Protocol 2-220 - Chest Pain / Suspected Cardiac Event

Polk, Hickory, Cedar, & St Clair EMS Protocols







Patient weight (lbs): (kg):

NEMSIS Protocol: 9914117 - Medical-Cardiac Chest Pain


Change Log:

DateLink to
Description of change
10/04/13pdfIndented BLS CPAP under Flail Chest.
10/07/13pdfClarified image for 12- and 15-Lead placement.
11/11/13Added quote from MO Statues on transporting TCD STEMI.
12/13/13Removed CPAP as BLS skill, now is assist ALS.
12/20/13Added CMH Cath Lab activation procedure.
01/29/14Added preferred IV locations, Combo Pads. Changed ER contact phone number. Changed EKG email address. Coordinated protocol with CMH policies.
02/02/14Changed EKG email address again.
12/12/14pdfRemoved Blood Draw. Added Fentanyl if nitro and Morphine contraindicated.
12/12/14pdfMade Intubation a DELIBERATE ACTION. Made Chest Decompression a DELIBERATE ACTION. Added weight-based dose for greater than 65 yr for Fentanyl.
12/15/14Added within 5 min for ASA administration.
12/26/14pdfAdded TXA.
03/02/15Removed DELIBERATE ACTION.
03/30/15Added STEMI destination determination flowchart.
04/03/15Added Use Tablet for STEMI transmission.
04/14/15Added consider to occlusive dressing.
05/31/15Re-worded indications for TXA for better clarity.
08/06/15pdfMoved Aspirin administration from EMT section to EMR section.
09/16/15Added by request of Dr. Merk to TXA indications that signs of shock must still be present after 1 L fluid bolus.
10/21/15Removed need to contact medical control for inferior MI. Added 1-2 L fluid bolus for right-sided MI. Clarified option for Fentanyl or Morphine for additional pain control.
11/17/15Added tension pneumothorax as indication for decompression.
02/03/16pdfAdded EMD section for MPDS medical direction.
06/27/16pdfAdded note that IV access must be in an AC space (left is preferred).
07/05/16Added comments to BLS side to put the patient in a gown with combo pads if STEMI.
07/22/16Moved Nitro SL to AEMT section.
07/24/16Moved 12-lead acquisition and transmission to BLS side with note about interpretation by ER physician if no ALS is available.
07/25/16At the request of Dr. Merk, added the comment to ensure IV access prior to nitro administration.
07/28/16At the request of Morrisville Fire, specified four 81 mg aspirin tablets.
07/28/16pdfAt the request of Polk EMS Manager, added BVM as an EMT option for stabilizing flail chest.
08/02/16At request of Dr. Kramer, changed transmitting 12-lead for BLS to closest ER for interpretation instead of CMH.
08/24/17pdfAdded comment to consider 2nd IV in R AC.
09/20/17Added comment that Nitro spray is contraindicated if phosphodiesterase inhibitor within 48 hours. Added comment to consider serial 12-lead EKGs. Added target scene time of 10 minutes.
11/11/17pdfAdded reference to encrypted radio for patient reports.
11/11/17pdfAdded comment that TXA could be used before fluid bolus if obvious life-threatening hemorrhage.
12/19/17pdfAdded comment to consider pelvic binder if absent or decreased pulses.
05/03/18pdfAdded comment to ensure accurate weight upon arrival at ER.
03/01/19pdfChanged targeted SBP from 80 to 100 based on PHTLS ver 9 recommendation. Added needle decompression sites with a preference being 5th intercostal midaxillary also based on PHTLS ver 9.
07/23/19pdfAdded link to performance graph for 12-lead time.
07/23/19Added link to new hemorrhage protocolremoved TXA.
11/27/19pdfMoved ASA to EMT section to comply with national scope of practice. Moved STEMI definitions to interpretation guide.
04/04/20pdfAdded content (without substantive modification) from old Protocol 5-040 - Chest Trauma. Would rather have another place to put flail chesttension pneumo treatments, but there is not a chest injury/trauma NEMSIS protocol.
04/04/20Added content (without substantive modification) from old Section 2-052 - STEMI Destination Matrix.
04/04/20pdfAdded content (without substantive modification) from old Protocol 2-050 - Chest Discomfort.
02/19/21pdfAHA 2020 changes to this protocol include specifying aspirin administration MUST be done by a healthcare professional. Patient self-administration or administration by rescue does not count. Ambulance personnel must administer a full dose after confirming absence of contraindications. This is due to changes to STEMI registry, request by STEMI committee on 11/10/20 and critical care committee on 1/28/21.
06/06/21pdfMoved to
10/14/21pdfAfter STEMI accreditation change requiring healthcare provider given ASA, the protocol committee recommended on 5/26/21 to reduce the ASA dose given by EMD, EMR, or fire dept EMTs to 81 mg. Conversation with Dr. Nicholes on 6/8/21, he indicated to remove pre-EMS ASA administration to limit overdosing aspirin.
10/14/21Changed 2-220-01 to 2-220-50 link.
11/05/21pdfMoved chest trauma information to the new General Trauma Protocol 2-451.
11/30/21Updated link to Aspirin.

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