Paramedic Accreditation/Continued Accreditation
March 30, 2015 draftCOUNTY OF MARIN EMS3300PARAMEDIC ACCREDITATION/CONTINUEDACCREDITATIONI.INITIAL ACCREDITATIONA.B.To be eligible for accreditation in Marin County an individual must:1.Provide evidence of possession of a valid California statewide paramediclicense which is current.2.Provide proof of employment with a designated paramedic service providerwithin the local EMS jurisdiction.3.Apply to the local EMS Agency. Application includes the following:a.Completion of application form which includes a statement that theindividual is not precluded from accreditation for reasons defined inSection 1798.200 of the Health and Safety Code.b.Check or money order payable to "County of Marin" in the amount as perfee schedule.4.Provide proof of completing an approved Marin County EMS System orientationnot to exceed eight (8) hours, that includes all topics specified in the current“Marin County Paramedic Initial Accreditation Learning Objectives”published on the EMS Agency website: www.marinems.org5.Comply with the following additional requirements:a.Permit verification of status with other certifying or accrediting agencies.b.Complete a written Protocol Quiz with 80% accuracy.Accreditation procedure1.The local EMS Agency shall accredit the individual to practice in Marin County.Accreditation to practice shall be continuous as long as State of Californiaparamedic licensure is maintained and local requirements are met. Theparamedic may practice immediately in the basic scope of practice when workingas a second paramedic during the accreditation process.2.Accreditation is indicated by the issuance of a card bearing the date of issuance,Marin County Accreditation number and the signature of the EMS AgencyMedical Director. the paramedic will be issued a sticker which will be attached tothe upper front right corner of the state-issued paramedic license. Additionallythe paramedic accreditation number will be changed to match the state-issuedparamedic number and shall start with the letter “M”, i.e., M00000. The newsticker will be issued at the completion of initial or continuous accreditationapplication for each paramedic. Any existing accreditation cards will attrition outover time. The paramedic accreditation number may be verified in the ESOAdHoc reports database.3.The EMS agency shall notify individuals applying for accreditation of the decisionto accredit within thirty (30) days of application. If requested by the applicantaccreditation may be extended at the discretion of the EMS Program4.EMS Agency shall notify the EMS Authority within ten days of the accreditationaction.Page 1 of 2
March 30, 2015 draftII.COUNTY OF MARIN EMS3300MAINTAINING ACCREDITATIONA.B.C.Accreditation is maintained when the following requirements are met:1.Successful completion of the paramedic licensure process. The paramedic shallforward proof of successful licensure and completion of local requirements toLEMSA prior to expiration date.2.Employment with a designated paramedic service provider within the localjurisdiction. Employer shall notify LEMSA within ten (10) days of paramedicleaving employment.st3.Completion of the annual Policy and Procedure Update by July 1 of each yearor as defined by the EMS Agency.Inactive Accreditation1.Accreditation becomes inactive if one or more of the following occur:a.Paramedic is not currently employed by a Marin County provider ORb.Paramedic has not met the local requirements for continued accreditationas listed above and is less than one year into the new licensure period ORc.License renewal does not occur prior to the license expiration.2.Accreditation will be continued if, prior to 180 days into the new licensure period:a.Paramedic presents a copy of the new/current license.b.Paramedic presents proof of completion of the most recent annual Policyand Procedure Update Training.c.A letter confirming employment is received by the LEMSA if applicable.Lapsed accreditation1. If accreditation becomes inactive for any reason and is not continued prior to 180days into the new licensure period, the paramedic must provide proof of Policy andProcedure update which has been completed in the last year.2. If accreditation becomes inactive for greater than one year the paramedic mustcomplete the initial accreditation process, as listed in section I.Page 2 of 2
