.04 SUSPECTED STROKE/TRANSIENT ISCHEMIC ATTACK (T.I.A.)===

==== PRINCIPLES ====

*Rapidly identify patients with suspected stroke
*Minimize scene time & safe, expediate transport to the appropriate facility
*Continuous review and improvement on the stroke management process
*[[Initial Medical Assessment and Care|INITIAL MEDICAL CARE]] 2.01
*Differential Diagnosis
**[[Altered_Mental_Status_(AMS)|ALTERED MENTAL STATUS (AMS)]] 5.03
**[[Sepsis_Septic_Shock|SEPSIS]] 5.17
*Establish a definitive last known well (LKW) time
*Complete a Cincinnati Pre-Hospital Stroke Exam

==== BE FAST Exam ====

*BE FAST and VAN assessments can be performed simultaneously

{| class="wikitable"
|Balance
|Is the person suddenly having trouble with balance or coordination?
|-
|Eyes
|Is the person experiencing suddenly blurred or double vision or a sudden loss of vision in one or both eyes without pain?
|-
|Face
|Face numbness or weakness, especially one side
“Smile”
|-
|Arm
|Arm numbness or weakness, especially on one side of the body
“Arms out like Superman”
|-
|colspan="2"|(VAN Positive or Negative?)
|-
|Speech 
|Slurred speech or difficulty speaking or understanding
“You can’t teach an old dog new tricks”
|-
|colspan="2"|(VAN Aphasic? Consider VAN Visual Disturbance and Neglect!))
|-
|Time 
|Time since – Last seen normal/Last Known Well (LKW)
|}

*Perform Blood Glucose
*Complete Stroke Checklist
**Identify any t-PA exclusions and document all findings
**Leave copy at hospital
**Forward or Fax the duplicate Stroke Checklist to County EMS QA office
**A copy of the completed stroke checklist must also accompany the abbreviated report for the agency.
*Obtain IV Access
**An 18 gauge is preferable.
**Avoid multiple attempts and IO's
**Notify ER staff and document location of any missed IV’s.
**'''Be conscientious of numerous IV attempts due to possibility of Fibrinolytic therapy and subsequent bleeding from both successful and attempted IV sites.'''
*Perform blood draw of all tubes.
**The crew shall hold onto the tubes at the hospital until a staff member is ready to label the blood tubes.
**Document that blood was drawn.
*HYPERTENSION - Do not treat hypertension.
*Elevate the head of the stretcher 15-30 degrees if systolic BP >100 mm Hg
*Do not allow aspiration
*Maintain head and neck in neutral alignment, without flexing the neck
*Protect paralyzed limbs from injury
*Obtain 12-lead EKG
*Nausea/vomiting - administer an antiemetic
*Have Patient hold both arms up for 10 seconds
**Is arm weakness present?
***YES - continue VAN assessment 
***NO - Patient is VAN negative.

====VAN Assessment====
{| class="wikitable"
|Visual 
|'''IS VISION GAZED IN ONE DIRECTION? NEW ONSET BLINDNESS?'''
Test: Ask the person to look up, then down then left, then right. Or have them follow your finger in those directions.

Normal: No preferred gaze and eyes move past midline upon request.

Abnormal: Gaze is deviated to one side and does not pass the midline upon request or new onset blindness.
|-
|Aphasia 
|'''CAN THE PERSON SPEAK & UNDERSTAND LANGUAGE?'''
Test: Ask them to name an ordinary object such as a pen. Or ask them to make a fist

Normal: The patient can understand language and name ordinary objects.

Abnormal: Inability to understand or express speech or name ordinary objects, does not follow simple commands such as “close your eyes” or make a fist

Slurred speech alone does not indicate a positive VAN test

|-
|Neglect 
|'''IS THE PATIENT IGNORING ONE SIDEOF THE BODY (Usually the left side)?'''
Test: Ask the patient to close their eyes and tell them that you will touch each arm individually and then both at the same time. Ask them to acknowledge each touch.

Normal: Patient acknowledges both individual touches and simultaneous touch.

Abnormal: Patient does not acknowledge simultaneous touch usually ignoring the left side

If the patient does not acknowledge individual touches this does not indicate a positive VAN test.

|}

'''ARM DRIFT PLUS ONE OF THE ABOVE IS VAN POSITIVE'''

Cincinnati and VAN assessments often are performed simultaneously

====TRANSPORT DESTINATION (Determined ONLY by VAN Assessment Results)====

If patient exhibits symptoms, regardless of time frame, call in as STROKE ALERT 

Stroke receiving center can determine acuity and level of aggressive action.

Transporting EMERGENCY or NON-EMERGENCY is determined by the crew but a LKW of <24 should receive EMERGENCY transportation.

Use of air medical resources is appropriate when the window for evaluation for Intra-arterial therapy is less than 1-hour and ground transport exceeds 30 minutes.

{| class="wikitable"
|+DESTINATION SELECTION
|-
|colspan="2"|All suspected stroke and TIA patients must be transported to a stroke-receiving facility, unless the patient is UNSTABLE.
|-
|VAN Negative
|PRIMARY STROKE CENTER
|-
|VAN Positive
|COMPREHENSIVE STROKE CENTER
|-
|VAN NEGATIVE or POSITIVE and tPA EXCLUSIONS
|COMPREHENSIVE STROKE CENTER
|}

=====COMPREHENSIVE STROKE DESTINATIONS=====
*Evaluation of suspected Large Vessel Occlusion (LVO) -or-
*Have contraindications for IV therapy such as Coumadin therapy, recent surgery, treatment of bleeding ulcer, etc.
{| class="wikitable"
|Advent Health Orlando
|Comprehensive Stroke Care
|-
|Orlando Regional Medical Center
|Comprehensive Stroke Care
|}

=====PRIMARY STROKE DESTINATIONS=====
The following hospitals have been approved by the Medical Director
{| class="wikitable"
|Advent Health Altamonte
|Primary Stroke Care
|-
|Advent Health Apopka
|Primary Stroke Care
|-
|Advent Health East
|Primary Stroke Care
|-
|Advent Health Orlando
|Comprehensive Stroke Care
|-
|HCA Lake Monroe
|Primary Stroke Care
|-
|Orlando Regional Medical Center
|Comprehensive Stroke Care
|-
|Oviedo Medical Center
|Primary Stroke Care
|-
|South Seminole Community Hospital
|Primary Stroke Care
|-
|Winter Park Memorial Hospital
|Primary Stroke Care
|}

Suspected Stroke Transcient Ischemic Attack TIA

2023-04-13T15:25:46Z

Mfrdmanager:

==Section 5 -MEDICAL==
===5.04 SUSPECTED STROKE/TRANSCIENT ISCHEMIC ATTACK (T.I.A.)===

==== PRINCIPLES ====

*Rapidly identify patients with suspected stroke
*Minimize scene time & safe, expediate transport to the appropriate facility
*Continuous review and improvement on the stroke management process
*[[Initial Medical Assessment and Care|INITIAL MEDICAL CARE]] 2.01
*Differential Diagnosis
**[[Altered_Mental_Status_(AMS)|ALTERED MENTAL STATUS (AMS)]] 5.03
**[[Sepsis_Septic_Shock|SEPSIS]] 5.17
*Establish a definitive last known well (LKW) time
*Complete a Cincinnati Pre-Hospital Stroke Exam

==== BE FAST Exam ====

*BE FAST and VAN assessments can be performed simultaneously

{| class="wikitable"
|Balance
|Is the person suddenly having trouble with balance or coordination?
|-
|Eyes
|Is the person experiencing suddenly blurred or double vision or a sudden loss of vision in one or both eyes without pain?
|-
|Face
|Face numbness or weakness, especially one side
“Smile”
|-
|Arm
|Arm numbness or weakness, especially on one side of the body
“Arms out like Superman”
|-
|colspan="2"|(VAN Positive or Negative?)
|-
|Speech 
|Slurred speech or difficulty speaking or understanding
“You can’t teach an old dog new tricks”
|-
|colspan="2"|(VAN Aphasic? Consider VAN Visual Disturbance and Neglect!))
|-
|Time 
|Time since – Last seen normal/Last Known Well (LKW)
|}

*Perform Blood Glucose
*Complete Stroke Checklist
**Identify any t-PA exclusions and document all findings
**Leave copy at hospital
**Forward or Fax the duplicate Stroke Checklist to County EMS QA office
**A copy of the completed stroke checklist must also accompany the abbreviated report for the agency.
*Obtain IV Access
**An 18 gauge is preferable.
**Avoid multiple attempts and IO's
**Notify ER staff and document location of any missed IV’s.
**'''Be conscientious of numerous IV attempts due to possibility of Fibrinolytic therapy and subsequent bleeding from both successful and attempted IV sites.'''
*Perform blood draw of all tubes.
**The crew shall hold onto the tubes at the hospital until a staff member is ready to label the blood tubes.
**Document that blood was drawn.
*HYPERTENSION - Do not treat hypertension.
*Elevate the head of the stretcher 15-30 degrees if systolic BP >100 mm Hg
*Do not allow aspiration
*Maintain head and neck in neutral alignment, without flexing the neck
*Protect paralyzed limbs from injury
*Obtain 12-lead EKG
*Nausea/vomiting - administer an antiemetic
*Have Patient hold both arms up for 10 seconds
**Is arm weakness present?
***YES - continue VAN assessment 
***NO - Patient is VAN negative.

====VAN Assessment====
{| class="wikitable"
|Visual 
|'''IS VISION GAZED IN ONE DIRECTION? NEW ONSET BLINDNESS?'''
Test: Ask the person to look up, then down then left, then right. Or have them follow your finger in those directions.

Normal: No preferred gaze and eyes move past midline upon request.

Abnormal: Gaze is deviated to one side and does not pass the midline upon request or new onset blindness.
|-
|Aphasia 
|'''CAN THE PERSON SPEAK & UNDERSTAND LANGUAGE?'''
Test: Ask them to name an ordinary object such as a pen. Or ask them to make a fist

Normal: The patient can understand language and name ordinary objects.

Abnormal: Inability to understand or express speech or name ordinary objects, does not follow simple commands such as “close your eyes” or make a fist

Slurred speech alone does not indicate a positive VAN test

|-
|Neglect 
|'''IS THE PATIENT IGNORING ONE SIDEOF THE BODY (Usually the left side)?'''
Test: Ask the patient to close their eyes and tell them that you will touch each arm individually and then both at the same time. Ask them to acknowledge each touch.

Normal: Patient acknowledges both individual touches and simultaneous touch.

Abnormal: Patient does not acknowledge simultaneous touch usually ignoring the left side

If the patient does not acknowledge individual touches this does not indicate a positive VAN test.

|}

'''ARM DRIFT PLUS ONE OF THE ABOVE IS VAN POSITIVE'''

Cincinnati and VAN assessments often are performed simultaneously

====TRANSPORT DESTINATION (Determined ONLY by VAN Assessment Results)====

If patient exhibits symptoms, regardless of time frame, call in as STROKE ALERT 

Stroke receiving center can determine acuity and level of aggressive action.

Transporting EMERGENCY or NON-EMERGENCY is determined by the crew but a LKW of <24 should receive EMERGENCY transportation.

Use of air medical resources is appropriate when the window for evaluation for Intra-arterial therapy is less than 1-hour and ground transport exceeds 30 minutes.

{| class="wikitable"
|+DESTINATION SELECTION
|-
|colspan="2"|All suspected stroke and TIA patients must be transported to a stroke-receiving facility, unless the patient is UNSTABLE.
|-
|VAN Negative
|PRIMARY STROKE CENTER
|-
|VAN Positive
|COMPREHENSIVE STROKE CENTER
|-
|VAN NEGATIVE or POSITIVE and tPA EXCLUSIONS
|COMPREHENSIVE STROKE CENTER
|}

=====COMPREHENSIVE STROKE DESTINATIONS=====
*Evaluation of suspected Large Vessel Occlusion (LVO) -or-
*Have contraindications for IV therapy such as Coumadin therapy, recent surgery, treatment of bleeding ulcer, etc.
{| class="wikitable"
|Advent Health Orlando
|Comprehensive Stroke Care
|-
|Orlando Regional Medical Center
|Comprehensive Stroke Care
|}

=====PRIMARY STROKE DESTINATIONS=====
The following hospitals have been approved by the Medical Director
{| class="wikitable"
|Advent Health Altamonte
|Primary Stroke Care
|-
|Advent Health Apopka
|Primary Stroke Care
|-
|Advent Health East
|Primary Stroke Care
|-
|Advent Health Orlando
|Comprehensive Stroke Care
|-
|HCA Lake Monroe
|Primary Stroke Care
|-
|Orlando Regional Medical Center
|Comprehensive Stroke Care
|-
|Oviedo Medical Center
|Primary Stroke Care
|-
|South Seminole Community Hospital
|Primary Stroke Care
|-
|Winter Park Memorial Hospital
|Primary Stroke Care
|}

Freestanding ED Transport Criteria

2022-10-11T13:08:53Z

Mfrdmanager: /* TRANSPORT EXCLUSION CRITERIA */

== Section 1 - ADMINISTRATIVE POLICIES ==

=== 1.19 FREESTANDING ED TRANSPORT CRITERIA ===

The following transport guidelines apply to any facility approved and designated as a free standing or stand alone emergency department as defined in Florida Statutes.

==='''TRANSPORT INCLUSION CRITERIA''' ===
The following conditions are acceptable impressions that are suitable for transport to the freestanding emergency department:
==== Stable patients with medical or trauma complaints not likely to require emergent admission or acute surgical intervention. These include, but are not limited to: ====
* Minor respiratory complaints
* Fever, chills, flu-like symptoms
* Cough, congestion, shortness of breath without signs of acute respiratory failure or unstable CHF
* Isolated chest pain without other profound signs and symptoms, abnormal EKG, multiple or complicated pre-existing medical conditions.
* Isolated musculoskeletal or orthopedic injuries
* Isolated head trauma in adults without acute neurological deficits or high index of suspicion of a more complex problem
* Headaches
* General abdominal or flank pain without signs of acute abdomen or surgical emergency
* Nausea/vomiting/diarrhea complaints without signs of shock
* Traumatic injuries not likely to require urgent surgical intervention
* Soft tissue injuries, lacerations, puncture wounds
* Gynecological complaints, vaginal bleeding, pelvic pain without signs of shock or severe pain or symptoms consistent with acute abdomen
* Urinary symptoms
* Pediatric patients with general medical complaints without significant signs and symptoms of shock, cardiac symptoms, impending respiratory failure, altered mental status or have complicated pre-existing conditions likely to require admission to a pediatric facility.

==== Unstable patients ====
* Cardiac arrest patients may be transported to the facility for stabilization
* Unstable or unobtainable airway requiring immediate stabilization
* Sepsis Alerts may be transported to a FSED to facilitate immediate antibiotics.
* The transporting unit will remain in the free standing ED standing by for emergent transfer of the patient to the appropriate hospital in the event of a successful ROSC, airway is secured and patient is stabilized.

=== '''TRANSPORT EXCLUSION CRITERIA''' ===
The following conditions ARE NOT acceptable impressions for transport to the freestanding emergency department:
* All Emergent “Alerts”: STEMI, STROKE, CARDIAC, TRAUMA
* Hip fractures
* Acute delirium
* Baker Acts
* Obstetrical patients
* Cardiac related complaints with significant signs and symptoms – CHF, dyspnea at rest, or patients with significant pre-existing medical conditions
* Patients exhibiting signs and symptoms consistent with an acute abdomen that most likely require urgent or emergent admission or surgical intervention
* Multi-system trauma
* Trauma Red patients
* Open fractures
* Pediatric patients with significant change in mental status or significant signs and symptoms that will most likely require admission to a pediatric facility including traumatic loss of consciousness
* Cardiac arrest patient who has had a positive Return of Spontaneous Circulation (ROSC) prior to arrival to the ED must be transported to the nearest appropriate ED with full hospital admission capabilities.

