Lemhi County Medical Supervision Plan Emergency Medical Service Patient Care Protocols



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Lemhi County

Medical Supervision Plan

Emergency Medical Service

Patient Care Protocols

EMR

EMT- Basic

EMT-I-85

Update___04/10/2013_ Table of Contents
LEMHI COUNTY VOLUNTEER EMERGENCY MEDICAL TECHNICIAN INDIRECT (OFF-LINE) MEDICAL CONTROL AGREEMENT
SYSTEM DESCRIPTION, RESPONSE AREA MAPS Updated 4/1/2013
LEMHI COUNTY EMS MEDICAL SUPERVISION PLAN 4/1/2013
ADDENDUM TO MEDICAL SUPERVISOR PLAN UPDATED 3/31/2013
Emergency Medical Service Patient Care Protocol Page

Routine Patient Care Guidelines

1,2

Routine Patient Care Guidelines Pediatric Assessment

3,4,5

Patient Status Determination & Transport Decision

6

Air Medical Transport

7

Interfacility Transfers Medical Control During Itrerfacility Transport


8,9

Communications

10

Allergic Reaction/Anaphylaxis

11

Asthma/COPD/RAD”

12

Diabetic Emergencies

13

Blood Glucometry/ Glucagon State Protocol

14,15

Stroke

16

Hyperthermia (Environmental)/ Hypothermia (Environmental)

17,18

Obstetrical Emergencies/ Neonatal Resuscitation

19,20

Pain Management

21

Fever ,Poisoning/Substance Abuse/Overdose, Seizure

22,23

Nausea/Vomiting ,Bradycardia ,Tachycardia

24

Acute Coronary Syndromes, Aspirin for chest pain of suspected ischemic origin

25

Congestive Heart Failure (Pulmonary Edema), Cardiac Arrest

26,27

Do not resuscitate (DNR) orders

28

Special Resuscitation situations and expectations

29

Abdominal Injuries (Penetrating), Drowning/Submersion Injuries

30

Eye and Dental Injuries, Dental Avulsion, Burns (Thermal) Burn Chart Adult /Pediatric

31,32,33

Traumatic Brain Injury, Thoracic Injuries

34

Upper Airway Suctioning, Airway /Breathing guidelines Airway Adjuncts

35,36

KING LT-D, Combi-tube ILS Airway Procedure

37,38

Blood Born/Air Born Pathogens, Decontamination

39,40

Behavioral Emergencies including Suicide Attempts and Threats

41

Crime Scene/Preservation and Evidence

42

Management of Patient Subdued by Taser

43

Abuse & Neglect- Child, Elderly or Other Vulnerable Individuals

44

Appendix Continued

Page


Child/Adult Abuse, EMS Provider Responsibility, Response to Domestic Violence

45,46

On-Scene Medical Personnel, Refusal of care /consent to treat

47,48,49

Pediatric restraint and transport

50

Responder rehabilitation on the incident scene

51

Hazardous Materials Exposure in Large scale/Mass Casualty

52,53,54

Chemical Burns

55

Nerve Agents and Organophosphates

56,57

Cyanide and Arsenic

58

Radiation Injuries

59

Mutual Aid

60

Deployment Plan Special Event, Wild Land Fire, Individual (Self)

61,62

Exposure Protocol/Plan/Matrix

63,64,65

EMS Provider Credentialing Plan

66,67,68,69

Air Plane Crash incident Protocol

70,71

Just in time training CemPak

72-76












Lemhi County

Volunteer Emergency Medical Technician

Indirect (off-line) Medical Control

Agreement
Letter of Agreement between;

Lemhi County EMS Agencies and Doctor Kelly Phelps

Agreement: Medical Director (Indirect/Off-line Medical Control) for Lemhi County EMS I-85 Transport and QRU Non-transport agencies.


I am of full knowledge that this is a non-compensated position.

As Medical Director (Indirect Medical Control) I will do the best of my abilities to fulfill the duties as such.


Duties include;

  • Liaison for EMTs with hospital and medical community.

  • Ensure proper training standard are met.

  • Maintain quality control program to include review of patient care reports.

  • Over see continuous quality improvement.