March 30, 2015 draftCOUNTY OF MARIN EMS7006PATIENT CARE RECORD (PCR)I.PURPOSETo establish requirements for completion, reporting, and submission of Marin County approvedPatient Care Records.II.RELATED POLICIESALS to BLS Transfer of Care, ATG 4Against Medical Advise (AMA), GPC 2Release at Scene (RAS), GPC 3III.DEFINITIONSA.Patient – someone who meets any one of the following criteria:1.Has a chief complaint or has made a request for medical assistance2.Has obvious symptoms or signs of injury or illness3.Has been involved in an event when mechanism of injury would cause theresponder to reasonably believe that an injury may be present4.Appears to be disoriented or to have impaired psychiatric function5.Has evidence of suicidal intent6.Is deadB.Emergency Medical (EM)/Authorization Order (AO) – a number assigned by a MarinCounty Communication’s Center to identify each 9-1-1 call dispatched for medicalassistance.C.Electronic Patient Care Record (ePCR) - the permanent record of prehospital patientevaluation, care, and treatment.D.Field Transfer Form (FTF) – a temporary, paper record of patient careE.Triage Tag – a paper record for multi-casualty incidents involving 6 or more patientsIV.POLICYA.An ePCR shall be completed for every call for which an EM/AO is issued except for thoseincidents which were cancelled either enroute or after being on scene no more than fiveminutes.B.For all patients transported, the ePCR will be completed by the personnel assigned to thetransport unit.C.For non-transported patients (e.g. AMA, RAS, Dead on Scene), the ePCR will becompleted by the paramedic or EMT most involved in patient care and responsible for thepatient's disposition.D.For calls where there is no medical merit, the ePCR will be completed according toprovider agency’s policy.E.The ePCR is the permanent PCR and will be filled out in a clear, concise, accurate, andcomplete manner and will include all care provided in the prehospital setting. Whenpossible, it shall include all 12 lead ECGs and any ECG other than normal sinus rhythm.F.The completed PCR includes all care rendered by the transporting providers as well asany care given prior to arrival of the transporting unit by bystanders and/or firstresponders. Documentation of care provided by first responders (of a different agencythan the transport unit) may be required by their department policy.G.When a patient is transported to a receiving facility, one copy of the PCR shall be left withthe receiving facility upon transfer of care.Page 1 of 2
March 30, 2015 draftCOUNTY OF MARIN EMS70061.H.I.J.K.V.In the event that personnel are unable to leave a completed PCR at the facility, aFTF will be completed in full and left in lieu of the ePCR. However, ALL criticalpatients (e.g., cardiac arrest, Early Notification patients) MUST have a completedPCR left at the hospital upon transfer of care. If a FTF was utilized, an ePCR willbe completed and received by the facility as soon as possible and no later than 3hours of transfer of care.For ground transportations to an out-of-county facility, a FTF will be given to the receivingprovider and a completed ePCR shall be produced and sent to that facility within 3 hoursof transfer of care.For air ambulance transportations, a FTF will be given to the air ambulance personnel,and an ePCR will be created within 3 hours of transfer of care and sent to the receivingfacility via ePCR program or FAX.Personnel assigned outside of the county to provide medical mutual aid (e.g. fire-lineEMT/Paramedic), shall complete