=== '''GENERAL TRANSPORT RULE TO FREESTANDING EDs:''' ===
Although it is impossible to list every complaint that meets criteria for transport to a freestanding emergency department, the general premise is to transport those patients who are NOT LIKELY to require emergent hospital admission, surgical or obstetrical intervention or other acute services not readily available in the freestanding ED. Pre-hospital providers are expected to closely evaluate the patient’s chief complaint, stability and condition to choose a transport destination that is '''IN THE BEST INTEREST OF THE PATIENT AND HIS OR HER CARE.''' When a situation arises where is questionable whether the patient meets freestanding ED transport criteria it is best to err in favor of transport to a full service initial facility.

[[Category:Administrative Policies|0121]]

Freestanding ED Transport Criteria

2022-10-11T13:08:18Z

Mfrdmanager: /* Unstable patients */

== Section 1 - ADMINISTRATIVE POLICIES ==

=== 1.19 FREESTANDING ED TRANSPORT CRITERIA ===

The following transport guidelines apply to any facility approved and designated as a free standing or stand alone emergency department as defined in Florida Statutes.

==='''TRANSPORT INCLUSION CRITERIA''' ===
The following conditions are acceptable impressions that are suitable for transport to the freestanding emergency department:
==== Stable patients with medical or trauma complaints not likely to require emergent admission or acute surgical intervention. These include, but are not limited to: ====
* Minor respiratory complaints
* Fever, chills, flu-like symptoms
* Cough, congestion, shortness of breath without signs of acute respiratory failure or unstable CHF
* Isolated chest pain without other profound signs and symptoms, abnormal EKG, multiple or complicated pre-existing medical conditions.
* Isolated musculoskeletal or orthopedic injuries
* Isolated head trauma in adults without acute neurological deficits or high index of suspicion of a more complex problem
* Headaches
* General abdominal or flank pain without signs of acute abdomen or surgical emergency
* Nausea/vomiting/diarrhea complaints without signs of shock
* Traumatic injuries not likely to require urgent surgical intervention
* Soft tissue injuries, lacerations, puncture wounds
* Gynecological complaints, vaginal bleeding, pelvic pain without signs of shock or severe pain or symptoms consistent with acute abdomen
* Urinary symptoms
* Pediatric patients with general medical complaints without significant signs and symptoms of shock, cardiac symptoms, impending respiratory failure, altered mental status or have complicated pre-existing conditions likely to require admission to a pediatric facility.

==== Unstable patients ====
* Cardiac arrest patients may be transported to the facility for stabilization
* Unstable or unobtainable airway requiring immediate stabilization
* Sepsis Alerts may be transported to a FSED to facilitate immediate antibiotics.
* The transporting unit will remain in the free standing ED standing by for emergent transfer of the patient to the appropriate hospital in the event of a successful ROSC, airway is secured and patient is stabilized.

=== '''TRANSPORT EXCLUSION CRITERIA''' ===
The following conditions ARE NOT acceptable impressions for transport to the freestanding emergency department:
* All Emergent “Alerts”: STEMI, STROKE, SEPSIS, CARDIAC, TRAUMA
* Obstetrical patients
* Cardiac related complaints with significant signs and symptoms – CHF, dyspnea at rest, or patients with significant pre-existing medical conditions
* Patients exhibiting signs and symptoms consistent with an acute abdomen that most likely require urgent or emergent admission or surgical intervention
* Multi-system trauma
* Trauma Red patients
* Open fractures
* Pediatric patients with significant change in mental status or significant signs and symptoms that will most likely require admission to a pediatric facility including traumatic loss of consciousness
* Cardiac arrest patient who has had a positive Return of Spontaneous Circulation (ROSC) prior to arrival to the ED must be transported to the nearest appropriate ED with full hospital admission capabilities.

=== '''GENERAL TRANSPORT RULE TO FREESTANDING EDs:''' ===
Although it is impossible to list every complaint that meets criteria for transport to a freestanding emergency department, the general premise is to transport those patients who are NOT LIKELY to require emergent hospital admission, surgical or obstetrical intervention or other acute services not readily available in the freestanding ED. Pre-hospital providers are expected to closely evaluate the patient’s chief complaint, stability and condition to choose a transport destination that is '''IN THE BEST INTEREST OF THE PATIENT AND HIS OR HER CARE.''' When a situation arises where is questionable whether the patient meets freestanding ED transport criteria it is best to err in favor of transport to a full service initial facility.

[[Category:Administrative Policies|0121]]

EMS Disaster Response Level

2021-05-26T15:04:13Z

Mfrdmanager:

==Section 1 - ADMINISTRATIVE POLICIES==
===1.15 EMS SATURATION DISASTER RESPONSE LEVELS===

There will be times when the demand for Emergency Medical Services (EMS) taxes or exceeds the capacity of the EMS system thereby, creating a disaster. The Maitland Fire Rescue EMS system (MFRD) is determined to have reserves available to handle the next emergency and has developed this plan and it’s concepts to define different levels of disaster status.

The following is a simplified view of EMS disaster status and also some specific concepts and actions to take when certain levels of disaster are reached within the MFRD system.

This plan is intended to be an outline of conditions that define EMS disaster response levels and help provide a template for actions to be taken by MFRD to expedite units back into service. These are subject to change at any given time. The overall most important concept is that this is not a license to "drop off" a patient at a hospital. With each patient we must identify when the patient requires active monitoring by a medical professional.

====Non-Transport Criteria====
* Minor extremity injuries with no deformities or loss of neurological/vascular function. Educate patient that “delayed treatment” is an acceptable practice, even if a fracture exists.
* Minor lacerations or abrasions with bleeding stopped with good distal function – educate patient on “delayed closure” is an accepted medical practice. NOTE: If the patient has a deep wound, inquire when they had their last tetanus shot and advise them to follow-up with a physician once adverse weather conditions have ended.
* Earache
* Typical headache for patient not in severe pain
* Back pain – typical patient not in severe pain
* Sore throat (that can swallow), have patient drink/swallow water
* Baker-acted patients without any injuries

====Treat and Release====
In the event we have patients requiring a breathing treatment or treatment for hypoglycemia and the patient feels better, and does not want to go to the hospital; it is appropriate to leave the patient with family or another caregiver. It is imperative that you perform a thorough evaluation and use good judgment before leaving any patient. In the event that you do transport a patient to the hospital and the ED is busy, please be patient and cordial with the ED staff. If we are in “Emergency Condition”, notify the charge nurse, and follow our standing procedures. Remember, teamwork, common sense, and good judgment goes a long way!

[[Category:Administrative Policies|0115]]

Sepsis Septic Shock

2021-01-07T19:26:01Z

Mfrdmanager:

==Section 5 -MEDICAL==
===5.17 SEPSIS / SEPTIC SHOCK===

====POSSIBLE SIGNS AND SYMPTOMS:====
*Systemic inflammatory Response Criteria (SIRS):
** Acute delirium
** Alteration in temperature (Temp. > 100.4° F (38° C) or < 96.8 F [36° C])
** Heart rate > 90 beats per minute
** ETCO2 ≤ 25 mm/Hg
** PaCO2 less than 32 mm/Hg
** Respiratory Rate greater than 20 breaths per minute
** Systolic blood pressure less than 90 mm/Hg
** New onset confusion or altered level of consciousness
** Blood sugar alteration – greater than 140 mg/dl in non-diabetic patient
** Decreased B/P with warm extremities
** Signs of decreased perfusion (mottling, pallor, capillary refill > 2 seconds)
** Flu-like symptoms (chills, shaking)
** Recent catheterization (eg. NG, Foley, etc.)
** Decreased urine output
** Increased or decreased fluid intake

'''[[Initial Medical Assessment and Care|Initial Medical Care]] (2.01) – Provide OXYGEN or assist ventilations as appropriate for patient condition.'''
* If altered mental status, refer to [[Altered Mental Status (AMS)|ALTERED MENTAL STATUS PRACTICE PARAMETER]] (5.03).
*Obtain a baseline blood glucose level.
** Administer [[Dextrose_50%25|DEXTROSE 50%]] or [[Dextrose_10%25|DEXTROSE 10%]] with BGL ≤ 50, consider a half-dose of if BGL < 100mg/dl AND > 50 m/dl. Re-check BGL after administration.
* Obtain an accurate temperature reading.
** IF fever greater than 101° F use passive cooling measures.
** If hypothermic – cover in blankets and take action to conserve heat.
* If patient presents with signs & symptoms of shock, refer to [[Shock|SHOCK PRACTICE PARAMETER (5.13)]]. If sepsis strongly suspected, consider fluid challenge.
** Establish two large bore IVs if possible
*** If hypotensive (< 90 mm/Hg) – Administer FLUID CHALLENGE at 20 ml/Kg
*** If unable to establish IV, consider an INTRAOSSEOUS infusion
* Perform blood draw of all tubes. The crew shall hold onto the tubes at the hospital until a staff member is ready to label the blood tubes. Document that blood was drawn.
* Complete the Sepsis Screening Form
** Write the patient's temperature on the form
** Two or more positive in any category = consider sepsis alert.
** Two in major category with a ETCO2 ≤ 25 mm/Hg = sepsis alert
* Limit scene time to 15 minutes
* If condition worsens despite fluid therapy, administer [[Dopamine|DOPAMINE]] 5-20 mcg/kg/minute titrated to systolic BP > 90 mm Hg.

'''''Notify hospital of suspected sepsis during radio report.'''''

====Sepsis Screening Form====
[[File:Sepsis Screening FEB 12.pdf]]

[[Category:Medical|0519]]

Sepsis Septic Shock

2021-01-07T18:59:11Z

Mfrdmanager:

==Section 5 -MEDICAL==

====POSSIBLE SIGNS AND SYMPTOMS:====
*Systemic inflammatory Response Criteria (SIRS):
** Acute delirium
** Alteration in temperature (Temp. > 100.4° F (38° C) or < 96.8 F [36° C])
** Heart rate > 90 beats per minute
** ETCO2 ≤ 25 mm/Hg
** PaCO2 less than 32 mm/Hg
** Respiratory Rate greater than 20 breaths per minute
** Systolic blood pressure less than 90 mm/Hg
** New onset confusion or altered level of consciousness
** Blood sugar alteration – greater than 140 mg/dl in non-diabetic patient
** Decreased B/P with warm extremities
** Signs of decreased perfusion (mottling, pallor, capillary refill > 2 seconds)
** Flu-like symptoms (chills, shaking)
** Recent catheterization (eg. NG, Foley, etc.)
** Decreased urine output
** Increased or decreased fluid intake

'''[[Initial Medical Assessment and Care|Initial Medical Care]] (2.01) – Provide OXYGEN or assist ventilations as appropriate for patient condition.'''
* If altered mental status, refer to [[Altered Mental Status (AMS)|ALTERED MENTAL STATUS PRACTICE PARAMETER]] (5.03).
*Obtain a baseline blood glucose level.
** Administer [[Dextrose_50%25|DEXTROSE 50%]] or [[Dextrose_10%25|DEXTROSE 10%]] with BGL ≤ 50, consider a half-dose of if BGL < 100mg/dl AND > 50 m/dl. Re-check BGL after administration.
* Obtain an accurate temperature reading.
** IF fever greater than 101° F use passive cooling measures.
** If hypothermic – cover in blankets and take action to conserve heat.
* If patient presents with signs & symptoms of shock, refer to [[Shock|SHOCK PRACTICE PARAMETER (5.13)]]. If sepsis strongly suspected, consider fluid challenge.
** Establish two large bore IVs if possible
*** If hypotensive (< 90 mm/Hg) – Administer FLUID CHALLENGE at 20 ml/Kg
*** If unable to establish IV, consider an INTRAOSSEOUS infusion
* Perform blood draw of all tubes. The crew shall hold onto the tubes at the hospital until a staff member is ready to label the blood tubes. Document that blood was drawn.
* Complete the Sepsis Screening Form
** Write the patient's temperature on the form
** Two or more positive in any category = consider sepsis alert.
** Two in major category with a ETCO2 ≤ 25 mm/Hg = sepsis alert
* Limit scene time to 15 minutes
* If condition worsens despite fluid therapy, administer [[Dopamine|DOPAMINE]] 5-20 mcg/kg/minute titrated to systolic BP > 90 mm Hg.

'''''Notify hospital of suspected sepsis during radio report.'''''

====Sepsis Screening Form====
[[File:Sepsis Screening FEB 12.pdf]]

[[Category:Medical|0519]]

Maitland Fire Rescue Department Practice Parameters

2020-11-16T15:39:43Z

Mfrdmanager: /* Section 9 - Procedure Guidelines */

__NOTOC__
==TABLE OF CONTENTS==

[[Medical Director Authorization]]

===Section 1 - Administrative Policies===

{| class="wikitable"
|-
! Section !! Description !! Revision Date
|-
| 1.01 || [[General Measures]] || April-16
|-
| 1.02 || [[Radio Report Format]] || March-16
|-
| 1.03 || [[Refusal of Service]] || October-17
|-
| 1.04 || [[Physician or Nurse on Scene]] || March-09
|-
| 1.05 || [[Initiation of CPR and Determination of Death]] || July-16
|-
| 1.06|| [[Determination of Death in Trauma]]|| March-09
|-
| 1.07|| [[Crime or Unattended Death Scene]] || March-09
|-
| 1.08|| [[Medical Evaluation of Person in Police Custody]]|| March-09
|-
| 1.09|| [[Trauma Transport Protocol]]|| Dec-19
|-
| 1.10|| [[Emergency Transport]]|| March-09
|-
| 1.11|| [[Criteria for Helicopter Transport]]|| March-09
|-
| 1.12|| [[Medical Patient Transport Decision]]|| April-14
|-
| 1.13|| [[Obstetrical Patient Transport Decision]]|| Feb-15
|-
| 1.14|| [[Emergency Inter Facility Transport]]|| March-09
|-
| 1.15|| [[EMS Disaster Response Level]]|| March-09
|-
| 1.16|| [[EMS Offload Policy]]|| March-09
|-
| 1.17|| [[EMS Quality Improvement Program]]|| March-09
|-
| 1.18|| [[Scope of Practice]]|| March-09
|-
| 1.19|| [[Freestanding ED Transport Criteria]]|| October-13
|-
| 1.20|| [[Hospital Capability Chart]]|| May-18
|-
| 1.21|| [[Documentation Guidance]]|| June-17
|}

===Section 2 - Primary Care===

{| class="wikitable"
|-
! Section !! Description !! Revision Date
|-
| 2.01 ||[[Initial Medical Assessment and Care]]||March-09
|-
|2.02 ||[[Initial Trauma Assessment and Care]]||September-17
|-
||2.03 ||[[Rapid Trauma Assessment, Focused History and Physical Exam]]||Sept-15
|-
||2.04||[[Analgesia and Sedation]]||November-2017
|-
||2.05||[[Drug Assisted Intubation]]||December-2016
|}

===Section 3 - Respiratory===

{| class="wikitable"
|-
! Section !! Description !! Revision Date
|-
| 3.01|| [[Acute Asthma or COPD with Wheezing]]|| February-19
|-
| 3.02|| [[Carbon Monoxide Inhalation]]|| March-09
|-
| 3.03|| [[Foreign Body Airway Obstruction]]|| March-09
|-
| 3.04|| [[Infectious Upper Airway Obstruction - Croup or Epiglottitis]]|| April-16
|-
| 3.05|| [[Severe Respiratory Pathogens]]|| November-10
|-
| 3.06|| [[Anxiety / Hyperventilation]]|| February-11
|}

