IX.medications that can be administered By trachea: 181
Failed Airway Algorithm 182
Automated External Defibrillation (AED) 183
I.General points: 183
Assisting With Medications 187
I.General Points 187
Chest Decompression 189
I.General Points 189
Gastric Intubation 193
I.General Points 193
Foley Catheter Insertion 195
I.General Points 195
Intraosseous Access 198
I.General Points 198
Intravenous Access 201
I.General Points 201
injected Medication Administration 203
I.General Points 203
II.Prepare dose 203
III.Subcutaneous Administration (SQ) 204
IV.Intramuscular Administration (IM) 204
V.IV Bolus Administration 204
VI.IV Infusion Administration 204
Pneumatic Anti Shock Garment (P.A.S.G) Guidelines 207
IV.Special Points 207
Pulse Oximetry 209
I.General points 209
VI.TREATMENT GUIDELINES 210
I.general orders 211
V.Risk Management 212
spinal immobilization 215
I.General Points: 215
II.The Spinal Assessment tool: 215
Celsius to Farenheit conversions 221
Glasgow coma Scale 222
Pediatric Vital signs 223
Telephone numbers 224
rule of nines 225
Abbreviation list 227
Acknowledgements This document was prepared by Robert Janik, MICP, as an employee of Southeast Region EMS Council, Inc. SEREMS was awarded grants to create and revise model prehospital emergency medical standing orders from the State of Alaska, Department of Public Health, Division of Community Health and EMS, through the Rural Hospital Flexibility Program Grant.
The following persons served as reviewers of this document. The work involved in reviewing this document is an example of their dedication to EMS in Alaska. Their comments shaped the final version.
Second Edition reviewers:
Bobbi Leichty, MICP, Southeast Region EMS Council Inc.
Mike Motti, EMT-3, SEARHC EMS
Bill O'Brien, EMT-3, Yukon Kuskokwim Region
David Rockney, MICP, IREMS
Jon Thomas, EMT-3, Alaska Fire Service
Charles Trull, NREMT-P, Northwest Arctic Borough Region
Ken Zafren, MD, Alaska Native Medical Center, Providence Alaska Medical Center
The late Scott Dull, MD, State EMS Medical Director
As is the case with most protocols, this set of model standing orders was developed through consultation of many resources. The State of Alaska treatment guidelines for Burns, Cold Water Near Drowning, Delayed Transport, Diving Emergencies, Hypothermia, Frostbite, and Trauma were incorporated with little change. Other significant resources were:
Southeast Region EMS Council BLS Treatment Guidelines
Southern Region EMS Council Regional Standing Orders
U.S. Department of Transportation National Standard Curricula for EMS
Wilderness Medical Associate's Wilderness EMT Curriculum
State of Alaska EMS Office-Responding to Behavioral Emergencies Guidelines
Ken Zafren Draft Avalanche Rescue Guidelines
To the Administrator:
These protocols were designed to serve as a model for those services wanting to adopt written protocols or those that need revised protocols. They are model guidelines and are not intended to be interpreted as strict orders. Services may modify this document to meet local needs. Treatments and procedures listed herein follow the State of Alaska curricula with few exceptions. The BLS portion of this protocol may be incorporated into your service immediately. The advanced life support orders in this document must be reviewed and approved by a physician medical director before EMTs and MICPs may perform advanced life support.
To the Physician Medical Director:
These protocols were developed to assist EMS agencies in establishing written standing orders. They are designed as a model set of medical standing orders. This document was peer reviewed by emergency physicians, mobile intensive care paramedics, and EMTs. The Medical Director approving this set of protocols should be familiar with their content and with the skill level of the providers expected to use them.
The orders are meant to be followed as guidelines for patient care. The Medical Director must decide which orders within will be standing orders and which will require on-line direction. As a general style within the text, the items prefaced by "consider" or "anticipate" should be interpreted as requiring on-line medical direction.
Medical Directors are encouraged to modify this document to meet local needs. Any deviations from the EMT scope of practice must be arranged through the provisions of 7 AAC 26.670. These arrangements must include a written request to the State EMS Office, a plan for training and evaluation and a list of authorized individuals who have completed the training. For example, EMT-3s may be trained and authorized to administer nebulized albuterol for asthma which is not listed in the scope of certified activities (scope of practice) for an EMT-3 (7 AAC 26.040.)
To the EMT/MICP
These model standing orders present guidelines for management of common pre-hospital emergencies. As with any protocol, they are not all encompassing. Nor are they meant to be strict "cookbook" orders. It is recognized that patients do not present in textbook fashion and techniques and procedures should be modified to meet the demands of field rescues.
These protocols are fairly liberal. They do not require contacting medical control for many orders. This is in recognition of the communication difficulties in this state. As a general style within the text, the items prefaced by "consider" or "anticipate" should be interpreted as requiring on-line medical direction. It is recommended, however, that medical control be contacted by voice when possible for every patient contact.
The management section presents sequential instructions. Every provider should follow the BLS section. EMT-2 providers should follow the BLS section and the EMT-2 section. EMT-3 providers should follow the BLS, EMT-2 and EMT-3 sections. MICPs should provide the care listed for all levels plus MICP. The Cardiac Arrest and Dysrhythmias protocols are exceptions to the sequencing. EMT-3 and MICP directions are separate. EMT-3s and MICPs should follow the BLS and EMT-2 orders and then progress directly to the EMT-3 or MICP orders.
Treatments and procedures listed herein follow the State of Alaska curricula with few exceptions. You may perform the BLS portion of this protocol. ALS treatments/procedures may only be performed under the direction of a physician, either by direct verbal communications or through physician signed standing orders.