Protocol 4-458 - Chronic Respiratory Disease Management (Including Asthma, COPD, Pneumonia, and Sleep Apnea)

CMH EMS & MIH Protocols

Condition GREEN: All Clear Zone... This is the safety zone.
Indications:
  • None of the YELLOW or RED indications are present.
What you can do:
  • Take your medications as ordered.
  • Continue to practice deep breathing and cough techniques.
  • Record the frequency of short-acting medications (i.e. rescue inhalers) must be used.
  • Track when exacerbations occur as related to possible triggers (i.e. illnesses, allergens, exercise, cold air, or hot air, smoke, aerosols, or chemical irritants).
  • Stop smoking and limit your exposure to others smoking.
  • Drink plenty of fluids.
  • Follow healthy eating habits.
  • Balance activity and rest periods.
  • Keep all medical appointments.
What your CHW might do:
  • Review health history and PCP care plan prior to visit.
  • Answer any questions and address any concerns you have.
  • Review any discharge instructions from any hospital, emergency room, and/or doctor visits.
  • Review goals from previous visit:__________
  • Assess adherence to care plan, including diet, exercise, medications, and keeping appointments.
  • Perform an assessment using a Peak Flow Meter.
  • Review disease process and prevention measures with you including how and when to correctly take your medications.
  • Education on your sepecific respiratory disease is to be expected for every encounter specific to your diagnosis(es).
  • Education on healthy eating and living habits is to be expected for every encounter.
  • Specific education on medications as they relates to your specific respiratory disease will be provided.
  • Discuss smoking cessation.
  • Discuss sleeping habits and waking periods.
  • Assessment of your home medical equipment along with any needed education.
  • Assess the environment for exacerbation triggers.
  • Complete a History and Physical Exam.
  • A complete Medications Reconciliation is to be expected at every encounter.
  • Complete a Safety Assessment.
  • Complete a Social Assessment.
  • Facilitate a Telehealth visit, if scheduled.
  • Follow any verbal orders as obtained via telehealth, phone call, or electronic messaging.
  • Schedule follow-up appointment(s) as needed that might include, but not limited to: Primary Care Provider, Addiction Recovery, Behavioral Health, Dental Care, Dietician, Home Health, Home Medical Equipment, Hospice, Pharmacy Services, Therapy Services, Public Health, Wound Care
  • Establish goals for next visit:__________
What your CP might do:
  • Ensure completion of applicable CHW items above.
  • Perform venous blood draw for the following test panel:
    • VBG
Condition YELLOW: Warning Zone... This is the watch zone.
Indications:
  • None of the RED indications are present.
  • Increased shortness of breath,
  • Increased coughing,
  • You begin coughing up blood- or rust-colored mucus,
  • Chest pain that gets worse when you cough,
  • Fever or chills,
  • Loss of appetite, nausea, or vomiting,
  • An uneasy feeling or you know something is not right,
  • Increased fatigue or no energy,
  • Increased reliance on rescue inhalers,
  • SpO2 less than 95% while on Oxygen,
  • Other indication set by your doctor:____________________
What you can do:
  • You may need an adjustment to your medications.
  • Improve your eating habits.
  • Increase your activity level.
  • Call your CHW or CP:____________________
  • Call your PCP:____________________
    • If outside business hours, 24-hour triage nurse screening is available by calling your PCP's number.
What your CHW might do:
  • Ensure completion of applicable items in the GREEN zone above.
What your CP might do:
  • Ensure completion of applicable CHW items above.
Condition RED: Medical Alert Zone... This is the danger zone.
Indications:
  • Altered mental status, confusion, or inability to think clearly,
  • Dizziness,
  • Reduced urination or not able to urinate,
  • Your heart rate is greater than 100,
  • Severe shortness of breath,
  • SpO2 less than 88% while on Oxygen,
  • Lips or fingers are turning grey or blue,
  • You have been in the YELLOW Zone for more than 24 hours without getting better,
  • Other indication set by your doctor:____________________
What you can do:
  • You need immediate evaluation by a medical professional.
  • Call your CHW or CP:____________________
  • Call your PCP:____________________
    • If outside business hours, 24-hour triage nurse screening is available by calling your PCP's number.
  • Call 9-1-1
What your CHW might do: What your CP might do:
  • Ensure completion of applicable CHW items above.
  • Assist you in the administration of your own prescribed medications.
  • Consider Albuterol 2.5 mg in NS 3 ml Nebulized.
  • Consider Duoneb 3 ml Nebulized (max 1 dose).
  • Transportation to an Emergency Room may be required if any of the following are present:
    • You called 9-1-1 or requested an ambulance.
    • Sudden onset of respiratory distress.
    • Atypical presentation from previous respiratory distress episodes.
    • Fever.
    • Atypical weakness.
    • Dizziness or altered mental status.
    • No prior diagnosis to explain the respiratory distress.

NEMSIS Protocol: 9914175 - General-Community Paramedicine / Mobile Integrated Healthcare

Citations:

Change Log:

DateLink to
previous
version		Description of change
03/16/23Created this section.
05/11/23pdfFirst draft using green, yellow, and red sections.
05/26/23pdfAdded review of discharge instructions. Added CP content from protocol 2-770. Removed Xopenex per Dr. Butvilas on 5/22/23.

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