OEMS
`
`
`
`
`
`
`
`
`
`
`
`
`
`
`
`
`
`
`ALABAMA EMS
`PATIENT CARE PROTOCOLS
`Seventh Edition
`October 2013
`
`
`ADPH OEMS PATIENT CARE PROTOCOLS
`
`
`
`SEVENTH EDITION, OCTOBER 2013
`Nalox1017
`Nalox-1 Pharmaceuticals, LLC
`Page 1 of 198
`
`

`

`
`
`This edition of the Alabama EMS Protocols is dedicated to the memory of
`Dan Castrillo,
`a Paramedic who dedicated himself to the scholarly pursuit of improving EMS,
`and to all of the EMS providers and their families
`who sacrifice themselves everyday in service to their friends and neighbors.
`
`ADPH OEMS PATIENT CARE PROTOCOLS
`
`
`
`SEVENTH EDITION, OCTOBER 2013
`Nalox1017
`Nalox-1 Pharmaceuticals, LLC
`Page 2 of 198
`
`

`

`
`
`PATIENT CARE PROTOCOLS
`TABLE OF CONTENTS
`
`
`Policies
` Scope of Practice
` Communications
` Death in the Field
` Disputes Regarding Patient Care
` Documentation of Care
` Do Not Attempt to Resuscitate (DNAR)
` Medical Direction Hospital
` Medical Management of the Scene
` Medical Professionals at the Scene
` Medication and Procedure Categories
` Optional Medications and Procedures
` Patient Rights
` Physician Medical Direction
` Refusal of Care or Transport
` Time at the Scene
` Trauma System
`
`Preface
`Section 1:
`
`1.01
`
`1.02
`
`1.03
`
`1.04
`
`1.05
`
`1.06
`
`1.07
`
`1.08
`
`1.08
`
`1.10
`
`1.11
`
`1.12
`
`1.13
`
`1.14
`
`1.15
`
`1.16
`
`
`Section 2: Operational Guidelines
`
`2.01
` Cancellation/Slow Down
`
`2.02
` Crime Scene Response
`
`2.03
` Hazardous Materials
`
`2.04
` Helicopter EMS
`
`2.05
` Staging for High Risk Response
`
`
`Section 3:
`
`3.01
`
`3.02
`
`3.03
`
`3.04
`
`3.05
`
`3.06
`
`3.07
`
`3.08
`
`3.09
`
`3.10
`
`3.11
`
`3.12
`
`3.13
`
`Treatment Protocols
` General Patient Care
` Abdominal Pain
` Adrenal Insufficiency
` Allergic Reaction
` Altered Mental Status
` Amputation
` Bites and Envenomations
` Burns
` Cardiac Arrest, Adult
` Cardiac Arrest, Pediatric
` Cardiac Dysrhythmias, Adult
` Cardiac Dysrhythmias, Pediatric
` Chest Pain or Acute Coronary Syndrome (ACS)
`
`
`
`1
`3
`4
`8
`9
`11
`12
`14
`15
`17
`19
`20
`21
`22
`24
`25
`26
`27
`
`30
`31
`32
`34
`37
`39
`
`40
`41
`42
`44
`46
`48
`50
`52
`54
`59
`63
`67
`69
`71
`
`ADPH OEMS PATIENT CARE PROTOCOLS
`
`
`
`SEVENTH EDITION, OCTOBER 2013
`
`Nalox1017
`Nalox-1 Pharmaceuticals, LLC
`Page 3 of 198
`
`

`

`
`
`3.14
`
`3.15
`
`3.16
`
`3.17
`
`3.18
`
`3.19
`
`3.20
`
`3.21
`
`3.22
`
`3.23
`
`3.24
`
`3.25
`
`3.26
`
`3.27
`
`3.28
`
`3.29
`
`3.30
`
`3.31
`
`3.32
`
`3.33
`
`3.34
`
`3.35
`
`
`
`Section 4:
`
`4.01
`
`4.02
`
`4.03
`
`4.04
`
`4.05
`
`4.06
`
`4.07
`
`4.08
`
`4.09
`
`4.10
`
`4.11
`
`4.12
`
`4.13
`
`4.14
`
`4.15
`
`Section 5:
`
`5.01
`
`5.02
`
` Childbirth
` Congestive Heart Failure
` Electromuscular Incapacitation Devices (Taser®)
` Fractures and Dislocations
` Head Trauma
` Hypertensive Emergencies
` Hyperthermia
` Hypoglycemia
` Hypothermia
` Influenza/Respiratory Illness
` Nausea and Vomiting
` Near Drowning
` Newborn
` Poisons and Overdoses
` Preeclampsia/Eclampsia
` Respiratory Distress
` Seizure
` Shock
` Spinal Injury
` Stroke
` Syncope
` Vaginal Bleeding
`
`Procedures
` Blind Insertion Airway Devices (BIAD)
` Capnography
` Cardioversion (Synchronized)
` Chest Decompression
` Continuous Positive Airway Pressure (CPAP)
` ECG (12-Lead)
` Endotracheal Intubation (Oral)
` Endotracheal Intubation (Nasal)
` External Pacing
` Hemostatic Agents
` Intraosseous Therapy
` Intravenous Therapy
` Patient Restraint
` Rectal Diazepam Administration
` Transportation of Pediatric Patients
`
` Medications
` Adenosine
` Albuterol and Ipratropium
`
`73
`75
`77
`79
`81
`83
`84
`85
`86
`88
`90
`91
`92
`94
`97
`98
`100
`102
`103
`107
`110
`111
`
`112
`113
`114
`115
`116
`118
`120
`121
`123
`125
`126
`127
`129
`130
`131
`132
`
`134
`135
`136
`
`ADPH OEMS PATIENT CARE PROTOCOLS
`
`
`
`SEVENTH EDITION, OCTOBER 2013
`
`Nalox1017
`Nalox-1 Pharmaceuticals, LLC
`Page 4 of 198
`
`

