Protocol 2-924 - Universal Patient Care

CMH EMS & MIH Protocols

EMD:

• Utilize appropriate MPDS protocol for all calls where a patient may be ill or injured.

EMR:

• Scene safety. Wear PPE and place PPE on your pateint as necessary. Some situations when PPE is indicated include, but not limited to the following:
• Reflective vest indications:
• You and/or your patient are not in a vehicle, but on a roadway (i.e. side of highway), OR
• You and/or your patient are not in a vehicle, but near moving vehicles (i.e. landing a helicopter), OR
• You and/or your patient are a pedestrian and visibility is reduced (i.e. foggy weather).
• Helmet indications:
• You and/or your patient are under other activities (i.e. someone above you), OR
• You and/or your patient are under objects that are likely to fall (i.e. loose building materials), OR
• You and/or your patient are walking or climbing on significantly uneven terrain (i.e. climbing a rocky embankment), OR
• You and/or your patient are near technical rescue activities (i.e. inside a vehicle with extrication in progress).
• Personal floatation device indication:
• You and/or your patient are within ten (10) feet of exposed moving liquids (i.e. river), OR
• You and/or your patient are within ten (10) feet of water deeper than three feet (i.e. swimming pool).
• Potentially contaminated scene or patients:
• Identify the substance with two sources, if possible: NIOSH, WebWISER
• Notify receiving facilities as soon as possible with possible contamination agent.
• Establish decontamination procedures according to research:
• All persons leaving the hot zone must be gross decontaminated:
• Remove outer clothing and jewelry.
• If contaminated with liquids, high volume water rinsing.
• Irrigate eyes and face.
• All persons leaving the warm zone must be technically decontaminated:
• Do not contaminate ambulances with patients or responders that have not been decontaminated.
• Do not perform most ALS procedures until technical decontamination has been performed due to causing additional breaks in the skin.
• Remove ALL clothing and jewelry.
• Gentle washing with soap and water.
• Coordinate with or establish incident command. Establish hot, warm, and cold zones, if applicable.
• BSI and ensure proper PPE.
• Determine nature of illness and/or mechanism of injury.
• Determine number of patients. If greater than five (5) patients: Refer to Guideline 1-850-25 - Mass Casualty.
• Determine need for additional resources.
• ABCs.
• LOC.
• Altered mental status: Refer to Protocol 2-077 - Altered Mental Status to assess and treat causes
• SAMPLE history.
• Focused assessment.
• Baseline vitals.
• Refer to Protocol 2-924-24 - Normal Vital Signs.
• Refer to Protocol 2-924-48 - Glasgow Coma Scale (GCS).
• Two sets of vitals should be obtained that include time, blood pressure, pulse, respirations, SpO2, and Pain level. If patient contact time is less than 15 minutes (i.e. very short transport time with a critical patient), one set of vitals may be appropriate.
• When appropriate, additional vitals may include Temperature, orthostatic blood pressure, and glucose. Consider assisting ALS with ETCO2.
• Treat per appropriate protocol.

EMT:

• Ensure completion of applicable items above.
• Responsive and no significant MOI:
• Treatment and transport decision (BLS/ALS).
• Goal of moving a TCD patient (Sepsis, STEMI, Stroke, or Trauma) towards definitive care within 10 minutes.
• Interfacility transfer of patients meeting BLS criteria with the only exception of Heparin- or Saline-locked IV may be transported BLS.
• Four-lead cardiac monitoring does not require the patient to be transported ALS, but an ALS patient does require cardiac monitoring. Any cardiac monitor for cardiac assessment or 12-Lead ECG must be transported ALS or transmitted to the ER for interpretation.
• A BLS ambulance with an ALS patient shall request ALS intercept or transport to the nearest emergency room or CMH unless the destination is refused by the patient.
• Transport.
• Routine use of lights and sirens is not warranted.
• Transport to the closest facility unless one of the two below:
• If the patient refuses the closest facility, transport to their choice, and obtain a refusal signature.
• Altered mental status and the closest facility is on CT divert, bypass and transport to next closest appropriate facility.
• Time critical diagnosis: Transport according to detination matrix:
• STEMI: Protocol 2-220-50 - STEMI Destination Matrix
• Stroke: Protocol 2-880-72 - STROKE Destination Matrix
• Trauma: Protocol 2-451-50 - TRAUMA Destination Matrix
• Ensure accurate weight is obtained on all patients upon arrival at the ER, if able.

AEMT:

• Ensure completion of applicable items above.
• Consider IV LR bolus to maintain SBP above 100.

RN:

• Ensure completion of all applicable items above.
• ALS indicated when new onset of the following:
• Significant MOI.
• Unresponsive.
• Responsive meeting one of the following:
• Altered mental status.
• Chest discomfort.
• Need for IV/IO or medications.
• Overdose or poisoning.
• Respiratory distress.
• Severe pain.
• Signs of shock.
• Rapid medical and/or trauma assessment.
• Treat per appropriate protocol.
• If transfer out of the hospital:
• Refer to Guideline 1-200-72 - Transfer Priority Calculator.
• If Priority 1 transfer:
• Shall be responded to in the same fashion and promptness as any other priority 1 dispatches.
• Patient care shall be provided by the RN or paramedic.
• If patient on a Ventilator and sedated with Propofol:
• Consider replacing Propofol at hospital bedside with Ketamine from ambulance stock.
• Ketamine 1 mg/kg IV/IO.
• Click "calculate" to get dose.

• Adult:	Pediatric:
  Consider Fentanyl 50-100 mcg IV/IO/IN (max 300 mcg).	Consider Fentanyl 1-2 mcg/kg IV/IO/IN (max 150 mcg) Click "calculate" to get dose.

• If patient on tPA drip, refer to Protocol 2-880 - Suspected Stroke.

Medic:

• Ensure completion of all applicable items above.

CP:

• Ensure completion of all applicable items above.

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