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EMERGENCY MEDICAL SERVICES PRE-HOSPITAL …

Commonwealth of Massachusetts Official Version DPH/OEMS. EMERGENCY MEDICAL SERVICES . PRE-HOSPITAL TREATMENT PROTOCOLS. COMPLETE TEXT. Tenth Edition Official Version # Effective 3/1/ 2012 . Edited Version! BLS Treatment Protocols ONLY!!! MASSACHUSETTS DEPARTMENT OF PUBLIC HEALTH. OFFICE OF EMERGENCY MEDICAL SERVICES . 99 Chauncy Street, 11th floor BOSTON, MA 02111. (617) 753-7300. Commonwealth of Massachusetts Official Version DPH/OEMS. Table of Contents ACKNOWLEDGMENTS. INTRODUCTION & GENERAL POLICIES. ASYSTOLE (Cardiac Arrest) .. 7. ATRIAL FIBRILLATION .. 8. ATRIAL FLUTTER .. 9. BRADYDYSRHYTHMIAS .. 10. ACUTE CORONARY SYNDROME .. 11. POST CARDIAC ARREST CARE / RETURN OF SPONTANEOUS.

Commonwealth of Massachusetts 10.01 Official Version DPH/OEMS ACKNOWLEDGMENT 3/1/2012 ACKNOWLEDGMENTS The Massachusetts Department of Public Health, Office of Emergency Medical Services gratefully

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Transcription of EMERGENCY MEDICAL SERVICES PRE-HOSPITAL …

1 Commonwealth of Massachusetts Official Version DPH/OEMS. EMERGENCY MEDICAL SERVICES . PRE-HOSPITAL TREATMENT PROTOCOLS. COMPLETE TEXT. Tenth Edition Official Version # Effective 3/1/ 2012 . Edited Version! BLS Treatment Protocols ONLY!!! MASSACHUSETTS DEPARTMENT OF PUBLIC HEALTH. OFFICE OF EMERGENCY MEDICAL SERVICES . 99 Chauncy Street, 11th floor BOSTON, MA 02111. (617) 753-7300. Commonwealth of Massachusetts Official Version DPH/OEMS. Table of Contents ACKNOWLEDGMENTS. INTRODUCTION & GENERAL POLICIES. ASYSTOLE (Cardiac Arrest) .. 7. ATRIAL FIBRILLATION .. 8. ATRIAL FLUTTER .. 9. BRADYDYSRHYTHMIAS .. 10. ACUTE CORONARY SYNDROME .. 11. POST CARDIAC ARREST CARE / RETURN OF SPONTANEOUS.

2 CIRCULATION (ROSC) .. 13. PREMATURE VENTRICULAR COMPLEXES (PVCs) DELETED .. 13. PULSELESS ELECTRICAL ACTIVITY (Cardiac Arrest) .. 14. SUPRAVENTRICULAR TACHYCARDIA .. 15. VENTRICULAR FIBRILLATION / PULSELESS VENTRICULAR TACHYCARDIA. (Cardiac Arrest) .. 16. VENTRICULAR TACHYCARDIA WITH PULSES .. 17. 2. ENVIRONMENTAL 18. DROWNING AND NEAR-DROWNING EMERGENCIES .. 18. ELECTROCUTION / LIGHTNING INJURIES .. 20. HYPERTHERMIA / HEAT EMERGENCIES .. 22. HYPOTHERMIA / COLD EMERGENCIES .. 24. RADIATION INJURIES .. 26. NERVE AGENT EXPOSURE PROTOCOL .. 28. 3. MEDICAL EMERGENCIES .. 32. ABDOMINAL PAIN (non-traumatic) .. 32. ALLERGIC REACTION / 33. ALTERED MENTAL/NEUROLOGICAL STATUS.