`

`
`
`5.03
`5.04
`5.05
`5.06
`5.07
`5.08
`5.09
`5.10
`5.11
`5.12
`5.13
`5.14
`5.15
`5.16
`5.17
`5.18
`5.19
`5.20
`5.21
`5.22
`5.23
`5.24
`5.25
`5.26
`5.27
`5.28
`5.29
`5.30
`
` Amiodarone
` Aspirin
` Atropine Sulfate
` Calcium Chloride
` Dextrose, 50%
` Diazepam
` Diphenhydramine
` Dopamine
` Epinephrine
` Fentanyl
` Furosemide
` Glucagon
` Haloperidol
` Hydroxocobalamin (Cyanokit)
` Lidocaine
` Lorazepam
` Magnesium Sulfate
` Midazolam
` Morphine Sulfate
` Naloxone
` Nitroglycerin
` Nitrous Oxide
` Normal Saline
` Ondansetron
` Oxygen
` Sodium Bicarbonate
` Thiamine
` Vasopressin
`
`
`
`
`
`
`
`
`
`
`
`
`
`
`
`
`
`
`
`
`
`
`
`
`
`
`
`
`
`
`Section 6: Acceptable EMS Equipment and Devices
`
`6.01
` Blind Insertion Airway Devices (BIAD)
`
`6.02
` Bougie (for Difficult Intubation)
`
`6.03
` Hemostatic Agents
`
`6.04
` Intraosseous Needle Insertion Devices
`
`Section 7: Disaster
`
`7.01
` Respiratory Illness/Influenza Mass Casualty Emergency
`
`7.02
` Search and Rescue Marking System
`
`7.03
` Triage of Mass Casualties
`
`Section 8:
`
`8.01
`
`8.02
`
`Forms
` Chest Decompression Report
` Do Not Attempt Resuscitation (DNAR) Form
`
`137
`138
`139
`140
`141
`142
`143
`144
`146
`147
`148
`149
`150
`151
`152
`153
`154
`155
`156
`157
`158
`159
`160
`161
`162
`163
`164
`165
`
`166
`167
`167
`167
`167
`
`168
`169
`172
`173
`
`176
`177
`178
`
`ADPH OEMS PATIENT CARE PROTOCOLS
`
`
`
`SEVENTH EDITION, OCTOBER 2013
`
`Nalox1017
`Nalox-1 Pharmaceuticals, LLC
`Page 5 of 198
`
`

`

`
`
`8.03
`8.04
`8.05
`
`
`
`
`
`Section 9:
`
`9.01
`
`9.02
`
`9.03
`
`
`
`
`
` Request to Be Transported to a Hospital on Divert
` Thrombolytic Checklist (STEMI)
` Thrombolytic Checklist (Stroke)
`
`Expanded Scope of Practice
` Rapid Sequence Intubation
` Needle Cricothyroidotomy
` Medications
`
`
`
`
`180
`181
`182
`
`183
`184
`190
`192
`
`ADPH OEMS PATIENT CARE PROTOCOLS
`
`
`
`SEVENTH EDITION, OCTOBER 2013
`
`Nalox1017
`Nalox-1 Pharmaceuticals, LLC
`Page 6 of 198
`
`