  • Review of all in-field intubations

  • Bi-annual audit of identified trending, through PCR reviews and discussion with department.

Lemhi County ILS, BLS EMS will;



  • Provide information to Medical Director on issues concerning EMS, hospital and medical community.

  • Offer monthly training open to all EMS providers.

  • Provide access of all PCR

  • Be available as directed per Medical Direction for review of PCR and run audits.

  • Supply copy of approved Standing Orders and State Protocols

  • Aid in financial responsibility for education for Medical Director (i.e. training provided by the State of Idaho, and conferences with-in department budgetary reason).

  • Provide description of Lemhi County EMTs system.

System Description

Salmon Advanced EMTs
The Salmon Advanced EMT a compensated volunteer department. Consisting of 22 volunteer .Governing board of the department consist of a president, 1st Vice, 2nd Vice,

Training Officer, Secretary, and Treasures,

Offices under the board: Infection Control Officer, Communication Officer, Building and Ambulance Maintenance Officer.

Lemhi County is responsible for budgetary needs for the department.

All patient billing go out through Lemhi County.

Skills Level for the Salmon Advanced EMT varies.

Advance personnel are Intermediate- 85 certified

Basic EMT

Emergency Response

Salmon Ambulance Service responds and received licensing at the Advanced level through the State of Idaho.

Scheduling;

Weekly


12 hour on-call shifts.

Man power: minimum “1” Advanced EMT, & “1”EMT-B/ER per shift.

Response: Most EMS personal respond from there resident or work facility.

Response to the ambulance building located at 203 Van Dreff Street in the City of Salmon, 5 minutes or less, per Salmon EMTs by-laws.

Salmon Advanced EMTs conduct monthly business meeting on the first Tuesday of the month, monthly run reviews conducted at this time.

Salmon Advanced EMTs conduct monthly training on the third Tuesday of every month.

The department is responsible to provide continuing education to all members including refresher course required for personnel recertification.

All members are notified in advanced of meeting and trainings.

Salmon Advanced EMT also provide instructor for Community First aid and CPR classes, along with class for all levels of EMS exempting Paramedic Level.

Areas of response:

City of Salmon, Hwy 93 N to Montana line, and NW to wilderness.

Hwy 93 South to Cow Creek MM 385 ( Custer county Ambulance Service under agreement with Lemhi County/Salmon EMTs is primary response unit from MM385 to Custer Co line due to the close proximity and shorter response time). This agreement is reviewed and renewed annually.

Hwy 28 E to Lemhi, (Lemhi to Leadore has a primary response of Leadore Advanced EMS service. However Salmon Advance unit will response if requested per Leadore or Lemhi County Dispatch

West of Salmon to Road less/Wilderness area in area that is accessible to Ambulance and EMS personnel.

Approximant; 3,500 square mile coverage.

Recertification is the sole responsibility of the certified person; however records of training and skills proficiency are maintained by Training Officer and County EMS Coordinator.

All remediation in training areas and individual skills will be conducted through the Training Officer or State approve training

Reprimand action : Will be conducted through the governing board along with direction of Medical Control, and will only be conducted in private.

Protocols Procedures;

Salmon Advanced EMTs follow County Developed Protocols and Procedures that have been approved by Department heads and State of Idaho and Protocols that are State Directed.

System Description

Leadore Advanced EMTs


The Leadore Advanced EMTs a true volunteer department. Consisting of 23 volunteers, governing board of the department consist of a President, 1st Vic, President ,Training Officer, Secretary, and Treasures,

Offices under the board; Infection Control Officer, Communication Officer,

Leadore Advanced EMTs INC, is responsible for budgetary needs for the department.

All patient billing go out through Leadore Advanced EMTs INC.


Skills Level for the Leadore Advanced EMT varies.

Advance personnel are Intermediate- 85 certified

Basic EMT Level

Emergency Responder Level.

Leadore Ambulance Service responds and received licensing at the Advanced /I-85 level through the State of Idaho.

Scheduling;

All call

Dispatched : State Communications and Lemhi County Sheriff’s Department.

Response: Most EMS personal respond from there resident or work facility.