a FTF for each patient contact. The FTF will be createdon site and a copy submitted to the provider agency as soon as possible after returning tothe county.Willful omission, misuse, tampering, or falsification of documentation of patient carerecords is cause for formal investigative action under Section 1978.200 of the CaliforniaHealth and Safety Code.GENERAL INSTRUCTIONSA.The patient care record is part of the patient’s permanent medical record and is used for,but not limited to, the following purposes:1.Transfer of information to other healthcare providers2.Medical legal documentation3.Billing for services4.Development of aggregate data reports for Continuous Quality Improvement (CQI),including specific quality indicators and identification of educational needs5.EMS Agency case investigationB.Reference to a Marin County EMS Notification Form or similar record should not beincluded on the patient care record.C.If ALS to BLS transfer of care is determined to be appropriate, documentation ofassessments and all care rendered must be completed by both the ALS and the BLS unitsaccording to policy ATG 4.D.Provider agencies are responsible for training their employees in the initiation, completion,distribution of patient care records, HIPAA and any accompanying forms based on theEMS Agency’s currently approved training curriculum.Page 2 of 2
March 30, 2015 draftCOUNTY OF MARIN EMS7006bAPPROVED MEDICAL ABBREVIATIONSPURPOSETo identify the abbreviations and symbols which an Emergency Medical Technician (EMT) or Paramedic mayuse for documentation purposes in Marin County.ABBREVIATIONSAbbreviation / Symbol C FLR1 2 @ egativedegrees Celsiusdegrees Fahrenheitleftrightprimarysecondaryless thangreater esbeforealert and orientedat scene / arrived at sceneabdomenantecubicalatrial fibrillationAutomatic Internal Cardiac Defibrillatorabove the knee amputationaltered level of consciousnessAdvanced Life Supportmorningagainst medical adviceacute myocardial infarctionarrived on sceneapproximatelyacetylsalicylic acid, aspirinas soon as possiblearrived to findbecausebundle branch blockblood glucoseblood glucose levelPage 1 of 6
March 30, 2015 FTFCOUNTY OF MARIN EMS7006bbilateralbelow the knee amputationBasic Life Supportbowel movementblood pressurebeats per minuteblood sugarburn surface areabag valve maskwithchief complaintcomplain ofcode twocode threecancercoronary artery diseasecongestive heart failureCalifornia Highway PatrolCentral Marin Police Authoritycomplain of / carbon monoxidechronic obstructive pulmonary diseasechest paincontinuous positive airway pressurecardio pulmonary resuscitationCincinnati prehospital stroke scalecirculation, sensation, movementcerebral vascular accidentdesignated decision makerdiabetic ketoacidosisDiabetes mellitusdo not resuscitatedeep vein thrombosisdiagnosiselectrocardiogramemergency departmentelectrocardiogramEmergency Medical DispatchEmergency Medical ServiceEmergency Medical TechnicianParamedicenrouteEmergency Roomelectronic PCR softwareendotrachealestimated time of arrivalend-tidal carbon dioxideendotracheal intubationalcoholendotracheal tubefemaleField transfer formPage 2 of 6
March 30, 2015 CLSLtLUQmMm/omAMADMCSOMDmEqmgmg/DlCOUNTY OF MARIN EMS7006bfractureGramgaugeGlasgow Coma Scalegastrointestinalgramgunshot wounddrop(s)genitourinaryhourhead, neck, backwaterheadachehand-held nebulizerHead of bedheart ratehypertensionhighwayhistoryInternal Cardiac Defibrillatorintensive care intravenous pushjugular venous distensionKendrick Extrication DevicekilogramsKaiser San RafaelKaiser Terra LindaliterleftlacerationLast known wellleft lateralleft lower quadrantloss of consciousness / level of consciousnesslung soundsleftleft upper quadrantminmaleMonth oldMilliampmucosal atomization deviceMarin County Sheriff's Office (deputy)medical doctormilliequilvalentmilligrammilligrams per deciliterPage 3 of 6