`

`ADPH EMS PROTOCOLS
`Preface
`
`
`
`SEVENTH EDITION, OCTOBER 2013
`
`KEY POINTS
`
`
`These protocols are intended to guide Emergency Medical Services Personnel (EMSP) in the response
`and management of emergency situations and the care and treatment of patients. Anyone who wants to
`change the protocols can make a request in writing to the State Emergency Medical Control
`Committee, or an EMSP may make the request by email to:
`
`Dr. William Crawford, State EMS Medical Director
`Alabama State Emergency Medical Control Committee
`c/o Office of EMS
`Alabama Department of Public Health (ADPH)
`P.O. Box 303017
`Montgomery, AL 36130-3017
`
`Or William.Crawford@adph.state.al.us
`
`This manual contains ALL the medications and procedures allowed for EMSP in Alabama. EMSP are
`responsible for their actions within the respective scope of practice of the license that they hold.
`Online Medical Direction (OLMD) cannot order EMSP to perform procedures or administer
`medications that are not presented in these protocols. EMSP should respectfully decline any orders
`which would cause them to violate their scope of practice.
`
`The medication section of this manual is provided for information purposes only. EMSP may
`administer medications only as listed in the protocol unless OLMD orders a deviation.
`
`This manual also serves as a reference for physicians providing OLMD to EMSP. Treatment direction
`which is more appropriate to the patient’s condition than the protocol should be provided by the
`physician as long as the EMSP scope of practice is not exceeded. Treatment direction includes basic
`care, advanced procedures, and medication administration. OLMD can expect an EMSP to respectfully
`decline any orders which would cause them to violate their scope of practice.
`
`Pediatric information is differentiated by label and font characteristics. Anything
`pertaining to pediatric patients will be presented in Green Bold Tahoma Font.
`Unless otherwise noted in a protocol, a pediatric patient is defined as someone
`15 years old or younger.
`
`ADPH OEMS PATIENT CARE PROTOCOLS
`
`1
`
`SEVENTH EDITION, OCTOBER 2013
`Nalox1017
`Nalox-1 Pharmaceuticals, LLC
`Page 7 of 198
`
`

`

`ADPH EMS PROTOCOLS
`Preface
`
`
`
`SEVENTH EDITION, OCTOBER 2013
`
`PROTOCOL UPDATES
`
`
`The ADPH EMS Protocols are revised through updates performed by request of the State Emergency
`Medical Control Committee (SEMCC) or the Office of EMS (OEMS) Director.
`
`Individual protocols and guidelines are updated through REVISIONS. Each protocol can be revised
`individually and the revision letter and revision date are noted on the protocol in the upper right hand
`corner. Periodically, the revisions are incorporated into the manual and a new Edition is released. The
`new EDITION number and date are printed on the cover and the lower right footnote.
`
`
`ADPH OEMS PATIENT CARE PROTOCOLS
`
`2
`
`SEVENTH EDITION, OCTOBER 2013
`Nalox1017
`Nalox-1 Pharmaceuticals, LLC
`Page 8 of 198
`
`

`

`ADPH EMS PROTOCOLS
`Policies
`
`
`
`REVISION A OCTOBER 2013
`1
`
`ADPH OEMS PATIENT CARE PROTOCOLS
`
`3
`
`SEVENTH EDITION, OCTOBER 2013
`Nalox1017
`Nalox-1 Pharmaceuticals, LLC
`Page 9 of 198
`
`

`

`REVISION A OCTOBER 2013
`1.01
`
`POLICIES
`Scope of Practice
`
`KEY POINTS
`
`Licensed Emergency Medical Services Personnel (EMSPs) are authorized to perform procedures and
`administer medications as defined by these protocols. Each level of EMSP, as defined by the EMS
`Rules, has a specific list of authorized procedures and medications as defined by that level’s scope of
`practice.
`
`EMSPs are prohibited from performing any procedure or utilizing any medication not approved by the
`State Board of Health even though they may have been taught these medications and procedures in
`their EMSP curriculum.
`
`Lower level EMSPs can assist higher level EMSPs with patient care activities as long as the lower
`level EMSP does not exceed his/her Scope of Practice regarding administration of medications or
`performance of procedures. Ultimately, the higher level EMSP is responsible for patient care and
`documentation.
`
`
`ADPH OEMS PATIENT CARE PROTOCOLS
`
`4
`
`SEVENTH EDITION, OCTOBER 2013
`Nalox1017
`Nalox-1 Pharmaceuticals, LLC
`Page 10 of 198
`
`