Ambulance Station Location : Station #1 “2” BLS Ambulances City of Leadore

Station #2 “1” BLS Ambulance 15 miles W. of Leadore

Leadore Advanced EMTs conduct monthly business meeting on the Third Monday of the month, monthly run reviews conducted at this time.

Leadore Advanced EMTs conduct monthly training on the First Monday of every month.

The department is responsible to provide continuing education to all members including refresher course required for personnel recertification.

All members are notified in advanced of meeting and trainings.

Leadore Advanced EMT also provide instructor for Emergency Responder and EMT-B courses.

Areas of response:

City of Leadore, 28 E to County line,

Hwy 28 West to Lemhi SW to Montana line to include 400 sq. miles into Montana through MOA with Bitterroot County, due to the close proximity and shorter response time). This agreement is reviewed and renewed annually.

Approximately 1,500 square mile coverage.

Recertification is the sole responsibility of the certified person; however records of training and skills proficiency are maintained by Training Officer.

All remediation in training areas and individual skills will be conducted through the Training Officer or State approve training

Reprimand action: Will be conducted through the governing board along with direction of Medical Control, and will only be conducted in privet.
Protocols Procedures;

Leadore Advanced EMTs follow County Developed Protocols and Procedures that have been approved by Department heads and State of Idaho and Protocols that are State Directed.

System Description

Salmon Search and Rescue QRU


Salmon Search and Rescue QRU; a true volunteer department under the direction of Lemhi County Sheriff’s Office. Consisting of 32 volunteer .Governing board of the department consist of a Commander, 1st Vice,

Training Officer, Secretary, and Treasures,

Offices under the board; Infection Control Officer, Communication Officer

Lemhi County Sheriff’s Office is responsible for budgetary needs for the department.

Skills Level for the Salmon Search and Rescue QRU varies.

Advance personnel are Intermediate- 85 certified

Basic EMT, Emergency Responder Level.
Salmon Search and Rescue QRU responds and received licensing at a BLS Non-Transport service, licensed through the State of Idaho.
Scheduling;

All Call response

Response: S&R personal respond from there resident or work facility.

S&R is responsible for all MVA extrication, Low/High angle rescue, and swift water rescue.

Salmon Search and Rescue QRU conduct monthly business meeting on the first Wednesday of the month, monthly run reviews conducted at this time.

Salmon Search and Rescue QRU conduct monthly training on the third Wednesday of every month.

The department is responsible to provide continuing education to all members including refresher course required for personnel recertification.

All members are notified in advanced of meeting and trainings.


Areas of response:

Lemhi County 4,579 square miles

Recertification is the sole responsibility of the certified person; however records of training and skills proficiency are maintained by Training Officer.
All remediation in training and individual skills will be conducted through the Training Officer or State approved training
Reprimand actions: Will be conducted through the governing board along with direction of Medical Control, and will only be conducted in privet.
Protocols Procedures;

Salmon Search and Rescue QRU follow County developed Protocols and Procedures that have been approved by Department heads and State of Idaho also Protocols that are State Directed.



Gibbonsville QRU Response Description

Gibbonsville QRU a true volunteer department under the Salmon Advanced EMTs.

Consisting of 12 volunteer

2 Response Vehicles Location Salmon River Road, Gibbonsville

Response area Fourth of July Creek north to Idaho Montana Boarder North Fork west to end of Salmon River Road

Governing board of the department consist of a

President

Vic President

Training Officer, Secretary, and Treasures,

Offices under the board; Infection Control Officer, Communication Officer

Skills Level for the Gibbonsville QRU

Advance personnel are Intermediate- 85 certified

Basic EMT Level

First Responder Level.

Scheduling;

All Call response




Elk Bend QRU Response Description

Elk bend QRU a true volunteer department licensed by State of Idaho.

Consisting of 12 volunteer

1 Response Vehicles Location Antelope Drive Elk Bend Idaho

Response area: Hwy 93 South at 45th parallel to County Line

Governing board of the department consist of a

President

Vice President

Training Officer, Secretary, and Treasures,

Offices under the board; Infection Control Officer, Communication Officer

Skills Level for the Elk Bend QRU

Basic EMT Level

Emergency Responder Level.