===Section 4 - Cardiac===
{| class="wikitable"
|-
! Section !! Description !! Revision Date
|-
|4.01 || [[Chest Pain Acute Coronary Syndrome]]||Sept-17
|-
|4.02 || [[Asystole]]||April-16
|-
|4.03 || [[Atrial Fibrillation Atrial Flutter]]||June-17
|-
|4.04||[[Pulseless Electrical Activity (PEA)]]||January-16
|-
|4.05||[[Premature Ventricular Contractions (PVC)]]||May-12
|-
|4.06||[[Supraventricular Bradycardia and AV Blocks]]||March-09
|-
|4.07||[[Supraventricular Tachycardia]]||April-12
|-
|4.08||[[Ventricular Fibrillation Pulseless Ventricular Tachycardia]]||December-16
|-
|4.09||[[Ventricular Tachycardia with a Palpable Pulse]]||July-12
|-
|4.10||[[Wide Complex Tachycardia Uncertain Origin]]||May-12
|-
|4.11||[[Acute Cardiogenic Pulmonary Edema Pneumonia]]||March-09
|-
|4.12||[[Code Cool Post ROSC Induced Hypothermia]]||March-09
|-
|4.13||[[Adult Immediate Post-Cardiac Arrest Care]]||April-12
|-
|4.14||[[Ventricular Assist Devices]]||August-18
|}

===Section 5 - Medical===

{| class="wikitable"
|-
! Section !! Description !! Revision Date
|-
|5.01||[[Acute Abdominal Pain]]||April-16
|-
|5.02||[[Allergic Reaction Anaphylactic Shock]]||April-16
|-
|5.03||[[Altered Mental Status (AMS)]]||April-17
|-
|5.04||[[Suspected Stroke Transcient Ischemic Attack TIA|Suspected Stroke or Transcient Ischemic Attack]]||May-18
|-
|5.05||[[Drug Overdose Poisoning]]||March-09
|-
|5.06||[[Cold Emergencies]]||April-12
|-
|5.07||[[Heat Emergencies]]||August-15
|-
|5.08||[[Hazardous Materials]]||March-09
|-
|5.09||[[Severe Hypertension]]||March-09
|-
|5.10||[[Hypo or Hyperglycemia]]||April-16
|-
|5.11||[[Psychological Behavioral Emergencies]]||March-09
|-
|5.12||[[Seizure]]||April-16
|-
|5.13||[[Shock]]||March-09
|-
|5.14||[[Sickle Cell Anemia Crisis]]||March-09
|-
|5.15||[[Syncope]]||March-09
|-
|5.16||[[Vertigo]]||March-09
|-
|5.17||[[Sepsis Septic Shock]]||September-17
|-
|5.18||[[Suspected Kidney Stone]]||April-16
|-
|5.19||[[Cyanide Poisoning]]||April-16
|-
|5.20||[[Excited Delirium or Drug Induced Agitation]]||November-17
|-
|5.21||[[Ebola Virus Disease Patient Management]]||October-14
|-
|5.22||[[Acute Adrenal Insufficiency]]||June-18
|}

===Section 6 - Trauma===
{| class="wikitable"
|-
! Section !! Description !! Revision Date
|-
|6.01||[[Animal Bites Stings]]||March-09
|-
|6.02||[[Burns - Thermal, Electrical, Chemical]]||March-09
|-
|6.03||[[Selective Spinal Immobilization]]||August-14
|-
|6.04||[[Chest Injuries]]||March-09
|-
|6.05||[[Decompression Sickness or Dysbarism]]||March-09
|-
|6.06||[[Extremity Injuries]]||Feb-15
|-
|6.07||[[Head Injuries]]||November-17
|-
|6.08||[[Near Drowning]]||March-09
|-
|6.09||[[Ophthalmic Injuries]]||March-09
|-
|6.10||[[Suspected Abuse Neglect]]||March-09
|-
|6.11||[[Suspected Sexual Assault]]||March-09
|-
|6.12||[[Trunk Penetrating Injuries]]||April-12
|-
|6.13||[[Hemorrhagic Shock]]||October-18
|}

===Section 7 - Pediatric and Obstetrical===
{| class="wikitable"
|-
! Section !! Description !! Revision Date
|-
|7.01||[[Pediatric Asystole]]||April-16
|-
|7.02||[[Pediatric Pulseless Electrical Activity PEA]]||April-16
|-
|7.03||[[Pediatric Tachycardia, Ventricular Fibrillation or Pulseless Ventricular Tachycardia]]||April-16
|-
|7.04||[[Pregnancy Induced Hypertension (PIH)]]||March-09
|-
|7.05||[[Preterm Labor]]||November-17
|-
|7.06||[[Emergency Childbirth]]||November-17
|-
|7.07||[[Childbirth Complications]]||November-17
|-
|7.08||[[Newborn Care]]||April-16
|-
|7.09||[[Post Partum Care]]||November-17
|-
|7.10||[[Pediatric Febrile Emergency]]||April-16
|-
|7.11||[[Vaginal Bleeding]]||March-09
|-
|7.12||[[Trauma In Pregnancy]]||March-09
|}

===Section 8 - Medication Guidelines===
INTRODUCTION
The following pages contain guidelines for the medications commonly encountered by the Paramedic. They identify the name and class of the drug, a short description, indications, contraindications, precautions, and dosages. This is only a guideline to medication administration and shall not circumvent the need to refer to the appropriate Standing Order or to contact Medical Control for orders and consultation. For detailed and extensive information on each drug, refer to the Physician's Desk Reference, the Advanced Cardiac Life Support text or an emergency pre-hospital pharmacology reference.

Certain medications listed have various dosages depending on the patient's condition. Refer to the appropriate Standing Order or contact Medical Control for specific dosage information. All IV piggyback medications must be placed on a micro-gtt. solution set for field administration and if available, an infusion pump or infusion regulator MUST BE UTILIZED.

The following medications are authorized to be administered by Maitland Fire Rescue EMS:

{| class="wikitable"
|-
! Medication Name!! Revision Date
|-
|[[Acetaminophen]]||March-09
|-
|[[Adenosine]]||January-20
|-
|[[Albuterol]]||April-16
|-
|[[Aspirin]]||March-09
|-
|[[Ativan]]||April-16
|-
|[[Atropine]]||July-17
|-
|[[Atrovent]]||April-16
|-
|[[Calcium Chloride]]||April-16
|-
|[[Cardizem]]||July-17
|-
|[[Cyanokit]]||April-16
|-
|[[Dextrose 10%]]||April-16
|-
|[[Dextrose 50%]]||April-16
|-
|[[Diphenhydramine]]||April-16
|-
|[[Dopamine]]||April-16
|-
|[[Epinephrine]]||April-16
|-
|[[Etomidate]]||April-16
|-
|[[Fentanyl]]||November-16
|-
|[[Flumazenil]]||April-16
|-
|[[Glucagon]]||April-16
|-
|[[Ketamine]]||November-17
|-
|[[Lasix]]||April-16
|-
|[[Lidocaine]]||July-17
|-
|[[Magnesium Sulfate]]||April-16
|-
|[[Morphine Sulfate]]||November-16
|-
|[[Naloxone]]||April-16
|-
|[[Nitro Drip]]||April-17
|-
|[[Nitro Spray]]||April-17
|-
|[[Nitro Tablets]]||April-17
|-
|[[Nitrous Oxide]]||November-16
|-
|[[Oxygen]]||March-09
|-
|[[Pepcid]]||April-16
|-
|[[Pontocaine]]||November-17
|-
|[[Promethazine]]||April-16
|-
|[[Racemic Epinephrine]]||April-16
|-
|[[Sodium Bicarbonate]]||April-16
|-
|[[Solu-Medrol]]||January-17
|-
|[[Toradol]]||March-09
|-
|[[TXA]]||October-20
|-
|[[Xopenex]]||April-16
|-
|[[Vasopressin]]||October-13
|-
|[[Valium]]||April-16
|-
|[[Versed]]||April-16
|-
|[[Zofran]]||April-16
|-
|[[Medication Infusion Tables]]||
|}

===Section 9 - Procedure Guidelines===
{| class="wikitable"
|-
! Section !! Description !! Revision Date
|-
|9.00||[[LUCAS Device]]||July-16
|-
|9.01||[[Pneupac VR1 Ventilator]]||March-09
|-
|9.02||[[Blood Alcohol Draw on Scene]]||March-09
|-
|9.03||[[Blood Draw using Vacutainer]]||March-09
|-
|9.04||[[Blood Glucose Test]]||March-09
|-
|9.05||[[Buretrol Usage]]||March-09
|-
|9.06||[[Cardiac Monitor]]||April-12
|-
|9.07||[[Cardioversion]]||March-09
|-
|9.08||[[Continuous Positive Airway Pressure Device]]||March-09
|-
|9.09||[[Cricothyrotomy Needle]]||March-09
|-
|9.10||[[Cricothyrotomy Surgical]]||March-09
|-
|9.11||[[Defibrillation]]||March-09
|-
|9.12||[[Defibrillation Pediatric]]||March-09
|-
|9.13||[[End Tidal CO2 Monitoring / Capnography]]||March-09
|-
|9.14.1||[[Intraosseous Infusion - Femoral]]||February-15
|-
|9.14.2||[[Intraosseous Infusion - Humeral Head]]||December-16
|-
|9.15||[[Intubation Endotracheal]]||March-09
|-
|9.16||[[Intubation Nasotracheal]]||March-09
|-
|9.17||[[Braun Syringe Infusion Pump]]||March-14
|-
|9.18||[[King Tube]]||March-09
|-
|9.19||[[Medication Administration Intramuscular]]||March-09
|-
|9.20||[[Medication Administration Nasal Atomizer]]||March-09
|-
|9.21||[[Medication Administration Nebulizer]]||March-09
|-
|9.22||[[Medication Administration Subcutaneous]]||March-09
|-
|9.23||[[Nasogastric/Orogastric Tube]]||March-09
|-
|9.24||[[Oxygen Administration]]||March-09
|-
|9.25||[[Peripheral IV Administration]]||March-09
|-
|9.26||[[Pleural Decompression]]||March-09
|-
|9.27||[[Removal of Taser Probes]]||March-09
|-
|9.28||[[Reconstitution of Medications]]||March-09
|-
|9.29||[[Transcutaneous Pacing Procedure]]||March-09
|-
|9.30||[[Emergency Escharotomy|Emergency Chest Wall Escharotomy]]||April-11
|-
|9.31||[[Central Venous Access Devices]]||June-12
|-
|9.32||[[Medication Administration Cross Check]]||Jun-12
|-
|9.33||[[Combat Application Tourniquet]]||Jan-14
|-
|9.34||[http://lifevest.zoll.com/medical-professionals/first-responder-resources Zoll LifeVest Wearable Defibrillator]||Dec-14
|-
|9.35||[[Medication Temperature Monitoring]]||Feb-19
|}

===Section 10 - References===
{| class="wikitable"
|-
! Section !! Description !! Revision Date
|-
|10.01||[[Abbreviations]]||March-09
|-
|10.02||[[Apgar Score]]||March-09
|-
|10.03||[[Glasgow Coma Score]]||March-09
|-
|10.04||[[Pediatric Vital Signs]]||March-09
|-
|10.05||[[Adult Trauma Alert Criteria]]||March-09
|-
|10.06||[[Pediatric Trauma Alert Criteria]]||March-09
|-
|10.07||[[Pediatric Trauma Score]]||March-09
|-
|10.08||[[Nitroglycerin Drip]]||March-09
|-
|10.09||[[Checking Range of Motion]]||March-09
|-
|10.10||[[Rules of Nine]]||March-09
|-
|10.11||[[Florida Statutes]]||March-09
|-
|10.12||[[Evaluation and Treatment Flow Chart]]||March-09
|-
|10.13||[[Spinal Injury Assessment Critical Criteria]]||March-09
|}

===Section 11 - Medical Director Memos===
{| class="wikitable sortable"
|-
! Subject !! Effective Date
|-
| [[Memo - Opening of Oviedo Medical Center|Opening of Oviedo Medical Center]] || 2017-01-29
|-
| [[Memo - Blood Draws - Florida Hospital|Blood Draws - Florida Hospital]] || 2017-01-25
|-
| [[Memo - Medical Alerts|Medical Alerts]] || 2016-04-27
|-
| [[Memo - Discontinuation of Central Venous Access|Discontinuation of Central Venous Access]] || 2013-08-03
|-
| [[Memo - Shortage of Atropine|Shortage of Atropine]] || 2013-04-11
|-
| [[Memo - EMS Blood Draws for SSCH|EMS Blood Draws for SSCH]] || 2013-03-07
|-
| [[Memo - Respiratory Breathing Treatments|Respiratory/Breathing Treatments]] || 2012-12-19
|-
| [[Memo - OB Transports|OB Transports]] || 2011-01-14
|-
| [[Memo - Aspirin Administration Documentation|Aspirin Administration Documentation]] || 2010-12-01
|-
| [[Memo - Alert Terminology|Alert Terminology]] || 2010-05-06
|}

Medication Temperature Monitoring

2020-11-16T15:39:18Z

Mfrdmanager: /* 9.37 MEDICATION TEMPERATURE CONTROL */

==Section 9 - Procedure Guidelines==
===9.35 MEDICATION TEMPERATURE CONTROL===

'''INDICATIONS:'''
* All medications must be temperature controlled. Using the TempStick temperature monitoring device will provide instantaneous measurements of the stored medications and send instant notifications if the temperature rises or falls below a defined temperature range.

'''PROCEDURE'''
* If at anytime an alarm is triggered due to exceeding the designated medication temperature ranges (35 degrees and 85 degrees), a notification will be sent to all EMS Officers and immediate actions will take place to fix the temperature issue.

'''EQUIPMENT:'''
* TempStick Temperature Monitoring Device

[[File:tempstick.jpg|left|Temperature Monitoring Device]]

[[Category:Procedure Guidelines|0924]]

Combat Application Tourniquet

2020-11-16T15:38:54Z

Mfrdmanager: /* 9.35 COMBAT APPLICATION TOURNIQUET */

==Procedure Guidelines==
===9.33 COMBAT APPLICATION TOURNIQUET===

Severe traumatic extremity injuries with uncontrolled bleeding may sometimes require the application of a tourniquet. The SOF T Tourniquet is designed to provide effective pressure on the injured extremity to occlude arterial bleeding. See PP 6.06 “[[Extremity Injuries]]” for indications.

====FEATURES:====
The SOF T uses a self-adhering band and friction adaptor buckle to fit a wide range of extremity sizes combined with a one-handed windlass system. The windlass system uses a free moving internal band to provide even circumferential pressure to the extremity.

[[File:Wide_Tourniquets_1-black_tourniquet.jpg|400px|left|Combat Application Tourniquet]]

 

====APPLICATION PROCEDURE:====
* SOF T
** Step 1
***Apply tourniquet proximal to the bleeding site.
***Route the band around the limb and pass the tip through the inside slit of the buckle.
***Pull the band tight.
**Step 2
***Pass the tip through the outside slit of the buckle.
***The friction buckle will lock the band in place.
**Step 3
***Pull the band very tight and securely fasten the band back on itself.
**Step 4
***Twist the rod '''until bright red bleeding has stopped and the distal pulse is eliminated'''.
**Step 5
***Place the rod inside the clip; locking it in place.
***'''Check for bleeding and distal pulse'''.
****If bleeding is not controlled, consider additional tightening or applying a second tourniquet proximal side by side to the first and reassess.
**Step 6
***Secure the rod inside the clip with the strap.
***'''Prepare the patient for transport and reassess'''.
***Record the time of application.