March 30, 2015 draftMGHMIMICUMINmlMOIMPHMSMSo4MVAMVCMVPDN&V or N/V or DO2O2 PMDPOPOCPOLSTPRNCOUNTY OF MARIN EMS7006bMarin General Hospitalmyocardial infractionmobile intensive care unitminimum / minutemillilitermechanism of injurymiles per hourmorphine sulfate / multiple sclerosismorphinemotor vehicle accidentmotor vehicle crashMill Valley Police Departmentnausea and vomitingSodium Chlorideno apparent distressnasal cannulaNovato Community Hospitalnegativeneurologicalnitroglycerinno known drug allergiesnasopharyngeal airwayNovato Police Departmetnon-rebreather masknormal salinenormal sinus rhythmnitroglycerinenausea, vomiting, diarrheaoxygenperipheral capillary oxygen saturationoverdoseorally disintegrating tabletoropharyngeal airwayafterpink warm drypremature atrial contractionpalpitationparity, e.g. gravid 2, para 1 means the patient has been pregnant twice andgiven birth once; also written G2P1penicillinpulmonary edema / pedal edema / patient exampulseless electrical activitypupils equal reactive to lightPupils equal, round, reactive to lightpremature junctional contractioneveningprimary/personal/private medical doctorby mouthposition of comfortPhysician Orders for Life Sustaining Treatmentas neededPage 4 of 6
March 30, 2015 draftPSYCHPTPTAPTSPTSDPulse OxPVCPVHPVTPXqRRARASRLQRMCRNROMROSCRPRPMRRRtRxsS. BradyS. TachS/NT/NDS/PS/SSBPSC, TRANSTTTTXUCSFCOUNTY OF MARIN EMS7006bpsychiatricpatientprior to arrivalpatientspost traumatic stress disorderperipheral capillary oxygen saturationpremature ventricular contractionPetaluma Valley Hospitalprivatepaineveryrightroom airreleased at sceneright lower quadrantroutine medical careregistered nurserange of motionreturn of spontaneous circulationreporting partyrespirations per minuterespiratory raterightprescriptionwithoutsinus bradysinus tachycardiaSoft, non-tender, no distentionstatus postsigns and symptomssystolic blood pressuresubcutaneoussublingualsmallspinal motion restrictionskilled nursing facilityshortness of breathperipheral capillary oxygen saturationSan Rafael PDST Segment Elevation Myocardial Infarctionsupraventricular ient ischemic attackto keep opentransfer of caretransport / transferTrauma Triage TooltreatmentUniversity California San FranciscoPage 5 of 6
March 30, 2015 draftUOAUSGCUTIUTLUTOVV/S or VSVAVFVTW/w/cw/oWBCWNLY/O or YOCOUNTY OF MARIN EMS7006bupon our arrivalUnited States Coast Guardurinary tract infectionunable to locateunable to obtainvictimvital signVeteran's Administrationventricular fibrillationventricular tachycardiawithwheelchairwide openwhite blood countwithin normal limitsYear(s) oldPage 6 of 6
MarchJuly 1, 2015COUNTY OF MARIN EMSBLS PR 1AUTHORIZED PROCEDURES FOR EMT-1PERSONNELALWAYS USE BODY SUBSTANCE ISOLATION PRECAUTIONSINDICATIONIn addition to the items listed in the basic Sscope of Ppractice of Emergency MedicalTechnician, EMTs may perform the following:PROCEDUREAdminister over the counter medications including Oral glucose or sugar solutions and asprin.Monitor intravenous lines delivering glucose solutions or isotonic balanced salt solutions including Ringer'slactate for volume replacement;Monitor, maintain, and adjust if necessary in order to maintain, a preset rate of flow and turn off the flow ofintravenous fluid;Transfer a patient, who is deemed appropriate for transfer by the transferring physician, and who hasnasogastric (NG) tubes, gastrostomy tubes, heparin locks, foley catheters, tracheostomy tubes and/orindwelling vascular access lines, excluding arterial lines;EMT Optional SkillsAccreditation for EMTs to practice optional skills shall be limited to those whose certificate is active and areemployed within the jurisdiction of the LEMSA by an employer who is part of the organized EMS system.The following optional skills may be performed after the EMT has received training approved by the LEMSA.Administration of epinephrine by auto-injector for suspected anaphylaxis and/or severe asthma. EMTs mustdemonstrate skills competency at least every two years to maintain accreditation.Administration of prepackaged Atropine and Pralidoxime Chloride.Page 1 of 1
