Lexington County South Carolina

REFERENCE: Intermediate Life Support Treatment Protocols for Patients Assigned as Standing Orders

1. By joint agreement of the Emergency Departments of Palmetto/Richland Medical Center, Providence Hospital and Lexington County Medical Center, due to medical necessity, those patients who have sustained severe head injuries and/or multiple trauma with trauma scores of ten (10) or less will be transported directly to the Level I trauma center, Richland Memorial Hospital. (See appendix for revised Trauma Triage Protocol).

2. Dorn VA Medical Center requests that no patients with a trauma score of eleven (11) or less be transported to their facility. They also request that no burns be transported to their facility.

4. Except for suspected Acute Myocardial Infarctions protocols, where IV lines are indicated in the following protocols, the Intermediate may elect to attempt an external jugular line, at their discretion, after two (2) attempts at obtaining an IV site on the extremities. In cardiac arrest situations, an external jugular line may be attempted as the initial site if no other access is felt to be obtainable.

5. Intraosseous lines may be used in children, eight (8) years or less, for vascular access. Intraosseous access should be attempted after two peripheral attempts for children in full cardiopulmonary arrest. In all other cases Medical Control must be contacted.

6. Clinical Presentation may require more than one set of “Standing Orders” to maximize prehospital care. In general any combination of the following “Standing Orders” may be utilized, as deemed necessary by the Intermediate, to effectively stabilize the patient.

7. CO2 detection will be used on all patients who are intubated. It must be applied as soon as practical after the patient has been secured in the unit. It will be continuously monitored until the patient is transferred to the ED staff.

9. All patients who use home oxygen, either continuously or on an as needed basis, will be transported using the prescribed rate of the home O2. However if the patient is maintaining an O2 saturation < 90% the flow rate should slowly be titrated upward to maintain an O2 saturation > 90 %

10. Pulse oximetry is to be obtained on all patients and is recognized as a vital sign.

11. In all patients, where the protocol specified an INT, the Intermediate may elect to initiate an IV of Normal Saline [0.9%] if there is an immediate or anticipated need for fluid resuscitation.

12. A BGL may be performed, at the Intermediate’s discretion, on any patient when it is not specified in the protocol.

ADULT PROTOCOLS

I. Cardiac Arrest Protocol P. 1

II. Suspected Acute Myocardial Infarction / Chest Pain Protocol P. 2

III. Respiratory Distress Protocol P. 3

IV. Adult Altered Mental Status/Seizures General Medical Protocol P. 4

V. Heat Related Protocol P. 5

VI. Major Trauma Protocol P. 6

PEDIATRIC PROTOCOLS

I. Pediatric Cardiac Arrest Protocol P. 7

II. Pediatric Altered Mental Status/Seizures/General Medical Protocol P. 8

III. Pediatric Dehydration/Hypovolemic Shock Protocol P. 9

IV. Pediatric Major Trauma Protocol P. 10

APPENDIX

I. Documentation / Paperwork

II. Carbon Monoxide Exposure

III. Revised Trauma Protocol

IV. Treatment Of Impaired/Suicidal Patients

V. No Transports

VI. Spinal Immobilization Protocol

NOTES ON STANDING ORDERS

1. “IO” is the abbreviation for Intraosseous.

I have received a copy of the above Qualifying Statements, ten(10) “Standing Orders” and six (6) Appendices. I understand these statements.

All previous protocols and “Standing Orders” are revoked.

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SIGNATURE DATE