`

`REVISION A OCTOBER 2013
`1.01
`
`POLICIES
`Scope of Practice (continued)
`
`EMT Scope of Practice
`
`An EMT, licensed by the ADPH-OEMS, is authorized to perform patient care procedures and
`administer medications as follows:
`
`Procedures:
`1. Patient assessment including taking and recording vital signs and appropriate history.
`2. Administration of supplemental oxygen via cannula or mask.
`3. Administration of aspirin for suspected cardiac chest pain.
`4. Use of oropharyngeal and nasopharyngeal airways.
`5. Use of bag-valve mask.
`6. Use of mouth to mask device with or without supplemental oxygen.
`7. Use of pulse oximetry devices.
`8. Opening and maintaining a patent airway using simple airway maneuvers.
`9. Use of suction equipment.
`10. Cardiopulmonary resuscitation.
`11. Simple management of a cardiac emergency including the use of an AED.
`12. Acquiring and transmitting 12-lead ECG (if AED is capable).
`13. Control of bleeding and shock through positioning, direct pressure, and tourniquet.
`14. Use of hemostatic agents.
`15. Bandaging.
`16. Spinal Motion Restriction.
`17. Splinting including traction splint.
`18. Joint dislocation immobilization.
`19. Application of pneumatic anti-shock garment.
`20. Assistance with emergency childbirth, NOT including any surgical procedures.
`21. Capillary puncture for the purpose of blood glucose monitoring.
`22. Use of automated glucometer.
`23. Properly lifting and moving a patient.
`24. Patient extrication.
`25. Mass casualty incident triage including triage tags.
`26.Scene management, such as directing traffic, but only when such activities do not interfere with
`patient care duties and law enforcement personnel are not at the scene.
`
`Medications (for use as specified in treatment protocols):
`1. Administration of aspirin and glucose paste.
`2. Assist self-administration of nitroglycerin, auto-inhalers, and auto-injection epinephrine.
`3. Site maintenance of heparin locks and saline locks.
`
`
`
`ADPH OEMS PATIENT CARE PROTOCOLS
`
`5
`
`SEVENTH EDITION, OCTOBER 2013
`Nalox1017
`Nalox-1 Pharmaceuticals, LLC
`Page 11 of 198
`
`

`

`REVISION A OCTOBER 2013
`1.01
`
`POLICIES
`Scope of Practice (continued)
`
`ADVANCED EMT Scope of Practice
`An Advanced EMT, licensed by the ADPH-OEMS, is authorized to perform all patient care procedures
`and administer all medications as defined in the EMT Scope of Practice AND the additional
`procedures and medications as follows:
`
`Procedures:
`1. Placement of Blind Insertion Airway Device (BIAD).
`2. Continuous Positive Airway Pressure (CPAP).
`3. Peripheral venipuncture (IV).
`4. Adult and pediatric intraosseous cannulation (IO).
`
`
`Medications (for use as specified in treatment protocols):
`1. Dextrose
`2. Nitroglycerin.
`3. Naloxone.
`4. Albuterol.
`5. Nitrous Oxide.
`6. Epinephrine (IM only).
`7. Glucagon.
`8. Ondansetron.
`9. Thiamine.
`10. Diphenhydramine.
`11. Normal Saline.
`
`ADPH OEMS PATIENT CARE PROTOCOLS
`
`6
`
`SEVENTH EDITION, OCTOBER 2013
`Nalox1017
`Nalox-1 Pharmaceuticals, LLC
`Page 12 of 198
`
`

`

`REVISION A OCTOBER 2013
`1.01
`
`POLICIES
`Scope of Practice (continued)
`
`INTERMEDIATE EMT Scope of Practice
`An Intermediate EMT, licensed by the ADPH OEMS, is authorized to perform all patient care
`procedures and administer all medications as defined in the EMT and the Advanced EMT Scope of
`Practice AND the additional procedures as follows:
`
`Procedures:
`1. Placement of oral and nasal endotracheal tubes.
`2. Use of cardiac monitoring equipment, including placement of electrical leads and obtaining 12-
`Lead ECG.
`3. Delivery of electrical therapy to patients including manual defibrillation and synchronized
`cardioversion.
`
`PARAMEDIC Scope of Practice
`A Paramedic, licensed by the ADPH-OEMS, is authorized to perform all patient care procedures and
`administer all medications as defined in the EMT, Advanced EMT, and Intermediate EMT Scope of
`Practice AND the additional procedures and medications as follows:
`
`Procedures:
`1. External Cardiac Pacing.
`2. Naso-gastric tube placement.
`3. Needle Decompression of a tension pneumothorax.
`
`
`Medications:
`1. Administration of medications on the list approved by the State Board of Health for such use in
`the EMS setting. Medications may be administered via the intravenous, intraosseous, intranasal,
`subcutaneous, intramuscular, oral, sublingual, rectal routes, and through inhalers and
`endotracheal tubes if approved for such administration by the State Board of Health; and,
`2. Within the constraints specified in the State EMS and Trauma rules, administration of
`medications and maintenance of I.V. drips for inter-hospital transfer patients.
`
`
`ADPH OEMS PATIENT CARE PROTOCOLS
`
`7
`
`SEVENTH EDITION, OCTOBER 2013
`Nalox1017
`Nalox-1 Pharmaceuticals, LLC
`Page 13 of 198
`
`