March 30, 2015 draftCOUNTY OF MARIN EMSALS PR 2ADULT INTRAOSSEOUS PROCEDUREALWAYS USE BODY SUBSTANCE ISOLATION PRECAUTIONSINDICATIONS Patient in extremis, cardiac arrest, profound hypovolemia, or septic and in need of immediatedelivery of medications / fluids and immediate IV access is not possibleCONTRAINDICATIONS Absolute contraindications: Recent fracture of involved bone (less than 6 weeks) Vascular disruption proximal to insertion site Inability to locate landmarks Relative contraindications: Infection or burn overlying the site Congenital deformities of the bone Metabolic bone diseaseEQUIPMENT Intraosseous infusion needle and/ or mechanical device Antiseptic swab commercially prepared chlorhexidine with alcohol swab or ampule. If patienthas allergy to chlorhexidine, use alcohol swab only. Sterile gauze pads 10-12 ml syringe filled with 10 ml saline IV NS solution and tubing with 3 way stopcock Supplies to secure infusion Pressure bag Lidocaine 2% (Preservative Free)PROCEDURE Aseptic technique must be followed at all times Position and stabilize leg site Locate primary site, 1-2 cm medial to tibial tuberosity Locate secondary site according to manufacturer’s specification Prepare insertion site using aseptic technique Air or gauze dry Insert IO needle according to manufacturer’s directions Confirm placement Attach syringe with 10 ml of saline to needle Rapid bolus with 10 ml saline* If patient awake and/or responsive to pain, infuse 2% Lidocaine 20-40 mg over 30-60seconds prior to 10 ml rapid saline bolus. Wait 30-60 seconds before fluid infusion. Mayrepeat Lidocaine in 15 minutes if needed. If resistance is met, remove needle, apply pressure to site Disconnect syringe Attach pre-flooded IV tubing Stabilize as recommended by manufacturer Fluid administration may require pressure Monitor insertion site and patient conditionPage 1 of 1
March 30, 2015 draftCOUNTY OF MARIN EMSALS PR10IV ACCESS PROCEDUREALWAYS USE BODY SUBSTANCE ISOLATION PRECAUTIONSINDICATION To describe a method for establishment of intravenous access in the pre-hospital settingEQUIPMENT IV catheter Equipment to secure line Tourniquet Syringe IV fluid / IV tubing if indicatedPROCEDURE Select insertion site and needle size as appropriate to the patients condition using the smallestcatheter and most distal site indicated Apply a tourniquet above the insertion site Don a clean pair of gloves Clean IV catheter insertion site with alcohol and apply Betadine solution using a back and forthmotion for 30 seconds with commercially prepared chlorhexidine with alcohol swab or ampule.If patient has allergy to chlorhexidine, clean with alcohol swab only. Allow the site to air dry for 2 minutes. If site is not dry after time, dry with sterile 2X2 Insert IV catheter; assure patency Attach appropriate solution, begin flow, adjust rate or attach “lock” if saline lock appropriate Secure with anchoring tape, avoiding puncture site Apply occlusive sterile dressing over the needle insertion site. Do not put tape over theocclusive dressing. If saline lock was started, irrigate with 5 ml NS. Saline locks may be used in lieu of intravenous lines when: Treatment protocol specifies IV NS TKO Fluid resuscitation or challenge is not anticipatedPage 1 of 1
March 30, 2015 draftCOUNTY OF MARIN EMSALS PR 11EXTERNAL CARDIAC PACING PROCEDUREALWAYS USE BODY SUBSTANCE ISOLATION PRECAUTIONSINDICATION Symptomatic bradycardia which may include: HR 50 with decreasing perfusion, chest pain,shortness of breath, decreased LOC, pulmonary congestion or congestive heart failure PHYSICIAN CONSULT Concomitant administration of Morphine Sulfate and MidazolamCRITICAL INFORMATION If patient is unstable, do not delay pacing for IV accessEQUIPMENT Cardiac monitor/ defibrillator/ external pacemaker Pacing capable electrode padsPROCEDURE ALS RMC Administer NS 250 ml bolus IV/IO If patient is