3 34. BRONCHOSPASM / RESPIRATORY DISTRESS .. 35. CONGESTIVE HEART FAILURE / PULMONARY EDEMA .. 37. EYE EMERGENCIES .. 39. HYPERTENSIVE EMERGENCIES .. 40. OBSTETRICAL EMERGENCIES .. 41. SEIZURES .. 46. SHOCK (HYPOPERFUSION) OF UNKNOWN ETIOLOGY .. 47. ACUTE STROKE .. 48. SYNCOPE OF UNKNOWN ETIOLOGY .. 49. TOXICOLOGY / POISONING / SUBSTANCE ABUSE / OVERDOSE .. 50. ADULT PAIN AND NAUSEA MANAGEMENT .. 52. ADULT UPPER AIRWAY OBSTRUCTION .. 53. DIABETIC 55. 4. TRAUMA EMERGENCIES .. 57. ABDOMINAL/PELVIC TRAUMA .. 57. BURNS / INHALATION INJURIES .. 59. HEAD TRAUMA / INJURIES .. 62. MUSCULOSKELETAL INJURIES .. 64. MULTI-SYSTEM TRAUMA .. 66. SOFT TISSUE / CRUSH INJURIES.

4 68. Commonwealth of Massachusetts Official Version DPH/OEMS. SPINAL COLUMN / CORD INJURIES .. 70. THORACIC TRAUMA .. 73. TRAUMATIC CARDIOPULMONARY ARREST (and POST-RESUSC CARE) 75. TRAUMATIC AMPUTATIONS .. 76. 5. PEDIATRIC EMERGENCIES .. 77. NEWBORN RESUSCITATION .. 77. PEDIATRIC ANAPHYLAXIS .. 79. PEDIATRIC BRADYDYSRHYTHMIAS .. 81. PEDIATRIC BRONCHOSPASM / RESPIRATORY DISTRESS .. 82. PEDIATRIC CARDIOPULMONARY ARREST: ASYSTOLE / AGONAL. IDIOVENTRICULAR RHYTHM / PULSELESS ELECTRICAL ACTIVITY (PEA)84. PEDIATRIC COMA / ALTERED MENTAL/ NEUROLOGICAL STATUS/. DIABETIC IN CHILDREN .. 86. PEDIATRIC SEIZURES .. 87. PEDIATRIC SHOCK .. 88. PEDIATRIC SUPRAVENTRICULAR TACHYCARDIA (SVT).

5 89. PEDIATRIC TRAUMA AND TRAUMATIC ARREST .. 90. PEDIATRIC UPPER AIRWAY OBSTRUCTION .. 91. PEDIATRIC VENTRICULAR FIBRILLATION / PULSELESS VENTRICULAR. TACHYCARDIA .. 92. PEDIATRIC PAIN and NAUSEA MANAGEMENT .. 93. APPENDIX A: MEDICATIONS LIST .. 94. APPENDIX B: MEDICAL ORDERS FOR LIFE SUSTAINING TREATMENTS (MOLST). and COMFORT CARE/DO NOT RESUSCITATE (DNR) ORDER VERIFICATION. PROTOCOL .. 95. APPENDIX C: WITHHOLDING AND CESSATION OF RESUSCITATION .. 102. APPENDIX D: EMERGENT AIRWAY PROTOCOLS (ADULT) .. 104. APPENDIX E: ENDOTRACHEAL TUBE SIZES .. 107. APPENDIX F: BURN CHART (Adult & Pediatric) .. 108. APPENDIX G: TRAUMA SCORES .. 109. APPENDIX H: REQUIRED SKILLS.

6 113. APPENDIX I: PROCEDURES .. 114. APPENDIX J: AIR MEDICAL TRANSPORT PROTOCOLS .. 116. APPENDIX K: PROCESS FOR CHANGES TO THE STATEWIDE TREATMENT. PROTOCOLS .. 118. APPENDIX L: MULTIPLE CASUALTY INCIDENTS (MCI) TRIAGE .. 120. APPENDIX M: PEDIATRIC VITAL SIGNS CHART .. 122. APPENDIX N: ALS INTERFACILITY TRANSFER 125. APPENDIX O: SPECIAL PROJECTS .. 149. APPENDIX P: APGAR SCORE .. 150. APPENDIX Q: THE MASSACHUSETTS STROKE SCALE (MASS) .. 151. APPENDIX R: FIBRINOLYTIC (THROMBOLYTIC) CHECKLIST .. 152. APPENDIX S: ADULT PAIN MANAGEMENT ASSESSMENT GUIDE .. 153. APPENDIX T: NERVE AGENT DOSING & REFERENCE TABLES .. 154. APPENDIX U: FIRE REHABILITATION AND TACTICAL EMS PRINCIPLES.