`

`REVISION A OCTOBER 2013
`1.02
`
`POLICIES
`Communications
`
`PURPOSE
`To provide guidance for Communication with Medical Direction, Receiving Hospitals, and Alabama
`Trauma Communications Center (ATCC).
`
`GUIDELINE
`Notify Alabama Trauma Communication Center (ATCC) when appropriate before leaving the
`scene to determine ATCC routing or hospital divert status for the final patient destination.
`
`ATCC contact numbers:
`Toll-Free Emergency: 1-800-359-0123, or
`Southern LINC EMS Fleet 55: Talkgroup 10/Private 55*380, or Nextel: 154*132431*4
`
`Notify Nurse or Paramedic at receiving hospital as soon as is reasonably possible when:
`(cid:120) Patient is stable.
`(cid:120) Patient requires only Category A treatment.
`
`
`Call On-Line Medical Direction (OLMD):
`(cid:120) As early as possible with unstable patients.
`(cid:120) Before using Category B (Cat B) (cid:11) procedures or medications.
`If in doubt as to protocol or procedure needed.
`(cid:120)
`If an EMSP needs patient care advice.
`(cid:120)
`
`
`ADPH OEMS PATIENT CARE PROTOCOLS
`
`8
`
`SEVENTH EDITION, OCTOBER 2013
`Nalox1017
`Nalox-1 Pharmaceuticals, LLC
`Page 14 of 198
`
`

`

`REVISION A OCTOBER 2013
`1.03
`
`POLICIES
`Death in the Field
`
`PURPOSE
`To establish guidelines for determining when resuscitative efforts should not be initiated or should be
`terminated.
`
`GUIDELINE
`WITHHOLDING RESUSCITATIVE EFFORTS
`1. Determining death in the field (DIF) without initiating resuscitative efforts should be considered
`under any of the following conditions:
`a. Decapitation.
`b. Massive crush injury or evisceration of the heart, lung, or brain.
`c.
`Incineration.
`d. Rigor Mortis in a warm environment.
`e. Venous pooling in dependent body parts (dependent lividity).
`f. Decomposition.
`g. Patient qualifies as a “DNAR” patient (see DNAR Protocol 1.06).
`h. A pulseless, apneic patient in a mass casualty incident, multiple-patient scene, where the
`resources of the system are required for the stabilization of living patients.
`i. A victim of blunt trauma with no vital signs in the field.
`2. OLMD must be contacted and must confirm the withholding of resuscitative efforts.
`3. If the patient is declared dead on scene, the body must not be moved until the proper authority
`(such as law enforcement agencies, the coroner, the medical examiner, or their designee), has
`been notified (if not already on scene), and they agree to the movement of the body.
`
`
`Traumatic Cardiac Arrest Special Considerations:
`1. In deaths from blunt trauma, a monitor is not necessary to use in initial assessment of the patient
`unless the paramedic doubts death has occurred. If the monitor is used, only a recognizable
`QRS of at least eighty (80) per minute should be considered compatible with life in these trauma
`patients.
`2. In cases of penetrating torso injury with no vital signs in the field, OLMD should be
`immediately contacted without delay. OLMD can determine whether to continue resuscitative
`efforts.
`
`ADPH OEMS PATIENT CARE PROTOCOLS
`
`9
`
`SEVENTH EDITION, OCTOBER 2013
`Nalox1017
`Nalox-1 Pharmaceuticals, LLC
`Page 15 of 198
`
`

`

`POLICIES
`Death in the Field (continued)
`
`
`REVISION A OCTOBER 2013
`1.03
`
`e.
`
`GUIDELINE (continued)
`DETERMINING DEATH IN CARDIAC MEDICAL ARREST
`1. Cardiopulmonary resuscitation and advanced life support may be terminated by prehospital
`personnel if all of the following criteria are met:
`a. Patient is in cardiac arrest at the time of arrival of advanced life support.
`b. Appropriate full advanced life support procedures, including Advanced Airway
`placement, are performed for twenty minutes with no spontaneous pulse, and no evidence
`of neurologic function, unless earlier termination is appropriate as determined by OLMD.
`c. OLMD approves termination of efforts.
`d. If OLMD stops resuscitation during transport, the patient must be taken to that OLMD
`physician to be pronounced dead.
`If the patient is declared dead on scene, the body must not be moved until the proper
`authority (such as law enforcement agencies, the coroner, the medical examiner, or their
`designee), has been notified (if not already on scene), and they agree to the movement of
`the body.
`2. All patients in Ventricular Fibrillation should, in general, have full resuscitation continued and
`be transported, except when DNAR or other withholding resuscitative efforts apply. If in doubt,
`contact OLMD.
`3. Termination will not be considered in any of the following circumstances:
`a. Patients with persistent ventricular fibrillation or pulseless ventricular tachycardia.
`b. Patients who have return of spontaneous pulse at any time during the resuscitative effort.
`c. Patients who exhibit neurologic function.
`d. Patients who arrest after the arrival of advanced life support.
`
`DOCUMENTATION
`1. All patient care provided should be documented with procedure and time.
`2. In non-traumatic deaths, all non-resuscitation or stopped resuscitation cases should have an
`ECG rhythm strip that shows the patient’s rhythm.
`3. All conversations with physicians should be fully documented with physician’s name, times,
`and instructions.
`4. If resuscitation is withheld on scene, and the coroner or medical examiner is not coming to the
`scene, if possible, obtain name and address of the deceased, name, address, and phone number
`of a family member, and name and phone number of patient’s private physician.
`
`
`PRECAUTIONS
`1. Most victims of electrocution, lightning, and drowning should have resuscitative efforts begun
`and be transported to the hospital.
`2. Hypothermic patients should be treated using the Hypothermia protocol (3.22).
`3. Consider the needs of survivors when discontinuing resuscitation.
`
`ADPH OEMS PATIENT CARE PROTOCOLS
`
`10
`
`SEVENTH EDITION, OCTOBER 2013
`Nalox1017
`Nalox-1 Pharmaceuticals, LLC
`Page 16 of 198
`
`