Scheduling;

All Call response


Lemhi County EMS Medical Supervision Plan

All Lemhi County Medical Emergency Response Units will provide to Dr Kelly Phelps on request documentation of the following for all EMS personnel affiliated with their Units. These records will be maintained and updated every three years.




  • EMS Bureau Certification

  • Records of affiliation with the individual Units

  • Any requirement to maintain affiliation (i.e. meeting attendance, minimum call response, etc)

  • Documentation of orientation completion-

To include review of;

EMS agency policies

♦ EMS agency procedures

♦ Medical treatment protocols- developed in conjunction with present Medical Director and reviewed every 2 Years, and any change of Medical Director

♦ Hospital Reporting Radio Communications

♦ Hospital/Facility destination policy.


Unit will provide periodic evaluation of providers; i.e., documentation of

  • successful completion of quarterly review/monthly meeting attendance

  • completion of any remediation required by Medical Director

  • successful completion of

♦ initial education and orientation

♦continuing education via monthly or quarterly EMS unit meeting

♦any addition out of unit continuing education completed
ASSESSMENT OF IMPROVMENT

Run sheet review (25% of all units’ runs will be reviewed)



  • Electronic review via Idaho State Bridge (PERCs) with feedback to units and administrators

  • Written response—may be requested by Unit Administrator or individual EMT for the following:

♦ Clarification of issues

♦ Explanation of documentation errors that are recurrent

♦ Patient care issues

Improvement may come in the form of

*Written explanation of documentation omission

* Presentation by EMTs involved to the entire unit of areas of concern (i.e., c-spine immobilization, difficult airway)


On site assessment

  • ED Physician on duty will be expected to give ongoing feedback to EMS personnel at the time of patient transfer of care.

  • Any issues of concern can be reported to EMS Medical Director in writing with date/patient name/EMT name


PERIODIC ASSESSMENT OF PSYCHOMOTOR SKILLS
Ongoing assessment will be requested by the Emergency Department physician on duty at time of patient transfer.

  • Problems identified should be reported in writing to EMS Medical Director with date/patient name/EMT name

  • Minor issues may be address at the time of the patient transfer by the physician on duty as time permits

Ongoing review to be conducted by each EMS unit to include skills assessment when deemed necessary – request for Medical Director Participation in review can be made directly to Dr Kelly Phelps by voice mail/email via unit administrator or Training Officer.

RESPONSE OF CERTIFIED EMS PERSONNEL

WHEN NEED FOR EMS IS APPARENT BUT EMT IS NOT ON DUTY
EMS personnel must provide patient care within the scope of practice as defined by their certification level with the state of Idaho.
Individual EMS providers must function within their certified scope of practice in the event of multiple or mass casualty, disaster response, wild land, ect.
This standard must be maintained if the EMT is on or off duty, providing paid or volunteer coverage, acting within the unit service area, area of mutual aid or far outside their service area or outside the State of Idaho.
Any deviation from scope of practice as defined by Idaho State EMS Bureau must be accompanied by written protocol/and signed by a physician Medical Director who will be responsible for the EMTs actions, Quality Assurance, training, etc. (i.e. the physician supervising in a clinic, in hospital, camp, wild land fire, forest service, etc.)
SPECIAL CIRCUMSTANCES

See Lemhi County EMS Treatment Protocol for the following:



  • Patient Destination

  • Air Med Transport

  • Mutual Aid

  • Patient Refusal (non transport)

  • Treat and Release


DOCUMENTATION

EMTs will provide for each run, documentation electronically via Idaho State Bridge (PERCS) form or via written run sheet provided by Idaho State.


This documentation will be maintained at the receiving hospital, Lemhi County EMS Office, Lemhi County EMS Unit Department archives and via Idaho Bridge PERCs.

EQUIPMENT

Lemhi County Ambulance and Quick Response units will maintain each ambulance/non- transport response unit in service with all equipment approved by Idaho State EMS Bureau for their level of licensure. Any equipment omitted or in addition to which is approved by the EMS Bureau will be in conjunction with the Medical Director’s approval. Documentation of equipment or on site inspection by the Medical Director must be available on request.