conscious, administer Midazolam 1 mg slow IV/IO. May repeat 1 mg every 3minutes to desired degree of sedation. Maximum dose 0.05 mg/kg. Morphine Sulfate IV/IO/IM for pain management as needed; maximum dose of 5 mg. If tolerated, position patient supine, applying pacing electrodes to bare chest according tomanufacturers recommendations (anterior/ posterior or sternal/ apex). Confirm and record ECG. Set pacing rate at 80, turn on pacing module, and confirm pacer activity on monitor. Increase output control until capture occurs or maximum output is reached. Once capture is confirmed, increase output by 10% Confirm pulses with paced rhythm. Monitor vital signs and need for further sedatives or pain control.DOCUMENTATION MiliAmps needed for capture Time pacing started/ discontinuedRELATED POLICIES/ PROCEDURES Bradydysrhythmia C 4 Adult Pain Management ATG 2 Adult Sedation ATG 3Page 1 of 1
March 2015 draftCOUNTY OF MARIN EMSALS PR 1212-LEAD ECG PROCEDUREALWAYS USE BODY SUBSTANCE ISOLATION PRECAUTIONSINDICATION Patients with a medical history and/ or presenting complaints consistent with Acute CoronarySyndrome (ACS). Indications for the procedure may include one or more of the following: Chest or upper abdominal pain, described as pressure or tightness Nausea or vomiting Diaphoresis Shortness of breath and/ or difficulty with ventilation Anxiety, feeling of “doom” Syncope or dizziness Other signs or symptoms suggestive of ACS PHYSICIAN CONSULT If interpretation of ECG is inconclusive and ST segment elevation is present, seek immediateconsultation with STEMI Receiving Center (SRC)CONTRAINDICATIONS Life threatening conditions including ventricular tachycardia, ventricular fibrillation, or 3rddegree AV block Uncooperative patients Any situation in which a delay to obtain ECG would compromise care of the patientEQUIPMENT ECG machine and leads if availablePROCEDURE Attach ECG limb leads to arms and legs Attach ECG chest leads as follows: V1: right of sternum, 4th intercostal space V2: left of sternum, 4th intercostal space V3: halfway between V2 and V4 V4: left 5th intercostal space, mid-clavicular line V5: horizontal to V4, anterior axillary line V6: horizontal to V5, mid- axillary line V4R- V6R: right 5th intercostal space, mid-clavicular line to mid axillary line (for suspectedright ventricular infarction (RVI) and/ or physician request). Lead V4R must be obtainedwhenever ST segment elevation is noted in leads II, III, and AVFSPECIAL CONSIDERATIONS If the 12-lead ECG demonstrates ST elevation and an acute ST elevation Myocardial Infarct issuspected refer to STEMI Policy C 9 Infarctions may be present with a normal 12-lead ECG. Consider taking a 15-lead ECG.RELATED POLICIES/ PROCEDURES Chest Pain/ Acute Coronary Syndrome C 8 STEMI Policy C 9Page 1 of 1
March30, 2015 draftCOUNTY OF MARIN EMSATG 1ROUTINE MEDICAL CARE (RMC)ALSALWAYS USE BODY SUBSTANCE ISOLATION PRECAUTIONSINDICATION To define procedures indicated by ALS RMC per treatment guidelines or Patient condition warrants ALS care/assessment, but does not meet the indication of any othertreatment policyTREATMENT As indicated: Vascular access Blood glucose monitoring as indicated by ALOC or patient history Cardiac monitor Advanced airway management Initiate oxygen therapy for respiratory distress, signs of hypoxia, suspected CO poisoning,or SpO2 saturation 94% Temperature ETCO2 12 lead ECG For pediatric patients, use length based color-coded resuscitation tape and applycorresponding wrist bandPage 1 of 1