`

`POLICIES
`Disputes Regarding Patient Care
`
`
`
`REVISION A OCTOBER 2013
`1.04
`
`PURPOSE
`To describe how EMS personnel should resolve disputes with each other or other medical
`professionals at emergency scenes, upon hospital arrival, or anytime the patient is in the care of the
`EMS provider.
`
`
`GUIDELINE
`(cid:120) Disagreements about care should be handled in a professional manner so as not to detract from
`patient care.
`
`(cid:120) The ADPH EMS Patient Care Protocols should be followed whenever possible and should be
`the basis for resolving disputes.
`
`If there is a dispute between EMS personnel or medical professionals concerning the care of a
`patient, OLMD should be contacted in order to resolve the dispute.
`
`(cid:120) Written reports should be prepared concerning any dispute arising at the scene, with a copy sent
`to the Off-Line Medical Director of each service and pertinent regional EMS agency or ADPH
`OEMS.
`
`
`(cid:120)
`
`ADPH OEMS PATIENT CARE PROTOCOLS
`
`11
`
`SEVENTH EDITION, OCTOBER 2013
`Nalox1017
`Nalox-1 Pharmaceuticals, LLC
`Page 17 of 198
`
`

`

`POLICIES
`Documentation of Care
`
`
`REVISION A OCTOBER 2013
`1.05
`
`PURPOSE
`1. Each EMS provider shall ensure that an accurate and complete patient care report is prepared
`for each instance in which:
`a. A patient was assessed.
`b. Medical care was rendered.
`c. A patient was transported.
`d. A patient was pronounced dead at the scene.
`e. A patient was transferred to another licensed service.
`f. A patient was transferred from one medical facility to another.
`g. The person or persons for whom EMS was dispatched refused treatment, transport, or
`both.
`2. Documentation should include at least:
`a. Patient problem presented.
`b. History.
`c. Primary Survey.
`d. Vital signs including pulse oximetry, with time.
`e. Secondary Survey.
`f. Treatment provided and time.
`g. ECG strip, if monitored.
`h. Capnography strip, if monitored.
`i. Any change in condition of patient.
`j. OLMD contact.
`k. Any deviation from protocol.
`
`ADPH OEMS PATIENT CARE PROTOCOLS
`
`12
`
`SEVENTH EDITION, OCTOBER 2013
`Nalox1017
`Nalox-1 Pharmaceuticals, LLC
`Page 18 of 198
`
`

`

`REVISION A OCTOBER 2013
`1.05
`
`POLICIES
`Documentation of Care (continued)
`
`3. If a patient refuses treatment or transport, documentation should include at least:
`a. Name of patient.
`b. Reason for response.
`c. Reason for patient refusal.
`d. Vital signs and time.
`e. Any other physical signs or symptoms.
`f. Competency of patient, to include that patient’s orientation, any mind altering chemicals
`which may affect judgment, and the explanation which the EMSP made concerning the
`complications the patient may encounter by refusing care.
`g. Level of consciousness – detailed.
`h. Any witnesses.
`4. An accurate and complete patient care report, as required by the EMS rules, shall be provided to
`the patient receiving facility upon delivery of the patient or as soon as practical. In no instance
`should delivery of the patient care report exceed twenty-four hours.
`5. Patient care reports must be completed in the electronic format and transmitted to the OEMS
`within 168 hours of the provided medical care.
`6. In general, abbreviations should be avoided in documentation. There are, however, some
`standardized abbreviations that are acceptable. The following is a list of acceptable
`abbreviations:
`ALS-advanced life support
`ASA-aspirin
`BIAD-blind insertion airway device
`BLS-basic life support
`BP-blood pressure
`BPM-beats per minute
`BVM-bag-valve-mask
`CHF-congestive heart failure
`COPD-chronic obstructive pulmonary disease
`CPAP-continuous positive airway pressure
`CPR-cardiopulmonary resuscitation
`DKA-diabetic ketoacidosis
`ECG-electrocardiogram
`ETCO2-end tidal carbon dioxide
`ETT-endotracheal tube
`GCS-Glasgow coma scale
`HR-heart rate
`Hx-History
`IM-intramuscular
`IN-intranasal
`IO-intraosseous
`IV-intravenous
`
`
`Kg-kilogram
`LBBB-left bundle branch block
`LOC-loss of consciousness
`MDI-metered dose inhaler
`Mg-milligram
`Min-minute
`ml-milliliter
`mmHG-millimeters of mercury
`N/A-not applicable
`NaCl-sodium chloride
`NEB-nebulized
`NPA-nasopharyngeal airway
`NSAID-non-steroidal anti-inflammatory drug
`OPA-oropharyngeal airway
`PCP-primary care physician
`PO-by mouth
`PRN-as needed
`q-every
`ROSC-return of spontaneous circulation
`RR-respiratory rate
`SL-sublingual
`SBP-systolic blood pressure
`
`
`
`ADPH OEMS PATIENT CARE PROTOCOLS
`
`13
`
`SEVENTH EDITION, OCTOBER 2013
`Nalox1017
`Nalox-1 Pharmaceuticals, LLC
`Page 19 of 198
`
`