[[File:Wide_Tourniquets_1-black_tourniquet.jpg|400px|left|Combat Application Tourniquet]]
[[Category:Procedure Guidelines|0936]]

Medication Administration Cross Check

2020-11-16T15:38:40Z

Mfrdmanager: /* 9.34 MEDICATION ADMINISTRATION CROSS CHECK */

==Section 9 - Procedure Guidelines==
===9.32 MEDICATION ADMINISTRATION CROSS CHECK===

With the reliance of medications as one of the primary treatment interventions during patient care it is important to recognize these products have potential harm as well as benefits. Patients could be harmed if the wrong medication, dose, concentration, or route of administration is used. To complicate matters, medications often come in similar packaging; have similar look-alike/sound-alike names which can further enhance the error potential. It is incumbent upon the entire EMS crew to be vigilant and observe careful medication administration protocol to reduce and prevent medical errors.

The provider administering any medication will follow the Medication Administration Cross Check (MACC) procedure each time any medication is used.

'''Medication Administration Cross Check Procedure:'''
* All MFRD Paramedics shall check the following prior to medication administration:
** '''Five patient rights'''
***Right Patient
***Right DRUG
***Right DOSE
***Right ROUTE
***Right Time
** Confirm any '''MEDICATION ALLERGIES''' that the patient may have and determine if there are any contraindications to administering the selected medicine.
** Confirm that the medication is '''NOT EXPIRED'''.
* The medication should be confirmed at each of the following steps:
** When the medication is retrieved from the drug box:
*** Check for correct medication
*** Check expiration date
****'''Do not use''' if medication is expired
** When the medication is drawn or IV bag is primed just prior to administration:
*** Confirm it is the correct medication
*** Confirm it is the correct dose
*** Confirm the medication is not expired
* If one provider selects or draws the medication but is given by another provider the two providers must have verbal confirmation of these checks:
** Provider 1 (drawing the medication) shall verbalize to the administering provider the following:
*** Name of medication
*** Dose of medication and any dilution used
*** Medication is not expired
** Provider 2 (administering the medication) shall confirm the information is accurate prior to administration.
'''Documentation:'''
* It is incumbent upon all providers to properly document on the incident run report all medications administered including name, dose, concentration (if applicable), route of administration and response to the medication.
* The provider must also describe the process in which the medication was identified and cross check completed in the patient report.

{| class="wikitable"
|-
! '''WARNING:'''
|-
| '''Medication Administration Cross Check''' is a required part of the administration procedure. All personnel must follow this procedure to prevent medication errors.
MFRD Paramedics must consider the '''RISK vs. BENEFIT''' of any medication given as medications may have adverse or lethal effects for the patient.
|}
[[Category:Procedure Guidelines|0935]]

Central Venous Access Devices

2020-11-16T15:38:25Z

Mfrdmanager: /* 9.33 CENTRAL VENOUS ACCESS DEVICES */

==Section 9 - Procedure Guidelines==
===9.31 CENTRAL VENOUS ACCESS DEVICES===

Central Venous Access Devices (CVAD) or central venous catheters are used as the mainstay of treatment for patients requiring long term administration of medications or providing medical treatments such as antibiotics, chemotherapy or dialysis. These devices may be maintained with normal saline or heparin to prevent clotting or occluding the catheter.

'''When to use:'''
* Maitland Fire Rescue Paramedics are authorized to access only '''Peripherally Inserted Central Catheters (PICC) and central venous catheters''' under the following conditions:
** After two peripheral IV attempts have been unsuccessful.
** Life-threatening event requiring immediate medication or fluid administration.
** Major trauma.
** Cardiac arrest.
* MFRD Paramedics '''are not authorized''' to access dialysis shunts or implanted ports.

'''How to identify:'''
* Central venous access devices come in a variety of styles. Always inquire, if possible, from the patient or family what type of access device is implanted on the patient.
** PICC lines are usually single or double lumen (port) with a smaller size tubing inserted into the forearm or upper arm of the patient.
** Central venous catheters may have from one to three lumens (ports) and are usually inserted near the neck and into the subclavian vein.
** Implanted ports are located in the chest wall and they resemble a triangular or round device under the skin of the patient. These have no exposed ports or lines and must be accessed with a special needle.
** Dialysis catheters are usually large caliber lines with one venous (blue) and one arterial port (red).

'''Procedure:'''
* Identify the location of the central venous access device.
* Cleanse the access port with alcohol or betadine.
* Central lines have clamps on each access port. Keep all clamps secured except the one being used for infusion.
* Any time the central line port is accessed and line or CLAVE type port being connected, the clamp must be secured to prevent air from entering the line. An open line can aspirate air into it causing an air embolus.
* Use a large syringe (12-20 ml) with a luer adapter to connect to the central line port.
* '''ASPIRATE''' the line gently and withdraw 10-15 ml of fluid and blood until you have only blood on the line.
** This is done to aspirate the saline or heparin that was previously infused to maintain the line.
* '''DO NOT PUSH/FLUSH''' the contents of the catheter into the bloodstream!
** If the catheter is heparinized it will cause coagulation changes and may be detrimental to the patient.
* Discard the syringe used to aspirate the contents of the catheter.
* Cleanse the access port again before inserting a new saline filled syringe.
* Using a new 12-20 ml syringe filled with normal saline, gently flush the line in and assess for patency.
** The line should flow smoothly without resistance.
** If the line is difficult to flush or you are unable to flush – '''DO NOT USE!'''
*** In the event the line cannot be flushed look for another IV site or gain access using an IO device.
* Once the line is accessed, connect IV tubing and infuse normal saline at the appropriate rate.
** Central lines and PICCs, once accessed must have continuous fluid infusion at a minimum of a KVO rate.
* MFRD Paramedics are not authorized to discontinue the infusion once it is started and the line is flowing patent.
** Hospital staff must evaluate infusion before disconnecting or removing access based on their policies.

'''Contraindications:'''
* Central Venous Access Devices must not be used:
** If a peripheral IV access can be easily attained
** As a preventative measure – prophylactic IV line
** The device is known to be occluded
** It is suspected to be infected or be the source of infection
** If other medications are already infusing through the line (compatibility problem)

{| class="wikitable"
|-
! '''WARNING'''
|-
| Central Venous Access Devices should be utilized ONLY if no other IV access can be obtained rapidly and before intraosseous access is performed during a '''LIFE-THREATENING''' emergency.
MFRD Paramedics must consider the '''RISK vs. BENEFIT''' of accessing these types of devices and use only when it is in the best interest of the patient.
|}
[[Category:Procedure Guidelines|0934]]

Emergency Escharotomy

2020-11-16T15:38:09Z

Mfrdmanager: /* 9.32 Emergency Chest Wall Escharotomy */

==Procedure Guidelines==
===9.30 Emergency Chest Wall Escharotomy===

====DEFINITION:====
* The Emergency Chest Wall Escharotomy is indicated when full-thickness circumferential and near-circumferential skin burns over the torso result in the formation of a tough, inelastic mass of burnt tissue (eschar). The eschar, by virtue of this inelasticity, results in the burn-induced significant compromise of chest wall excursions and can hinder ventilation. Similarly, airway patency and venous return may be compromised by circumferential burns involving the neck.
* Emergency Chest Wall Escharotomy is the surgical division of the nonviable eschar, which allows the cutaneous envelope to become more compliant. Hence, the underlying tissues have an increased available volume to expand into, preventing further tissue injury or functional compromise (see image below).
[[File:Chest_Burn.jpg|none|300px|]]

====INDICATIONS:====
* Patients presenting with circumferential or near-circumferential 2nd degree or higher burns to the torso with an impending or established respiratory compromise as a result of the burns.

====CONTRAINDICATIONS:====
* On patients with an impending or established respiratory/ventilator compromise as a result of circumferential or near-circumferential 2nd degree or higher burns to the torso there are no contraindications for this procedure.

====COMPLICATIONS:====
* May include continued respiratory compromise due to inadequate ventilation as a result of a partial or incomplete release of eschar.
* Excessive bleeding
* Incision or injury to underlying healthy tissue including neurovascular structures
* Infection

====PROCEDURE:====
* The patient is placed in a supine position while maintaining ventilatory support efforts.
* Time permitting – cleanse the area of any excess debri or loose clothing.
* Utilizing a surgical scalpel carry the incision of the eschar down through the level of the subcutaneous fat. An immediate release in tissue pressure is experienced often as a discernible popping sensation.
* Carry the incisions approximately 1 cm proximal, lateral and distal to the extent of the burn.
* Once the escharotomy is performed, monitor for improvement in ventilation as evidenced by improved compliance of ventilations using a bag/valve device, visible chest rise and improvements in oxygen saturation.
* If improved compliance is not seen after the initial incision, revise the escharotomy in an attempt to improved ventilatory support.
* Once completed, cover the torso / chest wall area with a sterile burn sheet.
* Maintain continuous monitoring of the patient’s respiratory compliance and oxygenation.
[[File:Escharotomy.jpg|none|400px|]]

[[Category:Procedure Guidelines|0932]]

Maitland Fire Rescue Department Practice Parameters

2020-11-16T15:37:39Z

Mfrdmanager: /* Section 9 - Procedure Guidelines */

__NOTOC__
==TABLE OF CONTENTS==

[[Medical Director Authorization]]

===Section 1 - Administrative Policies===

{| class="wikitable"
|-
! Section !! Description !! Revision Date
|-
| 1.01 || [[General Measures]] || April-16
|-
| 1.02 || [[Radio Report Format]] || March-16
|-
| 1.03 || [[Refusal of Service]] || October-17
|-
| 1.04 || [[Physician or Nurse on Scene]] || March-09
|-
| 1.05 || [[Initiation of CPR and Determination of Death]] || July-16
|-
| 1.06|| [[Determination of Death in Trauma]]|| March-09
|-
| 1.07|| [[Crime or Unattended Death Scene]] || March-09
|-
| 1.08|| [[Medical Evaluation of Person in Police Custody]]|| March-09
|-
| 1.09|| [[Trauma Transport Protocol]]|| Dec-19
|-
| 1.10|| [[Emergency Transport]]|| March-09
|-
| 1.11|| [[Criteria for Helicopter Transport]]|| March-09
|-
| 1.12|| [[Medical Patient Transport Decision]]|| April-14
|-
| 1.13|| [[Obstetrical Patient Transport Decision]]|| Feb-15
|-
| 1.14|| [[Emergency Inter Facility Transport]]|| March-09
|-
| 1.15|| [[EMS Disaster Response Level]]|| March-09
|-
| 1.16|| [[EMS Offload Policy]]|| March-09
|-
| 1.17|| [[EMS Quality Improvement Program]]|| March-09
|-
| 1.18|| [[Scope of Practice]]|| March-09
|-
| 1.19|| [[Freestanding ED Transport Criteria]]|| October-13
|-
| 1.20|| [[Hospital Capability Chart]]|| May-18
|-
| 1.21|| [[Documentation Guidance]]|| June-17
|}

===Section 2 - Primary Care===

{| class="wikitable"
|-
! Section !! Description !! Revision Date
|-
| 2.01 ||[[Initial Medical Assessment and Care]]||March-09
|-
|2.02 ||[[Initial Trauma Assessment and Care]]||September-17
|-
||2.03 ||[[Rapid Trauma Assessment, Focused History and Physical Exam]]||Sept-15
|-
||2.04||[[Analgesia and Sedation]]||November-2017
|-
||2.05||[[Drug Assisted Intubation]]||December-2016
|}

===Section 3 - Respiratory===

{| class="wikitable"
|-
! Section !! Description !! Revision Date
|-
| 3.01|| [[Acute Asthma or COPD with Wheezing]]|| February-19
|-
| 3.02|| [[Carbon Monoxide Inhalation]]|| March-09
|-
| 3.03|| [[Foreign Body Airway Obstruction]]|| March-09
|-
| 3.04|| [[Infectious Upper Airway Obstruction - Croup or Epiglottitis]]|| April-16
|-
| 3.05|| [[Severe Respiratory Pathogens]]|| November-10
|-
| 3.06|| [[Anxiety / Hyperventilation]]|| February-11
|}

===Section 4 - Cardiac===
{| class="wikitable"
|-
! Section !! Description !! Revision Date
|-
|4.01 || [[Chest Pain Acute Coronary Syndrome]]||Sept-17
|-
|4.02 || [[Asystole]]||April-16
|-
|4.03 || [[Atrial Fibrillation Atrial Flutter]]||June-17
|-
|4.04||[[Pulseless Electrical Activity (PEA)]]||January-16
|-
|4.05||[[Premature Ventricular Contractions (PVC)]]||May-12
|-
|4.06||[[Supraventricular Bradycardia and AV Blocks]]||March-09
|-
|4.07||[[Supraventricular Tachycardia]]||April-12
|-
|4.08||[[Ventricular Fibrillation Pulseless Ventricular Tachycardia]]||December-16
|-
|4.09||[[Ventricular Tachycardia with a Palpable Pulse]]||July-12
|-
|4.10||[[Wide Complex Tachycardia Uncertain Origin]]||May-12
|-
|4.11||[[Acute Cardiogenic Pulmonary Edema Pneumonia]]||March-09
|-
|4.12||[[Code Cool Post ROSC Induced Hypothermia]]||March-09
|-
|4.13||[[Adult Immediate Post-Cardiac Arrest Care]]||April-12
|-
|4.14||[[Ventricular Assist Devices]]||August-18
|}

===Section 5 - Medical===

{| class="wikitable"
|-
! Section !! Description !! Revision Date
|-
|5.01||[[Acute Abdominal Pain]]||April-16
|-
|5.02||[[Allergic Reaction Anaphylactic Shock]]||April-16
|-
|5.03||[[Altered Mental Status (AMS)]]||April-17
|-
|5.04||[[Suspected Stroke Transcient Ischemic Attack TIA|Suspected Stroke or Transcient Ischemic Attack]]||May-18
|-
|5.05||[[Drug Overdose Poisoning]]||March-09
|-
|5.06||[[Cold Emergencies]]||April-12
|-
|5.07||[[Heat Emergencies]]||August-15
|-
|5.08||[[Hazardous Materials]]||March-09
|-
|5.09||[[Severe Hypertension]]||March-09
|-
|5.10||[[Hypo or Hyperglycemia]]||April-16
|-
|5.11||[[Psychological Behavioral Emergencies]]||March-09
|-
|5.12||[[Seizure]]||April-16
|-
|5.13||[[Shock]]||March-09
|-
|5.14||[[Sickle Cell Anemia Crisis]]||March-09
|-
|5.15||[[Syncope]]||March-09
|-
|5.16||[[Vertigo]]||March-09
|-
|5.17||[[Sepsis Septic Shock]]||September-17
|-
|5.18||[[Suspected Kidney Stone]]||April-16
|-
|5.19||[[Cyanide Poisoning]]||April-16
|-
|5.20||[[Excited Delirium or Drug Induced Agitation]]||November-17
|-
|5.21||[[Ebola Virus Disease Patient Management]]||October-14
|-
|5.22||[[Acute Adrenal Insufficiency]]||June-18
|}

===Section 6 - Trauma===
{| class="wikitable"
|-
! Section !! Description !! Revision Date
|-
|6.01||[[Animal Bites Stings]]||March-09
|-
|6.02||[[Burns - Thermal, Electrical, Chemical]]||March-09
|-
|6.03||[[Selective Spinal Immobilization]]||August-14
|-
|6.04||[[Chest Injuries]]||March-09
|-
|6.05||[[Decompression Sickness or Dysbarism]]||March-09
|-
|6.06||[[Extremity Injuries]]||Feb-15
|-
|6.07||[[Head Injuries]]||November-17
|-
|6.08||[[Near Drowning]]||March-09
|-
|6.09||[[Ophthalmic Injuries]]||March-09
|-
|6.10||[[Suspected Abuse Neglect]]||March-09
|-
|6.11||[[Suspected Sexual Assault]]||March-09
|-
|6.12||[[Trunk Penetrating Injuries]]||April-12
|-
|6.13||[[Hemorrhagic Shock]]||October-18
|}

===Section 7 - Pediatric and Obstetrical===
{| class="wikitable"
|-
! Section !! Description !! Revision Date
|-
|7.01||[[Pediatric Asystole]]||April-16
|-
|7.02||[[Pediatric Pulseless Electrical Activity PEA]]||April-16
|-
|7.03||[[Pediatric Tachycardia, Ventricular Fibrillation or Pulseless Ventricular Tachycardia]]||April-16
|-
|7.04||[[Pregnancy Induced Hypertension (PIH)]]||March-09
|-
|7.05||[[Preterm Labor]]||November-17
|-
|7.06||[[Emergency Childbirth]]||November-17
|-
|7.07||[[Childbirth Complications]]||November-17
|-
|7.08||[[Newborn Care]]||April-16
|-
|7.09||[[Post Partum Care]]||November-17
|-
|7.10||[[Pediatric Febrile Emergency]]||April-16
|-
|7.11||[[Vaginal Bleeding]]||March-09
|-
|7.12||[[Trauma In Pregnancy]]||March-09
|}

===Section 8 - Medication Guidelines===
INTRODUCTION
The following pages contain guidelines for the medications commonly encountered by the Paramedic. They identify the name and class of the drug, a short description, indications, contraindications, precautions, and dosages. This is only a guideline to medication administration and shall not circumvent the need to refer to the appropriate Standing Order or to contact Medical Control for orders and consultation. For detailed and extensive information on each drug, refer to the Physician's Desk Reference, the Advanced Cardiac Life Support text or an emergency pre-hospital pharmacology reference.