7 158. APPENDIX V: THERAPEUTIC HYPOTHERMIA .. 159. APPENDIX W: SPECIAL CONSIDERATIONS .. 162. BIBLIOGRAPHY .. 164. Commonwealth of Massachusetts Official Version DPH/OEMS. DRUG 166. CLASSIFICATION OF THERAPEUTIC INTERVENTIONS IN CPR AND ECC .. 167. ACTIVATED CHARCOAL .. 168. ADENOSINE .. 169. ALBUTEROL .. 170. AMINOPHYLLINE .. 171. AMIODARONE .. 172. AMYL NITRITE, SODIUM NITRITE, SODIUM THIOSULFATE .. 173. (CYANIDE ANTIDOTE KIT) .. 173. ASPIRIN .. 174. ATROPINE SULFATE .. 175. CALCIUM CHLORIDE / CALCIUM GLUCONATE .. 177. DEXAMETHASONE SODIUM 178. DEXTROSE .. 179. DIAZEPAM .. 180. DIAZOXIDE .. 181. DILTIAZEM HCL .. 182. DIPHENHYDRAMINE .. 183.

8 DOPAMINE .. 184. 185. FENTANYL CITRATE .. 187. FUROSEMIDE .. 189. GLUCAGON .. 190. GLUCOSE - ORAL .. 191. GLYCOPROTEIN IIb / IIIa INHIBITORS .. 192. HEPARIN SODIUM .. 193. HYDROCORTISONE/METHYLPREDNISOLONE .. 194. HYDROXOCOBALAMIN (Vitamin B 12) .. 195. INSULIN .. 197. IPRATROPIUM BROMIDE .. 198. LABETALOL .. 199. LACTATED RINGERS Solution .. 200. LIDOCAINE HCL (2%) .. 201. LORAZEPAM .. 203. MAGNESIUM SULFATE .. 204. MANNITOL 20% .. 205. 206. 207. MIDAZOLAM .. 208. MORPHINE SULFATE .. 209. NALOXONE .. 210. NERVE AGENT ANTIDOTES (AUTO-INJECTORS) .. 211. 216. NITROGLYCERIN .. 217. NITROPASTE .. 218. OCTREOTIDE .. 219. ONDANSETRON .. 220. OXYGEN.

9 221. Commonwealth of Massachusetts Official Version DPH/OEMS. PRALIDOXIME CHLORIDE .. 222. PROCAINAMIDE .. 223. SODIUM BICARBONATE .. 224. STREPTOKINASE .. 225. TETRACAINE .. 226. THIAMINE .. 227. TISSUE PLASMINOGEN ACTIVATOR (tPA) .. 228. VASOPRESSIN (Pitressin) .. 229. Commonwealth of Massachusetts Official Version DPH/OEMS. ACKNOWLEDGMENTS. The Massachusetts Department of Public Health, Office of EMERGENCY MEDICAL SERVICES gratefully acknowledges the efforts of many individuals and organizations in the development of this text. The most prominent contributions of time and effort have come from the five Regional Councils in the Commonwealth and their respective MEDICAL Directors and Executive Directors.

10 Many thanks to all of you, and to those EMS physicians, EMT-Basics, Intermediates and Paramedics around the Commonwealth who have greatly influenced the development process and the resultant Protocols text. Abdullah Rehayem Jonathan L. Burstein, Director State EMS MEDICAL Director ACKNOWLEDGMENT 3/1/ 2012 . Commonwealth of Massachusetts Official Version DPH/OEMS. INTRODUCTION. INTRODUCTION TO STATEWIDE TREATMENT PROTOCOLS. The goal of any EMERGENCY MEDICAL SERVICES system is to provide the finest out-of- hospital MEDICAL care to all the citizens and visitors of its jurisdiction in a timely and efficient manner. The treatment protocols found in this text are designed to immediately manage emergent patient illnesses and injuries such that rapid intervention by all levels of EMT personnel will alleviate patient suffering and ultimately allow the patient to be delivered to a receiving hospital in an already improved clinical state whenever possible.


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