`

`POLICIES
`Do Not Attempt to Resuscitate (DNAR)
`
`
`
`REVISION A OCTOBER 2013
`1.06
`
`PURPOSE
`The goal is to provide comfort and emotional support with the highest quality medical care to patients
`in conformity with the highest ethical and medical standards. Unless a “DNAR” order is issued, any
`patient who sustains a cardiopulmonary arrest will receive full cardiopulmonary resuscitation with the
`objective of restoring life. If a DNAR order has been issued, the family may countermand that order
`and request that resuscitation be attempted.
`
`
`GUIDELINE
`1. The following procedures SHALL NOT be performed on a patient who is the subject of a
`confirmed DNAR order and who is PULSELESS AND APNEIC.
`a. CPR.
`b. Advanced Airway placement.
`c. Defibrillation.
`d. Assistance with respiratory efforts (i.e., “Bagging”)
`e. Oral/nasal airways.
`f. Suctioning.
`g. IV lines.
`h. Fluids.
`i. Medications, including oxygen.
`j. ECG monitoring, except to confirm cardiac rhythm for declaration of death (See Death in
`the Field Protocol 1.03).
`2. If there is any question about a DNAR order, contact OLMD.
`
`DEFINITIONS
`1. A DNAR (Do Not Attempt Resuscitation) Order is an order issued by a physician directing that,
`in the event the patient suffers a cardiopulmonary arrest, cardiopulmonary resuscitation will not
`be administered.
`
`2. Resuscitation includes attempts to restore failed cardiac and/or ventilatory function by
`procedures such as advanced airway placement, mechanical ventilation, chest compressions,
`defibrillation, and administration of drugs.
`
`3. Comfort care is defined as intravenous fluids, oxygen, suction, control of bleeding,
`administration of pain medications, and the provision of support and comfort to patients, family
`members, friends, and other individuals.
`
`
`ADPH OEMS PATIENT CARE PROTOCOLS
`
`14
`
`SEVENTH EDITION, OCTOBER 2013
`Nalox1017
`Nalox-1 Pharmaceuticals, LLC
`Page 20 of 198
`
`

`

`POLICIES
`Medical Direction Hospitals
`
`
`REVISION A OCTOBER 2013
`1.07
`
`KEY POINTS
`Medical direction must be provided by a medical direction hospital, or the agency’s designated
`Medical Director if he/she has a current Medical Control Physician Identification (MCPI) number and
`is board certified in emergency medicine or is current in ACLS and ATLS.
`
`Medical direction hospitals are defined as those hospitals that provide OLMD by physicians with
`current medical control physician certification and MCPI numbers. Medical direction hospitals shall
`provide requested OLMD for all patients being transported to their facility.
`
`OLMD for patients transported to non-medical direction hospitals must come from a medical direction
`hospital or from the agency’s designated Medical Director if he/she has a current MCPI number and is
`board certified in emergency medicine or is current in ACLS and ATLS. If difficulty is encountered
`reaching a medical direction hospital, an EMSP may contact the ATCC for assistance.
`
`MEDICAL DIRECTION HOSPITALS (BY REGION)
`Region One (AERO)
`Region Two (EAEMS)
`1. Athens-Limestone Hospital
`Cherokee Medical Center
`1.
`2. Crestwood Medical Center
`2. Citizens Baptist Medical Center
`3. Cullman Regional Medical Center
`3. Clay County
`4. Decatur Morgan Hospital-Decatur
`4. Coosa Valley Medical Center
`5. Decatur Morgan Hospital-Parkway
`5. Gadsden Regional Medical Center
`6. Dekalb Regional Medical Center
`6.
`Jacksonville Medical Center
`Eliza Coffee Memorial Hospital
`7.
`7.
`Lake Martin Community Hospital
`8. Helen Keller Memorial Hospital
`8.
`Lanier Health Services
`9. Highlands Medical Center
`9. Northeast Alabama Regional Medical
`10. Huntsville Hospital
`Center
`11. Huntsville Hospital for Women &
`10. Riverview Regional Medical Center
`Children
`11. Russell Medical Center
`12. Lawrence Medical Center
`12. Stringfellow Memorial Hospital
`13. Madison Hospital
`14. Marshall Medical Center North
`15. Marshall Medical Center South
`16. Russellville Hospital
`
`
`
`ADPH OEMS PATIENT CARE PROTOCOLS
`
`15
`
`SEVENTH EDITION, OCTOBER 2013
`Nalox1017
`Nalox-1 Pharmaceuticals, LLC
`Page 21 of 198
`
`