Certain medications listed have various dosages depending on the patient's condition. Refer to the appropriate Standing Order or contact Medical Control for specific dosage information. All IV piggyback medications must be placed on a micro-gtt. solution set for field administration and if available, an infusion pump or infusion regulator MUST BE UTILIZED.

The following medications are authorized to be administered by Maitland Fire Rescue EMS:

{| class="wikitable"
|-
! Medication Name!! Revision Date
|-
|[[Acetaminophen]]||March-09
|-
|[[Adenosine]]||January-20
|-
|[[Albuterol]]||April-16
|-
|[[Aspirin]]||March-09
|-
|[[Ativan]]||April-16
|-
|[[Atropine]]||July-17
|-
|[[Atrovent]]||April-16
|-
|[[Calcium Chloride]]||April-16
|-
|[[Cardizem]]||July-17
|-
|[[Cyanokit]]||April-16
|-
|[[Dextrose 10%]]||April-16
|-
|[[Dextrose 50%]]||April-16
|-
|[[Diphenhydramine]]||April-16
|-
|[[Dopamine]]||April-16
|-
|[[Epinephrine]]||April-16
|-
|[[Etomidate]]||April-16
|-
|[[Fentanyl]]||November-16
|-
|[[Flumazenil]]||April-16
|-
|[[Glucagon]]||April-16
|-
|[[Ketamine]]||November-17
|-
|[[Lasix]]||April-16
|-
|[[Lidocaine]]||July-17
|-
|[[Magnesium Sulfate]]||April-16
|-
|[[Morphine Sulfate]]||November-16
|-
|[[Naloxone]]||April-16
|-
|[[Nitro Drip]]||April-17
|-
|[[Nitro Spray]]||April-17
|-
|[[Nitro Tablets]]||April-17
|-
|[[Nitrous Oxide]]||November-16
|-
|[[Oxygen]]||March-09
|-
|[[Pepcid]]||April-16
|-
|[[Pontocaine]]||November-17
|-
|[[Promethazine]]||April-16
|-
|[[Racemic Epinephrine]]||April-16
|-
|[[Sodium Bicarbonate]]||April-16
|-
|[[Solu-Medrol]]||January-17
|-
|[[Toradol]]||March-09
|-
|[[TXA]]||October-20
|-
|[[Xopenex]]||April-16
|-
|[[Vasopressin]]||October-13
|-
|[[Valium]]||April-16
|-
|[[Versed]]||April-16
|-
|[[Zofran]]||April-16
|-
|[[Medication Infusion Tables]]||
|}

===Section 9 - Procedure Guidelines===
{| class="wikitable"
|-
! Section !! Description !! Revision Date
|-
|9.00||[[LUCAS Device]]||July-16
|-
|9.01||[[Pneupac VR1 Ventilator]]||March-09
|-
|9.02||[[Blood Alcohol Draw on Scene]]||March-09
|-
|9.03||[[Blood Draw using Vacutainer]]||March-09
|-
|9.04||[[Blood Glucose Test]]||March-09
|-
|9.05||[[Buretrol Usage]]||March-09
|-
|9.06||[[Cardiac Monitor]]||April-12
|-
|9.07||[[Cardioversion]]||March-09
|-
|9.08||[[Continuous Positive Airway Pressure Device]]||March-09
|-
|9.09||[[Cricothyrotomy Needle]]||March-09
|-
|9.10||[[Cricothyrotomy Surgical]]||March-09
|-
|9.11||[[Defibrillation]]||March-09
|-
|9.12||[[Defibrillation Pediatric]]||March-09
|-
|9.13||[[End Tidal CO2 Monitoring / Capnography]]||March-09
|-
|9.14.1||[[Intraosseous Infusion - Femoral]]||February-15
|-
|9.14.2||[[Intraosseous Infusion - Humeral Head]]||December-16
|-
|9.15||[[Intubation Endotracheal]]||March-09
|-
|9.16||[[Intubation Nasotracheal]]||March-09
|-
|9.17||[[Braun Syringe Infusion Pump]]||March-14
|-
|9.18||[[King Tube]]||March-09
|-
|9.19||[[Medication Administration Intramuscular]]||March-09
|-
|9.20||[[Medication Administration Nasal Atomizer]]||March-09
|-
|9.21||[[Medication Administration Nebulizer]]||March-09
|-
|9.22||[[Medication Administration Subcutaneous]]||March-09
|-
|9.23||[[Nasogastric/Orogastric Tube]]||March-09
|-
|9.24||[[Oxygen Administration]]||March-09
|-
|9.25||[[Peripheral IV Administration]]||March-09
|-
|9.26||[[Pleural Decompression]]||March-09
|-
|9.27||[[Removal of Taser Probes]]||March-09
|-
|9.28||[[Reconstitution of Medications]]||March-09
|-
|9.29||[[Transcutaneous Pacing Procedure]]||March-09
|-
|9.30||[[Emergency Escharotomy|Emergency Chest Wall Escharotomy]]||April-11
|-
|9.31||[[Central Venous Access Devices]]||June-12
|-
|9.32||[[Medication Administration Cross Check]]||Jun-12
|-
|9.33||[[Combat Application Tourniquet]]||Jan-14
|-
|9.34||[[http://lifevest.zoll.com/medical-professionals/first-responder-resources Zoll LifeVest Wearable Defibrillator]||Dec-14
|-
|9.35||[[Medication Temperature Monitoring]]||Feb-19
|}

===Section 10 - References===
{| class="wikitable"
|-
! Section !! Description !! Revision Date
|-
|10.01||[[Abbreviations]]||March-09
|-
|10.02||[[Apgar Score]]||March-09
|-
|10.03||[[Glasgow Coma Score]]||March-09
|-
|10.04||[[Pediatric Vital Signs]]||March-09
|-
|10.05||[[Adult Trauma Alert Criteria]]||March-09
|-
|10.06||[[Pediatric Trauma Alert Criteria]]||March-09
|-
|10.07||[[Pediatric Trauma Score]]||March-09
|-
|10.08||[[Nitroglycerin Drip]]||March-09
|-
|10.09||[[Checking Range of Motion]]||March-09
|-
|10.10||[[Rules of Nine]]||March-09
|-
|10.11||[[Florida Statutes]]||March-09
|-
|10.12||[[Evaluation and Treatment Flow Chart]]||March-09
|-
|10.13||[[Spinal Injury Assessment Critical Criteria]]||March-09
|}

===Section 11 - Medical Director Memos===
{| class="wikitable sortable"
|-
! Subject !! Effective Date
|-
| [[Memo - Opening of Oviedo Medical Center|Opening of Oviedo Medical Center]] || 2017-01-29
|-
| [[Memo - Blood Draws - Florida Hospital|Blood Draws - Florida Hospital]] || 2017-01-25
|-
| [[Memo - Medical Alerts|Medical Alerts]] || 2016-04-27
|-
| [[Memo - Discontinuation of Central Venous Access|Discontinuation of Central Venous Access]] || 2013-08-03
|-
| [[Memo - Shortage of Atropine|Shortage of Atropine]] || 2013-04-11
|-
| [[Memo - EMS Blood Draws for SSCH|EMS Blood Draws for SSCH]] || 2013-03-07
|-
| [[Memo - Respiratory Breathing Treatments|Respiratory/Breathing Treatments]] || 2012-12-19
|-
| [[Memo - OB Transports|OB Transports]] || 2011-01-14
|-
| [[Memo - Aspirin Administration Documentation|Aspirin Administration Documentation]] || 2010-12-01
|-
| [[Memo - Alert Terminology|Alert Terminology]] || 2010-05-06
|}

Transcutaneous Pacing Procedure

2020-11-16T15:34:20Z

Mfrdmanager: /* 9.30 TRANSCUTANEOUS PACING PROCEDURE */

==Procedure Guidelines==
===9.29 TRANSCUTANEOUS PACING PROCEDURE===

'''INDICATIONS:'''
* [[Asystole|Asystole Practice Parameter]] 4.02
* [[Supraventricular Bradycardia and AV Blocks|Supraventricular Bradycardia and A.V. Blocks Practice Parameter]] 4.09
* [[Pulseless Electrical Activity (PEA)|PEA with Absolute Bradycardia Parameter]] 4.04
'''PROCEDURE:'''
* Apply monitor and determine rhythm.
* Stop CPR, (if applicable).
* Place electrodes in proper position.
** Place the negative pad and negative pacer wire on left anterior chest, halfway between the xiphoid process and the left nipple, with the upper edge of the electrode below the nipple line.
** Place the positive pad and positive pacer wire on left posterior chest beneath the scapula and lateral to the spine.
* Turn the pacer on:
** Precautions: Pacemaker output may cause excessive pain/distress in the conscious patient. Consider administration of [[Sedative Hypnotics|Diazepam]] 2 -10 mg slow IVP.
* Set the rate at 70 beats per minute.
* Slowly increase milliamps until electrical and mechanical capture is achieved or maximum output is reached.
* Keep checking for a carotid or femoral pulse to determine the response to the pacing, (mechanical capture).
* If no response to maximum pacing output, interrupt pacing and proceed with appropriate protocol. Continue CPR, (if applicable).
* Leave pacing electrodes in place during drug therapy and check every 5 - 10 minutes for capture in maximum output setting if not successful initially.
* If capture present and patient remains hypotensive, increase rate of pacing, (do not exceed 80 BPM).

'''STANDBY PACING:'''
* Turn the pacer on.
''
'''Precautions: Pacemaker output may cause excessive pain/distress in the conscious patient. Consider administration of [[Sedative Hypnotics|MIDAZOLAM]] 1 -5 mg slow IVP to desired effect.'''''
* Set rate at 70 BPM.
* Set milliamps at 70.
* If patient becomes unstable, slowly increase milliamps until electrical and mechanical capture is achieved or maximum output is reached.

[[Category:Procedure Guidelines|0930]]

Maitland Fire Rescue Department Practice Parameters

2020-11-16T15:33:28Z

Mfrdmanager: /* Section 9 - Procedure Guidelines */

__NOTOC__
==TABLE OF CONTENTS==

[[Medical Director Authorization]]

===Section 1 - Administrative Policies===

{| class="wikitable"
|-
! Section !! Description !! Revision Date
|-
| 1.01 || [[General Measures]] || April-16
|-
| 1.02 || [[Radio Report Format]] || March-16
|-
| 1.03 || [[Refusal of Service]] || October-17
|-
| 1.04 || [[Physician or Nurse on Scene]] || March-09
|-
| 1.05 || [[Initiation of CPR and Determination of Death]] || July-16
|-
| 1.06|| [[Determination of Death in Trauma]]|| March-09
|-
| 1.07|| [[Crime or Unattended Death Scene]] || March-09
|-
| 1.08|| [[Medical Evaluation of Person in Police Custody]]|| March-09
|-
| 1.09|| [[Trauma Transport Protocol]]|| Dec-19
|-
| 1.10|| [[Emergency Transport]]|| March-09
|-
| 1.11|| [[Criteria for Helicopter Transport]]|| March-09
|-
| 1.12|| [[Medical Patient Transport Decision]]|| April-14
|-
| 1.13|| [[Obstetrical Patient Transport Decision]]|| Feb-15
|-
| 1.14|| [[Emergency Inter Facility Transport]]|| March-09
|-
| 1.15|| [[EMS Disaster Response Level]]|| March-09
|-
| 1.16|| [[EMS Offload Policy]]|| March-09
|-
| 1.17|| [[EMS Quality Improvement Program]]|| March-09
|-
| 1.18|| [[Scope of Practice]]|| March-09
|-
| 1.19|| [[Freestanding ED Transport Criteria]]|| October-13
|-
| 1.20|| [[Hospital Capability Chart]]|| May-18
|-
| 1.21|| [[Documentation Guidance]]|| June-17
|}

===Section 2 - Primary Care===

{| class="wikitable"
|-
! Section !! Description !! Revision Date
|-
| 2.01 ||[[Initial Medical Assessment and Care]]||March-09
|-
|2.02 ||[[Initial Trauma Assessment and Care]]||September-17
|-
||2.03 ||[[Rapid Trauma Assessment, Focused History and Physical Exam]]||Sept-15
|-
||2.04||[[Analgesia and Sedation]]||November-2017
|-
||2.05||[[Drug Assisted Intubation]]||December-2016
|}

===Section 3 - Respiratory===

{| class="wikitable"
|-
! Section !! Description !! Revision Date
|-
| 3.01|| [[Acute Asthma or COPD with Wheezing]]|| February-19
|-
| 3.02|| [[Carbon Monoxide Inhalation]]|| March-09
|-
| 3.03|| [[Foreign Body Airway Obstruction]]|| March-09
|-
| 3.04|| [[Infectious Upper Airway Obstruction - Croup or Epiglottitis]]|| April-16
|-
| 3.05|| [[Severe Respiratory Pathogens]]|| November-10
|-
| 3.06|| [[Anxiety / Hyperventilation]]|| February-11
|}

===Section 4 - Cardiac===
{| class="wikitable"
|-
! Section !! Description !! Revision Date
|-
|4.01 || [[Chest Pain Acute Coronary Syndrome]]||Sept-17
|-
|4.02 || [[Asystole]]||April-16
|-
|4.03 || [[Atrial Fibrillation Atrial Flutter]]||June-17
|-
|4.04||[[Pulseless Electrical Activity (PEA)]]||January-16
|-
|4.05||[[Premature Ventricular Contractions (PVC)]]||May-12
|-
|4.06||[[Supraventricular Bradycardia and AV Blocks]]||March-09
|-
|4.07||[[Supraventricular Tachycardia]]||April-12
|-
|4.08||[[Ventricular Fibrillation Pulseless Ventricular Tachycardia]]||December-16
|-
|4.09||[[Ventricular Tachycardia with a Palpable Pulse]]||July-12
|-
|4.10||[[Wide Complex Tachycardia Uncertain Origin]]||May-12
|-
|4.11||[[Acute Cardiogenic Pulmonary Edema Pneumonia]]||March-09
|-
|4.12||[[Code Cool Post ROSC Induced Hypothermia]]||March-09
|-
|4.13||[[Adult Immediate Post-Cardiac Arrest Care]]||April-12
|-
|4.14||[[Ventricular Assist Devices]]||August-18
|}

