2004 Patient Care Protocols

Summary of Changes

General changes

  1. Color coded sections for protocols:

a.       Table of Contents—white

b.      Introduction, Policy and Procedures—yellow

c.       ALS—blue

d.      BLS—green

e.       Pediatric—pink

f.        Pharmacology—gray

g.       MMRS, WMD--tan

  1. Certification key changed to reflect new provider levels E, I, and P.
  2. Global airway care, oxygenation, medical control contact, and transport decision statements are provided in the introduction to the ALS protocols.
  3. Added use of continuous Co2 monitoring device is required to monitor correct endotracheal tube placement and gas exchange.
  4. New—Skills section of protocols has been removed and has been replaced with the skills CD.  A copy of this CD will be sent to each jurisdiction or rescue squad for each building. This will contain video presentation on proper skills performance, always follow your OMD’s and the manufacturer’s instructions.
  5. Radio communications format has been changed.
  6. Regional medication box policy has been changed.  The new policy defines responsibilities of all parties involved in the medication box exchange program.
  7. Medical control hospital agreement has been updated.
  8. Activated Charcoal has been removed from the protocols in anticipation of a regional variance to remove this medication.
  9. Termination of efforts protocol has been updated.
  10. Removed ground ambulance policy.
  11. Added a resource list of phone numbers.
  12. Albuterol/Atrovent combination for first respiratory treatment.

ALS Protocols

  1. Brackets have been removed from all protocols for the Paramedic; Paramedic-certified providers can now provide all pre-hospital interventions without medical control consult.
  2. Pain management—isolated extremity trauma protocol allows for 2-5 mg of Morphine Sulfate to be given by I & P providers without medical control consult.
  3. New—Behavioral emergencies added de-escalation guidelines.
  4. New—Combative patient added along with chemical restraint guidelines.
  5. VFVT protocol—added Biphasic statement, and to administer Epinephrine & Amiodarone together, then shock.
  6. Added 4th Amiodarone to medication box.
  7. Cardiogenic shock—added drip chart in protocol.
  8. Acute Cardiac Syndrome—added updated warning for Nitro use in taking ED drugs such as Viagra, Levitra & Cialis.
  9. Fluid bolus has changed to 20 mL/kg up to 1000 mL with continuous reassessment.
  10. New—Stroke protocol added along with the Cincinnati Stroke Scale.
  11. Crush Injury protocol has been updated.
  12. New—Hypertension emergency protocol.
  13. New—Fibrinolytic checklist for ACS and Stroke.
  14. New—Medications Haloperidol (Haldol), and Promethazine (Phenergan)
  15. New—Extreme measures protocol.
  16. Lidoaine for pretreatment during intubation of head-injured patients.

BLS Protocols

  1. Combined all toxic exposure and poisons into one protocol.
  2. Combined all trauma protocols into one protocol.
  3. New—Behavioral emergencies: added de-escalation guidelines.
  4. New—Combative patient protocol
  5. New—Spinal rule-out protocol.  Spinal immobilization was moved to the BLS section of the protocols.
  6. Updated assisted medication protocols.  Epi-pen can be used without medical control contact.