JULY 1, 2001

SCOTT CARROLL, M.D.

MEDICAL CONTROL

TOM GROSS

EMS COORDINATOR

REFERENCE: Advanced 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.

3. The Pediatric Protocols apply to patients eight (8) years or less of age.

4. Except for suspected Acute Myocardial Infarctions protocols, where IV lines are indicated in the following protocols, the Paramedic may elect to attempt an external jugular line, at his 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 pre-hospital care. In general any combination of the following “Standing Orders” may be utilized, as deemed necessary by the Paramedic, to effectively stabilize the patient.

7. In Medical Arrest situations, research shows that an IV administration of medications is preferable to endotracheal tube administration. IV ADMINISTRATION OF MEDICATIONS IS EMPHASIZED.

8. CO2 detection will be used on all patients who are incubated. 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. Anticipate orders for pleural decompression in COPD patients in cardiac arrest and major trauma patients who show signs of a tension pneumothorax. CONTACT MEDICAL CONTROL.

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

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

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

CARDIAC ARRESTS - GENERAL STATEMENTS

1. All IV medications administered via peripheral line should be rapid push followed by a 20cc - 30cc bolus of fluid and elevation of the extremity.

2. Endotracheal drugs should be administered, when necessary, at 2 to 2.5 times the IV dose. 

ADULT PROTOCOLS

I. Cardiac Arrest Protocol                                                                              P. 1

II. Tachyarrhythmia Protocol                                                                          P. 2

III. Bradyarrythmia Protocol                                                                           P. 4

IV. Suspected Acute Myocardial Infarction / Chest Pain Protocol                     P. 5

V. Respiratory Distress Protocol                                                                   P. 6

VI. Anaphylaxis / Allergic Reaction Protocol                                                  P. 7

VII. Adult General Medical Protocol                                                              P. 8

VIII. Altered Mental Status / Seizures Protocol                                              P. 9

IX. Poisoning / Overdose Protocol                                                                P. 10

X. Heat Related Protocol                                                                             P. 11

XI. Major Trauma Protocol                                                                           P. 12

PEDIATRIC PROTOCOLS

I. Cardiac Arrest Protocol                                                                          P. 13

II. Tachyarrhythmia Protocol                                                                      P. 14

III. Bradyarrhythmia Protocol                                                                     P. 16

IV. Respiratory Distress Protocol                                                               P. 17

V. Altered Mental Status / Seizures Protocol                                              P. 18

VI. Dehydration / Hypovolemic Shock Protocol                                           P. 19

VII. Trauma Protocol                                                                                P. 20

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

VII. Morphine Protocol

NOTES ON STANDING ORDERS

1. “IO” is the abbreviation for Intraosseous.

2. In the Cardiac Arrest Protocols drugs noted “ * ” may be given via ET tube per the Qualifying Statements.

I have received a copy of the above Qualifying Statements,  nineteen (19) “Standing Orders” and seven (7) Appendices. I understand these statements.

All previous protocols and “Standing Orders” are revoked.

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