===Section 5 - Medical===

{| class="wikitable"
|-
! Section !! Description !! Revision Date
|-
|5.01||[[Acute Abdominal Pain]]||April-16
|-
|5.02||[[Allergic Reaction Anaphylactic Shock]]||April-16
|-
|5.03||[[Altered Mental Status (AMS)]]||April-17
|-
|5.04||[[Suspected Stroke Transcient Ischemic Attack TIA|Suspected Stroke or Transcient Ischemic Attack]]||May-18
|-
|5.05||[[Drug Overdose Poisoning]]||March-09
|-
|5.06||[[Cold Emergencies]]||April-12
|-
|5.07||[[Heat Emergencies]]||August-15
|-
|5.08||[[Hazardous Materials]]||March-09
|-
|5.09||[[Severe Hypertension]]||March-09
|-
|5.10||[[Hypo or Hyperglycemia]]||April-16
|-
|5.11||[[Psychological Behavioral Emergencies]]||March-09
|-
|5.12||[[Seizure]]||April-16
|-
|5.13||[[Shock]]||March-09
|-
|5.14||[[Sickle Cell Anemia Crisis]]||March-09
|-
|5.15||[[Syncope]]||March-09
|-
|5.16||[[Vertigo]]||March-09
|-
|5.17||[[Sepsis Septic Shock]]||September-17
|-
|5.18||[[Suspected Kidney Stone]]||April-16
|-
|5.19||[[Cyanide Poisoning]]||April-16
|-
|5.20||[[Excited Delirium or Drug Induced Agitation]]||November-17
|-
|5.21||[[Ebola Virus Disease Patient Management]]||October-14
|-
|5.22||[[Acute Adrenal Insufficiency]]||June-18
|}

===Section 6 - Trauma===
{| class="wikitable"
|-
! Section !! Description !! Revision Date
|-
|6.01||[[Animal Bites Stings]]||March-09
|-
|6.02||[[Burns - Thermal, Electrical, Chemical]]||March-09
|-
|6.03||[[Selective Spinal Immobilization]]||August-14
|-
|6.04||[[Chest Injuries]]||March-09
|-
|6.05||[[Decompression Sickness or Dysbarism]]||March-09
|-
|6.06||[[Extremity Injuries]]||Feb-15
|-
|6.07||[[Head Injuries]]||November-17
|-
|6.08||[[Near Drowning]]||March-09
|-
|6.09||[[Ophthalmic Injuries]]||March-09
|-
|6.10||[[Suspected Abuse Neglect]]||March-09
|-
|6.11||[[Suspected Sexual Assault]]||March-09
|-
|6.12||[[Trunk Penetrating Injuries]]||April-12
|-
|6.13||[[Hemorrhagic Shock]]||October-18
|}

===Section 7 - Pediatric and Obstetrical===
{| class="wikitable"
|-
! Section !! Description !! Revision Date
|-
|7.01||[[Pediatric Asystole]]||April-16
|-
|7.02||[[Pediatric Pulseless Electrical Activity PEA]]||April-16
|-
|7.03||[[Pediatric Tachycardia, Ventricular Fibrillation or Pulseless Ventricular Tachycardia]]||April-16
|-
|7.04||[[Pregnancy Induced Hypertension (PIH)]]||March-09
|-
|7.05||[[Preterm Labor]]||November-17
|-
|7.06||[[Emergency Childbirth]]||November-17
|-
|7.07||[[Childbirth Complications]]||November-17
|-
|7.08||[[Newborn Care]]||April-16
|-
|7.09||[[Post Partum Care]]||November-17
|-
|7.10||[[Pediatric Febrile Emergency]]||April-16
|-
|7.11||[[Vaginal Bleeding]]||March-09
|-
|7.12||[[Trauma In Pregnancy]]||March-09
|}

===Section 8 - Medication Guidelines===
INTRODUCTION
The following pages contain guidelines for the medications commonly encountered by the Paramedic. They identify the name and class of the drug, a short description, indications, contraindications, precautions, and dosages. This is only a guideline to medication administration and shall not circumvent the need to refer to the appropriate Standing Order or to contact Medical Control for orders and consultation. For detailed and extensive information on each drug, refer to the Physician's Desk Reference, the Advanced Cardiac Life Support text or an emergency pre-hospital pharmacology reference.

Certain medications listed have various dosages depending on the patient's condition. Refer to the appropriate Standing Order or contact Medical Control for specific dosage information. All IV piggyback medications must be placed on a micro-gtt. solution set for field administration and if available, an infusion pump or infusion regulator MUST BE UTILIZED.

The following medications are authorized to be administered by Maitland Fire Rescue EMS:

{| class="wikitable"
|-
! Medication Name!! Revision Date
|-
|[[Acetaminophen]]||March-09
|-
|[[Adenosine]]||January-20
|-
|[[Albuterol]]||April-16
|-
|[[Aspirin]]||March-09
|-
|[[Ativan]]||April-16
|-
|[[Atropine]]||July-17
|-
|[[Atrovent]]||April-16
|-
|[[Calcium Chloride]]||April-16
|-
|[[Cardizem]]||July-17
|-
|[[Cyanokit]]||April-16
|-
|[[Dextrose 10%]]||April-16
|-
|[[Dextrose 50%]]||April-16
|-
|[[Diphenhydramine]]||April-16
|-
|[[Dopamine]]||April-16
|-
|[[Epinephrine]]||April-16
|-
|[[Etomidate]]||April-16
|-
|[[Fentanyl]]||November-16
|-
|[[Flumazenil]]||April-16
|-
|[[Glucagon]]||April-16
|-
|[[Ketamine]]||November-17
|-
|[[Lasix]]||April-16
|-
|[[Lidocaine]]||July-17
|-
|[[Magnesium Sulfate]]||April-16
|-
|[[Morphine Sulfate]]||November-16
|-
|[[Naloxone]]||April-16
|-
|[[Nitro Drip]]||April-17
|-
|[[Nitro Spray]]||April-17
|-
|[[Nitro Tablets]]||April-17
|-
|[[Nitrous Oxide]]||November-16
|-
|[[Oxygen]]||March-09
|-
|[[Pepcid]]||April-16
|-
|[[Pontocaine]]||November-17
|-
|[[Promethazine]]||April-16
|-
|[[Racemic Epinephrine]]||April-16
|-
|[[Sodium Bicarbonate]]||April-16
|-
|[[Solu-Medrol]]||January-17
|-
|[[Toradol]]||March-09
|-
|[[TXA]]||October-20
|-
|[[Xopenex]]||April-16
|-
|[[Vasopressin]]||October-13
|-
|[[Valium]]||April-16
|-
|[[Versed]]||April-16
|-
|[[Zofran]]||April-16
|-
|[[Medication Infusion Tables]]||
|}

===Section 9 - Procedure Guidelines===
{| class="wikitable"
|-
! Section !! Description !! Revision Date
|-
|9.00||[[LUCAS Device]]||July-16
|-
|9.01||[[Pneupac VR1 Ventilator]]||March-09
|-
|9.02||[[Blood Alcohol Draw on Scene]]||March-09
|-
|9.03||[[Blood Draw using Vacutainer]]||March-09
|-
|9.04||[[Blood Glucose Test]]||March-09
|-
|9.05||[[Buretrol Usage]]||March-09
|-
|9.06||[[Cardiac Monitor]]||April-12
|-
|9.07||[[Cardioversion]]||March-09
|-
|9.08||[[Continuous Positive Airway Pressure Device]]||March-09
|-
|9.09||[[Cricothyrotomy Needle]]||March-09
|-
|9.10||[[Cricothyrotomy Surgical]]||March-09
|-
|9.11||[[Defibrillation]]||March-09
|-
|9.12||[[Defibrillation Pediatric]]||March-09
|-
|9.13||[[End Tidal CO2 Monitoring / Capnography]]||March-09
|-
|9.14.1||[[Intraosseous Infusion - Femoral]]||February-15
|-
|9.14.2||[[Intraosseous Infusion - Humeral Head]]||December-16
|-
|9.15||[[Intubation Endotracheal]]||March-09
|-
|9.16||[[Intubation Nasotracheal]]||March-09
|-
|9.17||[[Braun Syringe Infusion Pump]]||March-14
|-
|9.18||[[King Tube]]||March-09
|-
|9.19||[[Medication Administration Intramuscular]]||March-09
|-
|9.20||[[Medication Administration Nasal Atomizer]]||March-09
|-
|9.21||[[Medication Administration Nebulizer]]||March-09
|-
|9.22||[[Medication Administration Subcutaneous]]||March-09
|-
|9.23||[[Nasogastric/Orogastric Tube]]||March-09
|-
|9.24||[[Oxygen Administration]]||March-09
|-
|9.25||[[Peripheral IV Administration]]||March-09
|-
|9.26||[[Pleural Decompression]]||March-09
|-
|9.27||[[Removal of Taser Probes]]||March-09
|-
|9.28||[[Reconstitution of Medications]]||March-09
|-
|9.29||[[Transcutaneous Pacing Procedure]]||March-09
|-
|9.30||[[Transcutaneous Pacing Procedure]]||March-09
|-
|9.31||[[ResQGuard Impedance Threshold Device]]||April-11
|-
|9.32||[[Emergency Escharotomy|Emergency Chest Wall Escharotomy]]||April-11
|-
|9.33||[[Central Venous Access Devices]]||June-12
|-
|9.34||[[Medication Administration Cross Check]]||Jun-12
|-
|9.35||[[Combat Application Tourniquet]]||Jan-14
|-
|9.36||[http://lifevest.zoll.com/medical-professionals/first-responder-resources Zoll LifeVest Wearable Defibrillator]||Dec-14
|-
|9.37||[[Medication Temperature Monitoring]]||Feb-19
|}

===Section 10 - References===
{| class="wikitable"
|-
! Section !! Description !! Revision Date
|-
|10.01||[[Abbreviations]]||March-09
|-
|10.02||[[Apgar Score]]||March-09
|-
|10.03||[[Glasgow Coma Score]]||March-09
|-
|10.04||[[Pediatric Vital Signs]]||March-09
|-
|10.05||[[Adult Trauma Alert Criteria]]||March-09
|-
|10.06||[[Pediatric Trauma Alert Criteria]]||March-09
|-
|10.07||[[Pediatric Trauma Score]]||March-09
|-
|10.08||[[Nitroglycerin Drip]]||March-09
|-
|10.09||[[Checking Range of Motion]]||March-09
|-
|10.10||[[Rules of Nine]]||March-09
|-
|10.11||[[Florida Statutes]]||March-09
|-
|10.12||[[Evaluation and Treatment Flow Chart]]||March-09
|-
|10.13||[[Spinal Injury Assessment Critical Criteria]]||March-09
|}

===Section 11 - Medical Director Memos===
{| class="wikitable sortable"
|-
! Subject !! Effective Date
|-
| [[Memo - Opening of Oviedo Medical Center|Opening of Oviedo Medical Center]] || 2017-01-29
|-
| [[Memo - Blood Draws - Florida Hospital|Blood Draws - Florida Hospital]] || 2017-01-25
|-
| [[Memo - Medical Alerts|Medical Alerts]] || 2016-04-27
|-
| [[Memo - Discontinuation of Central Venous Access|Discontinuation of Central Venous Access]] || 2013-08-03
|-
| [[Memo - Shortage of Atropine|Shortage of Atropine]] || 2013-04-11
|-
| [[Memo - EMS Blood Draws for SSCH|EMS Blood Draws for SSCH]] || 2013-03-07
|-
| [[Memo - Respiratory Breathing Treatments|Respiratory/Breathing Treatments]] || 2012-12-19
|-
| [[Memo - OB Transports|OB Transports]] || 2011-01-14
|-
| [[Memo - Aspirin Administration Documentation|Aspirin Administration Documentation]] || 2010-12-01
|-
| [[Memo - Alert Terminology|Alert Terminology]] || 2010-05-06
|}

Trauma In Pregnancy

2020-11-13T17:36:45Z

Mfrdmanager:

==Section 7 - PEDIATRIC / OBSTETRICAL==
===7.12 Trauma in Pregnancy===

[[Initial Trauma Assessment and Care|INITIAL TRAUMA CARE PRACTICE PARAMETER (2.02)]] [[Oxygen|OXYGEN]] @ 100% via NRB mask or assist with BVM.
*Check for uterine contractions, vaginal bleeding and / or leaking amniotic fluid. Assess for fetal movements.
*Raise right side of backboard approximately 30 degrees.
*If hypotension / shock present, refer to [[Shock|SHOCK PRACTICE PARAMETER (5.13)]].
*If patient in labor refer to the [[Emergency Childbirth|EMERGENCY CHILDBIRTH PRACTICE PARAMETERS (7.06)]].

====EMERGENCY C-SECTION====
*Maternal health and well being should not be compromised to save a fetus of any gestational age.
*Emergency C-Section should only be considered when maternal death has verified and is determined to be irreversible
**Trauma that cannot support life accompanied by a rhythm that cannot support life.
**Trauma with [[Asystole|ASYSTOLE (4.02)]] or No vitals with [[Asystole|ASYSTOLE (4.02)]]
**'''''“Injuries and rhythm that is inconsistent with life.”'''''
* Fetus viability- 24 weeks gestational age or greater.
* For optimal survival C-Section should be performed within 4 minutes of maternal death
*Assess fetal heart tones if possible
* Prepare Equipment- OB kit, trauma pads, and infant resuscitation equipment.
* Locate anatomical landmarks for incision-Xiphoid Process and Pubis
* Using a scalpel, perform vertical incision midline between-Xiphoid Process and Pubis
** Cut through each layer of the abdominal wall with the scalpel and/or scissors.
**Lift skin and pull apart working through the layers
**Using the scalpel make initial incision in the uterus.
**Using scissors cut the uterine wall.
**Remove neonate,
**Suction the neonate’s airway.
**Double clamp the cord
**Keep the infant lower than the mother.
**Wait for the cord to stop pulsating,
**Record APGAR at 1 and 5 minutes.
**Transport to the appropriate facility.

[[File:Fundal_Heights.jpg|200px|thumb|left|Fundal Heights]]

[[Category:Pediatric and Obstetrical|0712]]

Vaginal Bleeding

2020-11-13T17:36:03Z

Mfrdmanager:

==Section 7 - PEDIATRIC / OBSTETRICAL==
===7.11 VAGINAL BLEEDING===

[[Initial Medical Assessment and Care|INITIAL MEDICAL CARE (2.01)]] - [[Oxygen|OXYGEN]] @ 100% via NRB mask or assist with BVM.
*Determine date of LMP; note passage of clots or tissue and save same for analysis.
* Examine perineum; DO NOT perform vaginal examination.

'''''Unknown pregnancy status and / or LMP, and / or known pregnancy in first six months:'''''
* Place patient in a position of comfort.
* If hypotensive, refer to [[Shock|SHOCK PRACTICE PARAMETER (5.13)]].
* If in active labor, refer to [[Emergency Childbirth|EMERGENCY CHILDBIRTH PRACTICE PARAMETERS (7.06)]].