Equipment check must be done after each run to ensure all equipment and supplies will be available for patient care on the next call.
COMMUNICATION

All Lemhi County EMS units will provide EMT guidelines for communication from the field to the receiving hospital which will include: (See communication protocol)



  • Patient (s) age, sex

  • Mechanism of injury or nature of illness

  • Vital signs

  • Rapid assessment

  • ETA to hospital


DIRECT ONLINE MEDICAL SUPERVISION
Direct Online Medical Supervision can be obtained when appropriate as indicated by Lemhi County EMS Protocols or at EMTs discretion by calling Steele Memorial Medical Center Emergency Department. Physician Medical Control will be available 24/7. Direct EMS line 208-756-5655, or radio frequency 155.340 car to car or/ State Communication Direct relay 155.280. All physicians on duty at Steele Memorial may be utilized for online Medical Control.


ON SCENE MEDICAL PERSONEL

In the event a physician is on scene of an accident or at a patient’s home and wishes to assume Medical Control:


Inform that physician:

  1. Level of EMS provider (i.e. EMT-B, EMT-I,)

  2. That medical control is available via Steele Memorial Medical Center


Documentation: any ongoing relationship with the patient (i.e. from physician, specialist, or bystander physician (i.e. no relationship).
Inform Physician that if they wish to assume Medical Control of patient care, they will be expected to accompany the patient for the duration of treatment during transportation.
All EMTs must practice within the scope of their certification level of practice—regardless of direction given by on scene Medical Control
Reference the following via Lemhi County Patient Care Guidelines Protocols

  • Air Medical

  • Special Resuscitation Situations and Exceptions

  • On Scene Physician Supervision

  • Patient Refusal/Non Transport

  • Treat and Release of Patient

  • Inter-facility Transfers /Out of Area Transfer

  • Mutual Aid


\

Addendum to Medical Supervisor Plan Updated 3/31/2013
Medical Supervision Plan for Salmon Advanced EMT Ambulance Service, Lemhi County EMS

Dr Kelly Phelps, Medical Director

: ADDENDUM REQUIRED TO MEET IDAHO EMSPC REQUIREMENTS FOR OPTIONAL MODULES
AS THE MEDICAL DIRECTOR FOR THE SALMON ADVANCED EMT,S AMBULANCE SERVICE I AM APPROVING THE ADOPTION OF THE FOLLOWING OPTIONAL MODULES. THE EMT MODULES WILL ALSO APPLY TO THE LEADORE AMBULANCE, ELK BEND QRU, AND SALMON SEARCH AND RESCUE WHERE I ALSO SERVE AS MEDICAL DIRECTOR. INITIAL AND CONTINUING TRAINING FOR THE MODULES WILL BE TAUGHT BY APPROVED IDAHO EMS BUREAU INSTRUCTORS. A DOCUMENTED SYSTEM IS ALREADY IN PLACE THAT IS REVIEWED BY ME THAT SHOWS COMPETENCY IN SKILLS AND WHEN AND HOW THEY WERE VERIFIED. THESE NEW SKILLS WILL BE ADDED TO THAT REPORT ONCE THE MODULES HAVE BEEN COMPLETED.
AT THE EMR LEVEL


  • CERVICAL STABILIZATION-CERVICAL COLLAR




  • SPINAL IMMOBILIZATION-LONG BOARD




  • SPINAL IMMOBILIZATION-SEATED




  • EXTREMITY SPLINTING


OUR EMR’S ARE CURRENTLY TRAINED IN EPINEPHRINE AUTO INJECTOR WITH PROTOCOLS ALREADY IN PLACE.
Medical Supervision Plan for All EMT, Lemhi County EMS

Updated (4/10/2013

Dr Kelly Phelps, Medical Director

AT THE EMT BASIC LEVEL



  • BLOOD GLUCOSE MONITORING-AUTOMATED







  • INTRAMUSCULAR MEDICATION ADMINISTRATION




  • SUBCUTANEOUS MEDICATION ADMINISTRATION




  • GLUCAGON



  • ASPIRIN FOR CHEST PAIN





Emergency Medical Service

Patient Care Protocols
Routine Patient Care Guidelines

All levels will complete an initial and focused assessment in every patient, and as standing orders, when necessary and appropriate skills and procedures to maintain the patient’s airway, breathing and circulation.