March 30, 2015 draftCOUNTY OF MARIN EMSATG 2ADULT PAIN MANAGEMENTALWAYS USE BODY SUBSTANCE ISOLATION PRECAUTIONSINDICATION Patient exhibits or is determined to have measurable or anticipated pain or discomfort PHYSICIAN CONSULT Patients with SBP 100 Patients with head trauma; multi-system trauma that includes abdominal/thoracic trauma;decreased respirations; ALOC (GCS 15); or women in labor 20 mg Morphine Sulfate is needed for pain management Concomitant administration of Morphine Sulfate and MidazolamCRITICAL INFORMATION Origin of pain (examples: isolated extremity trauma, chronic medical condition, burns,abdominal pain, multi-system trauma) Mechanism of injury Approximate time of onset Complaints or obvious signs of discomfort Use Visual Analog Scale (0-10) or Wong/Baker Faces Pain Rating Scale if non-Englishspeaking adult. Express results as a fraction (i.e. 2/10 or 7/10) Vital signs Presence of special infusion apparatus for narcotic or oncology agents may help to determinedosingTREATMENT Morphine Sulfate IV/IO: 5 mg slowly; MR q 5 minutes, max. dose 20 mg. If unable to establish IV/IO, administer Morphine Sulfate IM 5-10 mg; MR in 20 minutes,max. dose 20 mg If significant pain persists after Morphine Sulfate 10 mg IV/IO, may consider Midazolam1mg IV/IO with physician consult; MR in 3 minutes to maximum dose 2 mg. If nausea/vomiting, consider Ondansetron (Zofran ) 4mg ODT/IM or slow IV/IO over 30seconds; MR x1 in 10 minutes If patient unable to take Morphine Sulfate, refer to Sedation Policy, ATG3. Maintain O2 saturation 94%DOCUMENTATION- ESSENTIAL ELEMENTS Initial and post treatment pain score, expressed in a measurable form (i.e. 7/10) Interventions used for pain management (i.e. ice pack, splint, Morphine Sulfate, Midazolam) Reassessment after interventions Initial and post treatment vital signs: BP, HR, RR, O2 Saturation, ETCO2 (and GCS in patientswith ALOC) Physician consult if requiredPage 1 of 1
March 30, 2015 draftCOUNTY OF MARIN EMSATG 3ADULT SEDATIONALWAYS USE BODY SUBSTANCE ISOLATION PRECAUTIONSINDICATION Cardioversion / Cardiac Pacing Agitation / combativeness interfering with critical ALS interventions and airway control or thatendangers patient or caregiver Patients unable to tolerate Morphine Sulfate for pain management PHYSICIAN CONSULT Head injury (airway is stable) Multiple system trauma (airway is stable) Concomitant administration of Morphine Sulfate and MidazolamCRITICAL INFORMATION Relative contraindications: Nausea / vomiting ALOC Hypotension (SBP 100) Suspected drug / alcohol intoxicationTREATMENT ALS RMC, including ETCO2 Cardioversion / cardiac pacing If patient is conscious, administer Midazolam 1 mg slow IV/IO. May repeat 1 mg every 3minutes to desired degree of sedation. Maximum dose 0.05 mg/kg. Morphine Sulfate IV/IO/IM for pain management as needed; maximum dose of 5 mg. Agitation, combativeness or for patients unable to tolerate Morphine Sulfate- administerMidazolam IV/IO: 1 mg slowly; MR q 3 minutes to maximum dose 0.05 mg/kg. IN: 5 mg (2.5 mg in each nostril) IM: 0.1 mg/kg; MR x 1 in 10 minutes Patients receiving sedation for airway management who have long transport times may receivesedation maintenance doses of Midazolam 1 mg IV/IO every 15 minutesMidazolam for Sedation Weight Based Chart - MAXIMUM DOSE for IV/IO/IM onlyKgLbDose (0.05 mg/kg)40882 mg45992.25 mg501102.5 mg551212.75 mg601323 mg651433.25 mg701543.5 mg751653.75 mg801764 mg851874.25 mg901984.5 mg952094.75 mg 100 2205 mgPage 1 of 2
March 30, 2015 draftCOUNTY OF MARIN EMSATG 3SPECIAL CONSIDERATION Sedation for airway management does not mandate intubation, but may require airway/ventilationsupport Patients receiving Midazolam may experience hypotensionRELATED POLICIES Patient Restraint GPC11 Continuous Positive Airway Pressure (CPAP) Procedure ALS PR 13 External Cardiac Pacing Procedure ALS PR 11Page 2 of 2