'''''Third trimester bleeding:'''''
* Establish 2 large bore IV lines.
* Place patient in left lateral recumbent position.
* Mark fundal height and time of mark with pen; reassess fundal height every 20 minutes.
* If hypotensive, refer to [[Shock|SHOCK PRACTICE PARAMETER (5.13)]].
* If in active labor, refer to [[Emergency Childbirth|EMERGENCY CHILDBIRTH PRACTICE PARAMETERS (7.06)]].

[[Category:Pediatric and Obstetrical|0711]]

Pediatric Febrile Emergency

2020-11-13T14:25:44Z

Mfrdmanager:

==Section 7 - PEDIATRIC / OBSTETRICAL==
===7.10 PEDIATRIC FEBRILE EMERGENCY===

'''[[Initial Medical Assessment and Care|INITIAL MEDICAL CARE]] (2.01), [[Oxygen|OXYGEN]] @ 100% via NRB mask, via “blow by” or assist with BVM.'''
* Move patient to cool environment. (Cooler environment described as cooler than surrounding air or body temperature) - DO NOT CHILL PATIENT.
* Remove clothing if appropriate.
* If AMS, apply water to patient’s torso and lightly fan to facilitate evaporation process.
* If seizure activity present, refer to [[Seizure|SEIZURE PRACTICE PARAMETER]] (5.12).
* If the patient has experienced a febrile seizure, still has a temperature (>100.5 degrees), and has not been given acetaminophen within the last 4 hours.
** Administer [[Acetaminophen|ACETAMINOPHEN SUPPOSITORY]] as per the Handtevy System.
'''In a case of a pediatric febrile emergency where no oral [[Acetaminophen|ACETAMINOPHEN]] has been given or is not available, rectal suppositories may be administered.'''
* Definition of a febrile emergency in all children Temperature greater than 100.5° F AMS, and/or Febrile seizures
* All infants age four (4) months or less with a fever of 100.5° F or greater without any other symptoms are treated as a febrile emergency at all times

[[Category:Pediatric and Obstetrical|0710]]

Childbirth Complications

2020-11-13T14:25:03Z

Mfrdmanager: /* 7.07 CHILDBIRTH COMPLICATIONS */

==Section 7 - PEDIATRIC / OBSTETRICAL==
===7.07 CHILDBIRTH COMPLICATIONS===

[[Initial Medical Assessment and Care|INITIAL MEDICAL CARE (2.01)]], [[Oxygen|OXYGEN]] @ 100% via NRB mask or assist with BVM.

====BREECH BIRTH:====
'''''NEVER ATTEMPT TO PULL THE INFANT FROM THE VAGINA.'''''
* As soon as the legs are delivered, support the baby's body wrapped in a towel.
* After the shoulders are delivered, if face down, gently elevate the legs and trunk to facilitate delivery of the head.
* Head should deliver in 30 seconds. If NOT, reach two sterile gloved fingers into vagina to locate baby's mouth. Push vaginal wall away from baby's mouth to form an airway.
* Apply gentle pressure to the fundus. If head does NOT deliver in 2 minutes, keep your fingers in place to maintain the airway.

====PROLAPSED CORD:====
* Elevate mother's hips.
* Place sterile gloved hand into vagina between pubic bone and presenting part with cord between two fingers to monitor cord pulsations and exert counter-pressure on presenting part.
* Cover exposed cord with moist dressing and keep warm.

====Appropriate Obstetric Receiving Facilities====
*Central Florida Regional Hospital (Seminole)
*Florida Hospital Altamonte (Seminole)
*Oviedo Medical Center (Seminole)
*Winnie Palmer Hospital (Orange) '''''Call ORMC and transport at their directive'''''
*Florida Hospital Orlando (Orange)
*Winter Park Memorial (Orange)

[[Category:Pediatric and Obstetrical|0707]]

Preterm Labor

2020-11-13T14:24:23Z

Mfrdmanager: /* 7.05 PRETERM LABOR */

==Section 7 - PEDIATRIC / OBSTETRICAL==
===7.05 PRETERM LABOR===

* Patient must confirm POSITIVE pregnancy test and be between 20 and 35 weeks gestation.
* If patient states she is having regular contractions and is not having any SEVERE PAIN or HEAVY BLEEDING (i.e. suspected Placenta Previa or Abrupto Placenta).
** Administer [[Albuterol|ALBUTEROL]] 2.5 mg via updraft every 10 minutes while monitoring heart rate.

[[Obstetrical Patient Transport Decision|OBSTETRICAL TRANSPORT DESTINATION Practice Parameter]] (1.13)
*Patient known to be < 20 weeks gestation:
** Last menstrual period < 20 weeks, or verifiable Ultrasound proven dates or other proof of < 20 weeks gestation.
** Transport to the closest Emergency department (not closest obstetric facility).

*Patient known gestation or possible gestation > 20 weeks:
** If imminent delivery or medically unstable mother, transport to the closest ED, (not the closest obstetric facility).
** If patient with non traumatic abdominal, pelvic or back complaints (including bleeding or vaginal fluid leak). ***Transport to the closest appropriate obstetric facility.
***Contact appropriate obstetric facility ED for radio report and any additional direction/assistance.
***May transport to the patient’s requested obstetric receiving facility, (i.e. high risk pregnancy with pre-selected Obstetrical destination) if patient is not having an imminent delivery.

* If patient is a TRAUMA ALERT/ TRAUMA RED
**Transport to Orlando Regional Medical Center (as per protocol)
**Trauma yellow and green are to be transported to the ED of closest OB receiving facility

====Appropriate Obstetric Receiving Facilities====
*Central Florida Regional Hospital (Seminole)
*Florida Hospital Altamonte (Seminole)
*Oviedo Medical Center (Seminole)
*Winnie Palmer Hospital (Orange) '''''Call ORMC and transport at their directive'''''
*Florida Hospital Orlando (Orange)
*Winter Park Memorial (Orange)

[[Category:Pediatric and Obstetrical|0705]]

Pregnancy Induced Hypertension (PIH)

2020-11-13T14:23:48Z

Mfrdmanager:

==Section 7 - PEDIATRIC / OBSTETRICAL==
===7.04 PREGNANCY INDUCED HYPERTENSION (PIH)===

'''[[Initial Medical Assessment and Care|INITIAL MEDICAL CARE]] (2.01). OXYGEN @100% via NRB mask or assist with BVM.'''

* Seizure precautions.
* GENTLE HANDLING. Minimal CNS stimulation.
* Position patient on left side or raise right side of backboard approximately 30 degrees.
* For systolic BP > 160 on two readings,
** Administer [[Magnesium Sulfate|MAGNESIUM SULFATE]] 4-6 gm IV added to 100cc NaCL using a dial-a-flow or buretrol over 10 minutes.
* If seizure occurs and the pt is hypertensive, refer to [[Seizure|SEIZURE PRACTICE PARAMETER]] (5.12). Treat with [[Versed|VALIUM]] and call for orders on administration of [[Magnesium Sulfate|MAGNESIUM SULFATE]] 4 gm IV over 30 minutes after seizure is controlled.

[[Category:Pediatric and Obstetrical|0704]]

Pediatric Tachycardia, Ventricular Fibrillation or Pulseless Ventricular Tachycardia

2020-11-13T14:23:22Z

Mfrdmanager:

==Section 7 - PEDIATRIC / OBSTETRICAL==
===7.03 PEDIATRIC VENTRICULAR FIBRILLATION /PULSELESS VENTRICULAR TACHYCARDIA===

* Initiate 5 cycles of high quality (30:2) one-rescuer or (15:2) two-rescuer CPR for approximately 2 minutes to allow blood to circulate and continue throughout resuscitation, minimizing interruptions.
*Maintain rate of between 100-120 compressions per minute.
*Maintain compression depth of at least 1/3 of the depth of the chest.
*Allow for complete chest recoil between compressions.
*Minimize interruptions
*Assist ventilations with [[Oxygen|OXYGEN]] @ 100% via BVM. DO NOT HYPERVENTILATE
* INTUBATE and establish peripheral IV or IO line as able.
* DEFIBRILLATION @ 2 J/kg.
**Proceed to next step only if V-Fib / Pulseless V-Tach persists.
**If rhythm converts, follow appropriate Practice Parameters.

'''''Refer to Handtevy System for specific medication administration based on weight / length.'''''
* [[Epinephrine|EPINEPHRINE]] 1:10,000 (0.1mg/ml) 0.01 mg / kg IV /IO
* Repeat [[Epinephrine|EPINEPHRINE]] 1:10,000 (0.1mg/ml) 0.01 mg / kg every 3 - 5 minutes of continued arrest.

* DEFIBRILLATION @ 4 J/kg. Continue CPR immediately.
* If rhythm converts, follow appropriate Practice Parameters.

* If hypovolemia suspected, fluid bolus 20 ml / kg.
* [[Amiodarone|AMIODARONE]] 5 mg/kg, IVP or IO - refer to Broselow Tape for patient specific dose.
:'''OR'''
* [[Lidocaine|LIDOCAINE]] 1.0 mg/kg IV / IO.

* DEFIBRILLATION @ 6 J/kg. Continue CPR immediately.
* If rhythm converts, follow appropriate Practice Parameters

* After 10 minutes, [[Lidocaine|LIDOCAINE]] 1.0 mg/kg IV / IO.
* DEFIBRILLATION @ 8 J/kg. Continue CPR immediately.
* If rhythm converts, follow appropriate Practice Parameter

'''''If V-Fib converts to a pulse-producing tachycardic rhythm, follow with [[Lidocaine|LIDOCAINE]] boluses IVP.'''''

[[Category:Pediatric and Obstetrical|0703]]

Pediatric Pulseless Electrical Activity PEA

2020-11-13T14:22:56Z

Mfrdmanager:

==Section 7 - PEDIATRIC / OBSTETRICAL==
===7.02 PEDIATRIC PULSELESS ELECTRICAL ACTIVITY (PEA)===

'''CONSIDER MEDICAL ETIOLOGY OF PEA AND REFER TO APPROPRIATE PRACTICE PARAMETER:'''
*Hypoxia / Acidosis, [[Initial Medical Assessment and Care|INITIAL MEDICAL CARE]] (2.01).
*Hypovolemia, [[Shock|SHOCK]] (5.13).
*Tension Pneumothorax, [[Chest Injuries|CHEST INJURIES]] (6.04).
*Hypothermia, [[Cold Emergencies|COLD EMERGENCIES]] (5.06).

* Initiate 5 cycles of (30:2) one-rescuer or (15:2) two-rescuer CPR for approximately 2 minutes to allow blood to circulate and continue throughout resuscitation, minimizing interruptions. Assist ventilations with [[Oxygen|OXYGEN]] @ 100% via BVM. '''DO NOT HYPERVENTILATE'''
* INTUBATE and establish peripheral IV or IO line as able.
* If hypovolemia suspected, fluid bolus 20 ml / kg.

'''''Refer to Handtevy System for medication administration'''''
* [[Epinephrine|EPINEPHRINE]] 1:10,000 (0.1mg/ml) 0.01 mg/kg IV / IO
* Repeat [[Epinephrine|EPINEPHRINE]] 1:10,000 (0.1mg/ml) 0.01 mg/kg IV / IO, every 3-5 minutes of continued arrest.

'''''If P.E.A. rate < 60 complexes per minute,'''''
* [[Atropine|ATROPINE SULFATE]] 0.02 mg/kg, (minimum dosage is 0.1 mg)
* REPEAT every 3-5 minutes of continued arrest for a maximum dose of 1 mg

'''''Ventilation and oxygenation always precede drug therapy'''''

[[Category:Pediatric and Obstetrical|0702]]

Pediatric Asystole

2020-11-13T14:22:30Z

Mfrdmanager:

==Section 7 - PEDIATRIC / OBSTETRICAL==
===7.01 PEDIATRIC ASYSTOLE===

====CONSIDER MEDICAL ETIOLOGY OF ASYSTOLE AND REFER TO APPROPRIATE PRACTICE PARAMETER:====
*Hypoxia / Acidosis, [[Initial Medical Assessment and Care|INITIAL MEDICAL CARE]] (2.01)
*Injuries, [[Chest Injuries|CHEST INJURIES]] (6.04)
*Suffocation caused by a foreign body, [[Foreign Body Airway Obstruction|FBAO]] (3.03)
*Smoke inhalation, [[Burns - Thermal, Electrical, Chemical|BURNS]] (6.02)
*SIDS
*Sepsis / Hypovolemia, [[Shock|SHOCK]] (5.13)
*Hypothermia, [[Cold Emergencies|COLD EMERGENCIES]] (5.06)

* Initiate 5 cycles of (30:2) one-rescuer or (15:2) two-rescuer CPR for approximately 2 minutes to allow blood to circulate and continue throughout resuscitation, minimizing interruptions. Assist ventilations with [[Oxygen|OXYGEN]] @ 100% via BVM. DO NOT HYPERVENTILATE
* If hypothermic, refer to [[Cold Emergencies|COLD EMERGENCIES]] (5.06)
* INTUBATE and establish peripheral IV or IO line as able
* If hypovolemia suspected, fluid bolus 20 ml/kg

'''''Refer to Handtevy System for medication administration'''''
* [[Epinephrine|EPINEPHRINE]] 1:10,000 (0.1 mg/ml) 0.01 mg/kg IV / IO
* Repeat [[Epinephrine|EPINEPHRINE]] 1:10,000 (0.1 mg/ml) 0.01 mg/kg IV / IO, every 3-5 minutes of continued arrest
* [[Atropine|ATROPINE SULFATE]] 0.02 mg/kg (minimum dosage is 0.1 mg)
* Repeat every 3-5 minutes of continued arrest for maximum dose of 1 mg

'''''Ventilation and oxygenation always precede drug therapy.'''''

{| class="wikitable"
|-
! The current national guidelines do not include [[Atropine|ATROPINE]] for treatment of TRUE ASYSTOLE as there is no proof it has a therapeutic benefit. 
Under the Seminole County Practice Parameters the use of [[Atropine|ATROPINE SULFATE]] is indicated in cardiac arrest that may be caused by extreme bradycardia/hypotension.
 
The Paramedic may use [[Atropine|ATROPINE SULFATE]] based on clinical impression where there is a possibility that its use will have a positive therapeutic benefit. 
If ATROPINE SULFATE is used, the recommended dose is: [[Atropine|ATROPINE SULFATE]] 0.02 mg/kg rapid IVP or IO Repeat every 3 - 5 minutes up to a total of 0.04 mg/kg
|}

[[Category:Pediatric and Obstetrical|0701]]

Hemorrhagic Shock

2020-11-13T14:22:05Z

Mfrdmanager:

== Section 6 - TRAUMA==
=== 6.13 HEMORRHAGIC SHOCK ===
=== HYPOTENSION WITH SIGNS OF DECREASED TISSUE PERFUSION SECONDARY TO BLOOD LOSS ===

INITIAL TRAUMA CARE - Provide OXYGEN or assist ventilations as appropriate for patient condition.
* Control any external hemorrhage if present
* For spontaneously breathing patients with a systolic blood pressure less than 100 mm Hg and no known contraindications to the device, apply the [[ResQGuard Impedance Threshold Device|ResQGuard impedance threshold device]] with mask or mouth-piece as indicated (procedure 9.31) if available. Monitor systolic Blood pressure every 2-3 minutes.
* Consider administration of [[TXA|Tranexamic Acid (TXA)]] if:
** Sustained Systolic Blood Pressure is less than 90 mmHg AND
** Sustained heart rate of 110 beats per minute or higher
** Strongly consider transport of patient to a Trauma Center if TXA administered even if atraumatic hemorrhage.
* Establish 2 large bore IV lines if Systolic BP less than 90 mm Hg. Fluid boluses in increments of 200 - 300 ml, to titrate systolic BP greater than 90 mm Hg. Monitor for signs of fluid overload.
* Limit fluid administration to 2000cc due to possibility of DIC.
* If known hemorrhagic shock infuse fluid rapidly until systolic BP greater than 90 mm Hg. Monitor patient for signs of fluid overload.