Initial Assessment

Scene size-up

Assess the scene for safety, mechanism of injury, and number of patients.

Notify the receiving facility as soon as possible.

Request additional resources as needed ( e.g.) ALS interception, air medical transport, additional ambulances, extrication, hazardous materials team, ECT.

Use the Incident Command System (ICS) when possible.

Level of Consciousness

Manually stabilize the patient’s cervical spine if trauma is involved or suspected.

Assess level of consciousness using the AVPU scale.

Airway

Assess the patient for a patent airway.

Open the airway using the head-tilt/chin-lift, or jaw thrust if suspicious of cervical spine injury.

Suction the airway as needed.

Consider an OPA or NPA airway adjunct. if you are trained and qualified to use.

Consider an advanced airway interventions King Airway or Combi-Tub as appropriate and if trained in use.



Breathing

Assess patients breathing taking note of rate, rhythm, and quality of respirations. Assess lung sounds.

Look for nasal flaring or accessory muscle use.

Assess the chest for symmetrical chest rise, intercostals or supra-clavicle retraction, instability, open pneumothorax, or other signs of trauma.

Treat foreign body obstructions with current guidelines.

Assist ventilations when outside the ventilation

Apply high flow oxygen per non-re-breather if indicated. Circulation

Assess the patients pulse, taking note of rate, rhythm, and quality.

Look for and control any gross bleeding.

Assess patient’s skin color, temperature, and moisture.

IV access and fluid resuscitation as appropriate for the patient’s condition, protocols. An IV established for the purpose, IV line with 0.9% Normal Saline @ KVO and an attempt to obtain a blood sample. After IV is established, administer fluid to maintain systolic pressure >90 mmHg. Apply AED and initiate CPR in accordance with currant guidelines

1.

Make Transport Decisions Early


Which hospital?

Normal priority or “Load and Go”?

Is an ALS or paramedic intercept indicated?

Is the patient a candidate for air medical transport?


Focused Assessment and Treatment

Obtain chief complaint, history of present illness and prior medical history.

All patients will receive a physical assessment as is appropriate for their presentation.

Provide oxygen therapy as appropriate for patient’s condition.

Determine level of pain.

Consider treating anxiety to facilitate patient care (See Behavior Emergencies-2.2).

Apply cardiac monitor when appropriate and available. (Basic and Intermediate providers may obtain EKG print-out).

Control active bleeding using direct pressure, elevation, pressure bandage, and pressure points.

Fully immobilize spine when indicated See advanced spinal assessment protocol 6.6).

Splint, elevate and apply cold packs to swollen deformed extremity. Apply a traction splint for a suspected femur fracture. Assess and document CSMs before and after immobilization.

Bandage lacerations and abrasions.

Cover eviscerations with occlusive dressing and cover to prevent heat loss.

Stabilize impaled object. Do not remove impaled object unless it is interfering with CPR or your ability to maintain patient’s airway.

Perform serial exams and monitor en route to hospital.




Obtain Vital Signs

Monitor vital signs at a minimum of every 15 minutes (5 minutes if the patient is unstable). Include:

Level of Consciousness. (AVPU)

Skin color, temperature, and moisture.

Respiration rate, Quality, Pulse rate, Blood Pressure, Sp O2.

Blood glucose sample if indicated.

Temperature if fever or hypothermia suspected.

Refer to operational protocols for further treatment options.

2.

Pediatric Assessment

Pediatric Definitions

Assessment of pediatric patient must take into account the characteristics of a child’s anatomy and physiology at each stage of development.



Medical

For the purpose of this protocol a “pediatric patient” is defined as a child who fits on the Broselow tape (36 kg or 145cm). If longer than the Broselow tape, they are considered an adult. Use of the Broselow tape is recommended if performing invasive procedures on all pediatric patients.

While this protocol does not address some emotional and developmental issues, for the most therapies, the use of length-based determination of equipment and medication is evidence based. Use of the Broselow tape is particularly helpful in a situation where there in no confirmed weight or age.