March 30, 2015 draftCOUNTY OF MARIN EMSC1VENTRICULAR FIBRILLATION /PULSELESS VENTRICULAR TACHYCARDIAALWAYS USE BODY SUBSTANCE ISOLATION PRECAUTIONSINDICATION Pulseless, apneic with cardiac rhythm of ventricular fibrillation or wide complex tachycardiaCRITICAL INFORMATION Witnessed or unwitnessed Effective Bystander CPRTREATMENT Witnessed arrest: CPR until defibrillator available Consider pre-cordial thump if witnessed and no defibrillator immediately available Unwitnessed arrest: CPR for 2 minutes prior to defibrillation ALL arrests: CPR for 2 minutes between shocks. Do not check rhythm immediately after shock. If available, use mechanical CPR (contraindicated in pediatrics and traumatic arrests) Defibrillate as per manufacturer’s recommendations: LifePak: 200J, 300J, 360J Zoll: 120J, 150J, 200J Repeat defibrillations 30-60 seconds after drug administrations ALS RMC If VF/VT converts to another rhythm post defibrillation, refer to appropriate protocol for further treatment If VF/VT continues: Epinephrine 1:10,000 1.0 mg IV/IO; repeat q 3-5 minutes; If VF/VT persists after three defibrillations or recurs: Consider Amiodarone 300 mg IV/IO push (diluted in, or followed by, 20 to 30 ml NS). Initial dose canbe followed by ONE 150 mg IV/IO push in 3 to 5 minutes If rhythm converts with return of pulses, refer to ROSC policy. If rhythm converts with return of pulses after Amiodarone, monitor and consider infusion of Amiodaronedrip (150mg in 100 ml NS, 1 mg/minute 40 gtts/min. with 60 drops ml/ tubing)SPECIAL CONSIDERATIONS Establishment of IV/IO, airway and medication administration should occur during CPR and should notinterrupt the CPR cycles If rhythm converts without administration of Amiodarone, monitor and transport Consider pre-cordial thump if witnessed and no defibrillator immediately available Consider and treat possible contributing factors: Hypovolemia Toxins (overdoses) Hypoxemia Ta
as a second paramedic during the accreditation process. 2. Accreditation is indicated by the issuance of a card bearing the date of issuance, Marin County Accreditation number and the signature of the EMS Agency Medical Director. the paramedic will be issued a sticker which will be attached to
Crafton Hills College Paramedic Program has the longest continuous accreditation of any public institution in California. The program received its initial accreditation in 1985, at which time the accreditation committee awarded a full five year accreditation. Crafton Hills has maintained its excellent record and continuous accreditation. This .
Crafton Hills College Paramedic Program has the longest continuous accreditation of any public institution in California. The program received its initial accreditation in 1985, at which time the accreditation committee awarded a full five year accreditation. Crafton Hills has maintained its excellent record and continuous accreditation.
GRADY EMERGENCY MEDICAL SERVICES ACADEMY PARAMEDIC CLINICAL EDUCATION MANUAL STATE OF GEORGIA - PARAMEDIC SCOPE OF PRACTICE Under O.C.G.A. § 31-11-54, persons training to be a paramedic may perform all skills allowed for paramedics, as long as they are under the supervision of a physic
The EMS Program is a selective admissions program. Three schedules are offered for the Paramedic Programs, each starting at a different time of the year. The Paramedic Program can be taken either as an AAS Degree or Certificate. You must have your Texas EMT certificate before you start your Paramedic course. Evening Program (Fall):
Paramedic Program Associate of Science Degree T he mission of the Paramedic Program is to provide a . strong educational foundation so the future paramedics may improve the health and welfare of Kern County by providing the highest quality prehospital emergency medical care. The Paramedic Program is designed to provide students
Mt. Nebo Training and Paramedic Lead Instructor Coordinator Salt Lake City, UT Kirk Mittelman — NREMT-P Paramedic Program Director Mt. Nebo Paramedic, LLC Salt Lake City, UT John Mohler — RN, BSN, CFRN, CCRN John Mohler & Co Carlin, NV Small Mine Development State of Nevada EMS Newmont
Mt. Nebo Training and Paramedic Lead Instructor Coordinator SLC, UT Kirk Mittelman NREMT-P Paramedic Program Director Mt. Nebo Paramedic, LLC SLC, UT Margaret Mittelman NREMT-P Associate Professor Utah Valley University Provo, UT John Mohler – RN, BSN, CFRN, CCRN John Mohler & Co. Carlin, NV Steve M
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