'''''ADMINISTRATION OF DOPAMINE TO HYPOVOLEMIC PATIENTS IS CONTRAINDICATED.'''''

[[Category:Trauma|0613]]

Ophthalmic Injuries

2020-11-13T14:21:17Z

Mfrdmanager:

==Section 6 - TRAUMA==
===6.09 OPHTHALMIC INJURIES===

[[Initial Trauma Assessment and Care|INITIAL TRAUMA CARE]], (2.02).

====CHEMICAL:====
* Quickly assess gross visual acuity.
* After obtaining a thorough history to rule out a penetrating injury, [[Pontocaine|Pontocaine Ophthalmic]] may be utilized to anethetisize the eye.
** (Adults and Children: 1-2 gtt per affected eye)
* Thoroughly irrigate affected eye(s) using continuous NaCl irrigation through IV tubing and / or Nasal Cannula. Start irrigation as soon as possible and continue while en route to hospital.

====PENETRATING:====
* '''DO NOT''' remove impaled object.
* Protect injury by applying eye shield and bandage over eye(s) avoiding any pressure onto eye itself.
* Patch other eye.
* Keep patient from bending or straining.
* '''DO NOT USE PONTOCAINE IN PENETRATING EYE INJURIES!'''

====BLUNT TRAUMA:====
* If blood noted in anterior chamber, (hyphema), transport with head elevated at least 60 degrees.
* Dim lights to patient comfort.
* Apply eye shield if needed.

[[Category:Trauma|0609]]

Head Injuries

2020-11-13T14:20:45Z

Mfrdmanager:

Decompression Sickness or Dysbarism

2020-11-13T14:19:58Z

Mfrdmanager:

==Section 6 - TRAUMA==
===6.05 DECOMPRESSION SICKNESS / DYSBARISM===

'''ASSESS FOR SIGNS AND SYMPTOMS:'''
* There are two primary types of decompression sickness:
** Fast onset (Arterial Gas Embolism [AGE]) develops within 10 minutes of the dive
** Delayed onset usually within 1 - 12 hours after diving
* Signs and Symptoms:
** Rapid change in mental status or unconscious upon surfacing
** Rapid changes in breathing pattern or apnea
** Extreme fatigue
** Difficulty in thinking
** Vertigo
** Progressive muscle paralysis
** Bloody sputum
** Tinnitus or severe ringing in the ears
** Severe, throbbing pain involving the muscles, joints and abdomen
** Nausea and/or vomiting
** Pruritus and mottling of the skin

'''[[Initial Trauma Assessment and Care|INITIAL TRAUMA CARE, (2.02)]] OXYGEN @ 100% via NRB mask or assist with BVM.'''
* Obtain IV access and INFUSE NORMAL SALINE, 1000 ml over 30 minutes.
** Stop infusion if signs of system overload appear
* If nausea or vomiting is present, ADMINISTER [[Zofran|Ondansteron (Zofran)]] 4 mg IVP.
** [[Promethazine|PROMETHAZINE]] may be used as a second agent to treat nausea or if intractable vomiting is present.
* Consider facility with hyperbaric services as primary destination.
* Contact receiving facility early to allow them time to gather and prepare Hyperbaric Team.
* Transport patient in left lateral position.
** '''Avoid head down position''' – it causes an increased ICP, elevates intrathoracic pressure and complicates patient movement.
* Inquire from patient or bystanders the following dive profile information:
** Type of dive (rescue, commercial, recreational)
** Type of gases used (compressed air, nitrox, heliox)
** Water Type (Fresh, salt or contaminated)
** Number of dives and the approximate depths if possible.
** Total dive time for each dive completed today (this is extremely important for hyperbaric treatment).

{| class="wikitable"
|-
! If the patient is presenting with an altered mental status the Paramedic should notify the appropriate facility from the scene to make arrangements for the hyperbaric chamber and inquire if the patient is to go directly to the hyperbaric chamber for immediate treatment.
|}

{| class="wikitable"
|-
! BLACK BOX WARNING:
Traditionally SCEMS Practice Parameters emphasize pain management. In the case of decompression sickness/dysbarism pain management utilizing narcotic pain medications MUST BE AVOIDED.
|}

{| class="wikitable"
|-
! AIR TRANSPORT
The use of air transport shall be carefully evaluated – if air transport must be utilized the pilot must be notified as typical EMS rotorcraft are not pressurized. The flight plan must be adjusted to the lowest allowable altitude to prevent further complications for the patient.
|}

'''If other significant injuries exist, follow Trauma Transport Protocol or appropriate Practice Parameters.'''

'''HYPERBARIC CHAMBERS:'''
*Florida Hospital South, Orlando
*UF Health System (Shands) Hospital, Gainesville
*Holmes Regional Medical Center, Melbourne

[[Category:Trauma|0605]]

Burns - Thermal, Electrical, Chemical

2020-11-13T14:19:11Z

Mfrdmanager:

==Section 6 - TRAUMA==
===6.02 BURNS- THERMAL, ELECTRICAL, CHEMICAL===

'''[[Initial Trauma Assessment and Care|INITIAL TRAUMA CARE]] (2.02).'''
* Initiate IV or IO ONLY if transport ETA to IRF is greater than 20 minutes.
* Evaluate depth of burn and estimate extent using Rule-of-Nines.
* Wear sterile gloves and mask until burn wounds are covered.
* Do NOT break blisters. Cover burn wounds with DRY sterile dressings.
* Open sterile sheet on stretcher before placing patient for transport.
* Cover patient with dry, sterile sheet and blanket to maintain body temperature.

'''CHEST WALL BURNS:'''
* Circumferential or near-circumferential burns 2nd degree or higher involving the chest wall affecting the patient’s ventilatory effort perform an [[Emergency Escharotomy|EMERGENCY CHEST WALL ESCHAROTOMY]] (Procedure 9.32).
* Support the airway as necessary with bag valve device, 100% oxygen and advanced airway placement as necessary to support ventilations and respiratory effort.

'''THERMAL BURNS:'''
* If < 10 % body surface area involved, apply sterile saline soaked dressings.
* If > 10 % body surface area involved, apply sterile dry dressings.

'''INHALATION BURNS:'''
* Note presence of wheezing, hoarseness, stridor, carbonaceous sputum / cough, singed nasal hair, eyebrows / lashes.
* Increase [[Oxygen|OXYGEN]] to 100% by NRB mask or assist ventilations with BVM.
* Administer updraft of [[Albuterol|ALBUTEROL]] 2.5mg, may repeat if necessary
* [[Solu-Medrol|METHYLPREDNISOLONE / SOLU-MEDROL]] 125mg IVP
* [[Intubation Nasotracheal|INTUBATE]] if severe respiratory distress, preferably nasal route.
* If intubation unsuccessful and airway not patent, consider [[Cricothyrotomy Surgical|CRICOTHYROTOMY]].

'''ELECTRICAL BURNS:'''
* Establish scene safety. Have electrical source turned-off or remove patient from source.
* Immobilize as indicated.
* Assess ECG for arrhythmias and refer to appropriate Practice Parameters
* Assess for entry and exit wounds including neurovascular status of affected part.
* Cover wounds with dry sterile dressings, (cooling not necessary).

'''CHEMICAL BURNS:'''
* If powdered chemical, brush away excess. Remove clothing if possible and place in a plastic bag.
* Irrigate with copious amounts of water or saline ASAP and while en route.
* Refer to [[Hazardous Materials|HAZ-MAT PRACTICE PARAMETER]] (5.08)

'''Refer to [[Analgesia and Sedation|ANALGESIA / SEDATION PRACTICE PARAMETERS]] (2.04).'''

[[Category:Trauma|0602]]

Animal Bites Stings

2020-11-13T14:18:27Z

Mfrdmanager:

==Section 6 – TRAUMA==
===6.01 ANIMAL BITES / STINGS===

'''''PATIENTS PRESENTING WITH SIGNS AND SYMPTOMS CONSISTENT WITH [[Allergic Reaction Anaphylactic Shock|ANAPHYLAXIS]] MUST BE TREATED WITH THE APPROPRIATE PRACTICE PARAMETERS (5.02).'''''

====INITIAL [[Initial Medical Assessment and Care|MEDICAL]] / [[Initial Trauma Assessment and Care|TRAUMA]] CARE, (2.01) / (2.02)====
* Irrigate and cleanse wound with Normal Saline.
* Assess degree of bite or sting by measuring bite / sting marks. Outline edematous, erythemic and ecchymotic areas with pen, and note time. Repeat every 15 minutes.
* If systemic reaction occurs, treat as anaphylaxis. NaCl boluses and be prepared to administer [[Dopamine|DOPAMINE]] (5-20 mcq/kg/min, titrate to BP> 90 mmHg) if no response or if conditions worsens.
* Keep patient supine and calm. Immobilize affected part. Keep the injured area low. Remove distal jewelry.
* Remove stingers, if present, taking care to avoid compression.
* Attempt to identify animal, insect, or reptile that caused the injury.
* If multiple stings, administer [[Diphenhydramine|DIPHENHYDRAMINE (BENADRYL)]] for histamine reaction. May need to be repeated. (If no IV, give IM). Think [[Solu-Medrol|METHYLPREDNISOLONE (SOLU-MEDROL)]] early; dosage 125 mg, rapid IV or IM. Consider a second dose, if stings approximately 30 or more.
* For severe muscle spasms with spider bites or scorpion stings, administer either,
**[[Valium|DIAZEPAM (VALIUM)]], 5 mg IVP slowly,
**[[Versed|MIDAZOLAM (VERSED)]] IVP slowly or IN for sedation if needed
***Less than 60 y/o 1 mg/minute titrate to effect (Maximum of 5 mg)
***Greater than 60 y/o 0.5 mg/minute titrate to effect (Maximum of 3 mg).
*If animal bite, contact animal services:
**Orange County 407-352-4390
**Seminole County 407-665-5110

====BROWN RECLUSE SPIDER BITE:====
* Brown Recluse Spiders colonies are not found in the peninsula of Florida. It is extremely rare to find a Brown Recluse Spider in our area. Wounds that appear like they could be a bite from a Brown Recluse Spider are more than likely MRSA and should be handled as any other infected wound.
For more information on Brown Recluse Spiders, please refer to this website from the University of California: [http://spiders.ucr.edu/brs.html Brown Recluse Spiders]
[[File:BRSpiderMap.gif|200px|link=http://spiders.ucr.edu/brs.html]]

====BLACK/RED/BROWN WIDOW SPIDER BITE:====
*Evaluate for specific signs / symptoms
** Immediate localized pain
** Progressive muscle spasms (usually beginning in the abdomen and back)
** Rigid abdomen
** Seizures
** Paralysis

If ALS required: support airway, cardiac monitoring, O2 saturation and end-tidal CO2,
* Establish an IV in uninjured extremity
* For severe muscle spasms administer either;
**[[Valium|DIAZEPAM (VALIUM)]], 5 mg IVP slowly,
**[[Versed|MIDAZOLAM (VERSED)]] IVP slowly or IN for sedation if needed
***Less than 60 y/o 1 mg/min titrate to effect (Maximum of 5 mg)
***Greater than 60 y/o 0.5 mg/minute titrate to effect (Maximum of 3 mg)
*RAPID TRANSPORTATION and alert the receiving facility of the specific bite/sting.

====VIPERIDS (PIT VIPERS): Includes rattlesnakes, copperheads, cottonmouths====
*Evaluate for specific signs / symptoms
** Distinct “fang marks” or puncture wounds
** Swelling or pain at the site
** Weakness, nausea or vomiting
** Parenthesis fasciculations
** Numbness and tingling around the face and head
** Metallic taste, change in taste sensation
** Hypotension and shock
** Allergic reaction/ Anaphylaxis

IF ALS required: support airway, cardiac monitoring, O2 saturation and end-tidal CO2, establish an IV in uninjured extremity

RAPID TRANSPORTATION and alert the receiving facility of the specific bite/sting.

====ELAPIDS: Includes coral snakes, cobras and mamba====
* Evaluate for specific signs / symptoms
* Contact Florida Poison Control at 1-800-222-1222. There is limited supply of coral snake antivenin available and Poison Control will advise which hospital to transport to. There are very few hospitals that have the antivenin on hand.
* Most signs /symptoms may be delayed up to 12 hours and are related to the type of Venom (a neurotoxin)
* CNS disturbances may be observed
* Respiratory paralysis may develop
* Follow treatment for pit vipers

IF ALS required: Support airway, cardiac monitoring, O2 saturation and end-tidal CO2, establish an IV in an uninjured extremity.

RAPID TRANSPORTATION and alert the receiving facility of the specific bite sting.

====SCORPION STINGS:====
*Evaluate for specific signs / symptoms
** Mild to sharp pain which progresses to numbness
** Salivation
** Slurred speech or Muscle twitching
** Allergic reaction

IF ALS required: Support airway, cardiac monitoring, O2 saturation and end-tidal CO2, establish an IV in an uninjured extremity.

For severe muscle spasms administer either,
* [[Valium|DIAZEPAM (VALIUM)]], 5 mg IVP slowly,
* [[Versed|MIDAZOLAM (VERSED)]] IVP slowly or IN for sedation if needed
**Less than 60 y/o 1 mg/min titrate to effect (Maximum of 5 mg)
**Greater than 60 y/o 0.5 mg/minute titrate to effect (Maximum of 3 mg).

RAPID TRANSPORTATION and alert the receiving facility of the specific bite or sting.

'''''DO NOT APPLY ICE OR COLD PACKS, TOURNIQUETS, MAKE INCISIONS AROUND THE AREA OR ATTEMPT TO SUCTION SNAKE BITES OR MARINE STINGS.'''''

[[Category:Trauma|0601]]

Acute Adrenal Insufficiency

2020-11-13T14:17:38Z

Mfrdmanager: Created page with "==Section 5 -MEDICAL== ===5.22 ACUTE ADRENAL INSUFFICIENCY=== Adrenal insufficiency or Addison’s disease is an endocrine disorder that occurs when the adrenal glands do not..."

==Section 5 -MEDICAL==
===5.22 ACUTE ADRENAL INSUFFICIENCY===

Adrenal insufficiency or Addison’s disease is an endocrine disorder that occurs when the adrenal glands do not produce sufficient amounts of cortisol and other glucocorticoid hormones needed to respond to stress and inflammatory reactions and needed to re-establish homeostasis after a stress response.

Early signs and symptoms of patients in acute adrenal crisis include pallor, dizziness, headache, weakness/lethargy, abdominal pain, nausea/vomiting and hypoglycemia. If left untreated, symptoms may progress to hypotension, shock, seizures and eventual heart failure.

'''TREATMENT'''
* Airway/breathing management
** Administer O2 via proper adjunct to maintain oxygen saturation of 95% or greater
* Initiate cardiac monitoring;
** Record and evaluate 12 lead ECG strip
* Establish IV Access
** If indicated (i.e. tachycardia, hypotension), 20 ml/kg normal saline to maintain systolic BP of 90 mmHg.
** Monitor for evidence of fluid overload
* Determine Blood Glucose Level
* Assess temperature
* Treatment based on identification, assessment and patient’s level of distress
** For patient’s confirmed to have Acute Adrenal Insufficiency by either the presence of a medical alert bracelet, designation of medical records or other patient, family or medical confirmation.
*** Assist with administration of patient’s Solu-Cortef if present
*** If Solu-Cortef not available, administer [[Solu-Medrol|Solu-Medrol]] 125 mg slow IV push

[[Category:Medical|0522]]