Legal

*In the case of behavioral of emotional problems, a pediatric patient is defined as any child less than 15 years of age.

*The legal definition of a child is one who has not yet reached his/her eighteenth birthday and is not emancipated.

*With the exception of life threatening emergencies, EMS personnel are to attempt to contact the child’s parent or legal guardian and or obtain the guardian’s informed consent to treat and transport the child.

Interpreting a child’s vital signs and symptoms as though they were an adult may result in an inaccurate assessment and incorrect treatment.



Pediatric Ventilation Guidelines


Respiration Rate Ventilation

Age Too Slow Too Fast Breaths/Minute



Newborn < 30 >80 40-60

Infant < 20 > 70 30-40

1-6 Yrs < 16 > 40 20-30

6-12 Yrs < 12 > 30 16-20

12-16 Yrs < 10 > 24 12-16

Pediatric Vital Signs by Age


Age Heart Rate Respiration Systolic BP

Avg. Range Range Avg. Range



Newborn 140 90-170 40-60 72 52-92

1 month 135 110-180 30-50 82 60-104

1 year 120 80-160 20-30 94 70-118

2 years 110 80-130 20-30 95 73-117

4 years 105 80-120 20-30 96 65-117

6 years 100 75-115 18-24 97 76-116

8 years 90 70-110 18-22 99 79-119

10 years 90 70-110 16-20 102 82-122

12 years 85 60-110 16-20 106 84-128

14 years 80 60-105 16-20 110 84-136

3.
APGAR SCORES



Sign

Score = 0

Score = 1

Score = 2

Heart Rate

Absent

Below 100

Above 100

Respiratory Effort

Absent

Weak, Irregular or gasping

Good, crying

Muscle tone

Flaccid

Some flexion of extremities

Well flexed, or active movement of extremities

Reflex Irritability

No response

Grimace or weak cry

Good cry

Color

Blue all over, or pale

Peripheral cyanosis

Pink all over



Pediatric Glasgow Coma Scale

Infants Children

E

Y

E

Spontaneous

To Speech/Sound

To Pain

No Response



4

3

2



1

Spontaneous

To Speech/Sound

To Pain

No Response



M

O

T

O

R


Moves Spontaneously

Withdraws from touch

Withdraws from Pain

Abnormal Flexion

Abnormal Extension

No Response



6

5

4



3

2

1



Obeys Command

Localized Painful Stimuli

Withdraws from Pain Abnormal Flexion

Abnormal Extension

No Response


V

E

R

B

A

L

Coos and Babbles

Irritable Cry

Cries to Pain

Moans to Pain

No Response


5

4

3



2

1


Oriented

Confused


Inappropriate words

Incomprehensible

No Response

4.


PEDIATRIC TRAUMA TRIAGE CRITERIA


Component

+ 2

+1

-1

Weight

> 20kg

10-20 kg

< 10kg

Airway

Normal

Oxygen adjunct: mask, cannula, NPA, or OPA

Assist/ advanced airway BVM/ETT

Coma, Unresponsive, Weak or no peripheral pulse

SBP< 50 mmHg


Level of Consciousness

Awake

Altered /or history of loss of consciousness

Assist/ advanced airway BVM/ETT

Coma, Unresponsive, Weak or no peripheral pulse

SBP< 50 mmHg


Circulation

Peripheral pulse good, SBP>90 mmHg

Brachial / Femoral pulse

Palpable

SBP 90-50

No Palpable pulse

BP below 50



Fracture

None seen or suspected

Single closed Fracture

Any open or multiple fracture

Cutaneous

No visible

Contusion, abrasion or laceration < 7cm, not through fascia

Tissue loss laceration>7cm Penetrating injury


A child is considered to have serious trauma if:

A color triage score of one (1) black box or two (2) gray boxes.

A numerical triage score < 9

Penetrating wounds to head, neck, torso or extremities proximal to elbow or knee

Two or more long bone fractures, pelvic fracture, or flail chest

Open or depressed skull fracture

Full thickness (3°) burns, partial thickness (2°) burns > 10% BSA or burns combined with trauma

Paralysis

Amputation proximal to the wrist or ankle

5.

Patient Status Determination & Transport Decision
Status I (Critical)

Cardiac arrest.