`

`POLICIES
`Medical Direction Hospitals (continued)
`
`
`REVISION A OCTOBER 2013
`1.07
`
`MEDICAL DIRECTION HOSPITALS (BY REGION) (continued)
`Region Three (BREMSS)
`Region Four (West)
`1. Brookwood Medical Center
`1. DCH Regional Medical Center
`2. Children’s Hospital
`2. Northwest Medical Center
`3. Medical West
`3. Vaughn Regional Medical Center
`4.
`Princeton Baptist Medical Center
`5.
`Shelby Baptist Medical Center
`6.
`St. Vincent’s – Birmingham
`7.
`St. Vincent’s – Blount
`8.
`St. Vincent’s – East
`9.
`St. Vincent’s – St. Clair
`10. Trinity Medical Center
`11. UAB Highlands
`12. UAB Hospital
`13. Walker Baptist Medical Center
`
`Region Five (SEAEMS)
`
`Region Six (AGEMSS)
`
`1. Monroe County Hospital
`2.
`Providence Hospital
`3.
`South Baldwin Regional Medical Center
`4.
`Springhill Medical Center
`5. USA Medical Center
`
`
`
`
`
`1. Andalusia Regional Hospital
`2. Baptist Medical Center East
`3. Baptist Medical Center South
`4.
`Prattville Baptist
`5. Dale Medical Center
`6.
`East Alabama Medical Center
`7.
`Elmore Community Hospital
`8.
`Flowers Hospital
`9.
`Jackson Hospital
`10. L.V. Stabler Memorial Hospital
`11. Medical Center Barbour
`12. Medical Center Enterprise
`13. Southeast Alabama Medical Center
`14. Troy Regional Medical Center
`
`
`
`
`ADPH OEMS PATIENT CARE PROTOCOLS
`
`16
`
`SEVENTH EDITION, OCTOBER 2013
`Nalox1017
`Nalox-1 Pharmaceuticals, LLC
`Page 22 of 198
`
`

`

`POLICIES
`Medical Management of the Scene
`
`
`REVISION A OCTOBER 2013
`1.08
`
`PURPOSE
`To assist in determining who is in charge of patient care at the scene of an emergency.
`
`
`GUIDELINE
`1. The highest level EMSP on the first arriving ALS unit will assume responsibility for directing
`overall patient care and will continue this function unless relieved by the responding
`jurisdiction’s personnel. The responding jurisdiction’s personnel must be authorized such
`responsibilities by local, city, county, district ordinances or legislative acts, or must have been
`dispatched by the recognized dispatch agency. These personnel must also be of equal or higher
`EMSP license level.
`2. It is the responsibility of the highest level EMSP on the scene to determine the appropriate level
`of care for transport of the patient. When the highest level EMSP on the scene determines that a
`lower level of care is appropriate for the patient, that EMSP may turn over patient care to an
`EMSP licensed at a lower level of care who is willing to accept patient care responsibilities.
`3. An EMSP shall yield patient care responsibilities to an EMSP licensed at a higher level when
`directed to do so by the higher-level EMSP. An Advanced EMT, Intermediate EMT or
`Paramedic who is providing ALS care to a patient may be relieved by any other licensed
`Advanced EMT, Intermediate EMT or Paramedic authorized to provide the necessary level of
`care if the relieving EMSP is willing to assume patient care duties.
`4. The responsibilities of the EMSP directing overall patient care include:
`a. Avoiding direct patient care activities if enough personnel are available. This EMSP must
`watch over the entire patient care scene activities and be sure that the patient care activities
`are being accomplished in a rapid, efficient, appropriate, and timely manner. If there are
`only two EMSPs at the scene, the senior EMSP must do those patient care activities which
`will allow him/her to watch over the whole scene easily.
`b. Assigning other EMSPs to provide patient care.
`c. Determining when transportation of the patient is to occur.
`d. Performing medical coordinatio