Respiratory arrest

Patient requires assisted ventilation and/or advanced airway management

Potential surgical emergency, i.e. suspected internal hemorrhage

Consider transporting patient classifying as Status I trauma patients by air medical transport from scene

to Level I or Level II Trauma Center, contact medical control.

Transport to closest appropriate hospital.

Consider appropriate air medical transportation and/or ALS or Paramedic intercept.
Status II (UNSTABLE)

Patient unresponsive or responsive to painful stimuli only.

Severe and /or deteriorating respiratory condition.

Significant hypotension.

Transport to closest appropriate hospital.

Consider appropriate air medical transportation and/or ALS intercept.


Status III (POTENTIALLY UNSTABLE)

Patient alert, vitals stable with simple uncomplicated injuries.

Most medical complaints.

Transport to closest appropriate hospital.


Status IV (Stable-Transport for Diagnostic Tests)

Patients being transported to undergo non-emergency diagnostic tests that will not be seen in the emergency department or evaluated by a physician in the emergency department

Transport to designated hospital.
NOTES OF CLARIFACATION

* Should a patient deteriorate to Status I while un route to a hospital, the EMS unit may divert to the nearest hospital after consultation with medical control and notification of both the hospital of original destination and the new destination hospital.

* In cases where the patient’s status is uncertain, consult with medical control and proceed as directed.

* Status IV patients should be transported to their previously arranged destination unless their condition deteriorates to status III, II, or I.

* The destination hospital is determined by the highest medical level providing patient care. It should not be determined by police or bystanders.

* Transfers from ground ambulance to air medical transport shall occur at the closest appropriate landing site, including hospital heliports, airports, or unimproved landing sites deemed safe per pilot discretion. In cases where a hospital is used strictly as the ground to air ambulance transfer point, no transfer of care to the hospital is implied or should be assumed by hospital personnel, unless specifically requested by the EMS providers.

6.

Air Medical Transport

The propose of these guidelines is to establish a clinical framework for Pre-hospital personnel

to make decisions regarding when to access air medical transport. The following constitute

the foundation for these guidelines.


EMS personnel may request air medical transport (AMT) when operational conditions exist and/or

The indicated clinical conditions are present:


Patient with an uncontrolled airway or uncontrolled hemorrhage should be brought to the nearest

Hospital unless advanced life support (ALS) service (by ground) can intercept in a more timely fashion.


AMT is not indicated for patients in cardiac arrest.
Request AMT as soon as practicable after initial assessment: Consider placing AMT on standby

based on dispatch information. Communication with local medical control should be established

as soon as practical to advise that AMT is responding, however these guidelines have been established

so that Air Medical Transport Does Not Require on-line medical control approval.



Operational Conditions

  • When patient meets defined clinical medical criteria and scene time plus ground transport time

to the nearest Level I trauma hospital exceeds the ETA of air medical transport; or

  • Patient location, weather or roads conditions preclude the use of standard ground ambulance; or

  • Multiple casualties/ patients are present which will exceed the capabilities of the local hospital and agencies.

Clinical Conditions

Physiologic Criteria

Severe respiratory compromise with respiratory arrest or abnormal respiratory rate.

Circulatory insufficiency: sustained systolic pressure< 90 or signs of shock.

Severe traumatic brain injury: AVPU scale P or U, GCS < 9, or motor component < 5.

Anatomic Criteria

Penetrating or severe blunt trauma to the chest or abdomen.



Additional Notes

ATM may be indicated in a wide range of conditions other than those listed above. In cases where the patients status is uncertain, consult with medical control and proceed as directed.

If extrication plus ground transport time is less than air transport arrival time to scene, consider initiated ground transport and divert helicopter to local hospital.

The destination hospital is determined by the highest medical level providing patient care. It should not be determined by police or bystander.


Transfer from ground ambulance to air ambulance shall occur at the closest appropriate landing site, including hospital heliport, airports, or unimproved landing site deemed safe per pilot discretion. In cases

Where a hospital heliport is used strictly as the ground to air transfer point, no to transfer of care to the hospital is implied or should be assumed by hospital personnel, unless specifically requested by the EMS providers.


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