IREMSC Regional And Fairbanks North Star Borough Standing Orders

IREMSC Regional and Fairbanks North Star Borough Standing Orders By Regional Standing Orders Committee Fairbanks North Star Borough And Interior Region EMS Council, Inc 2503 18th Ave Fairbanks, Alaska 99701 Revised August 6, 2015 Revised September 2, 2016 Updated January 11, 2017 Updated February 2021

5TH EDITION INTERIOR REGION EMS COUNCIL AND FAIRBANKS NORTH STAR BOROUGH REGIONAL STANDING ORDERS REVISED 10/2016; UPDATED 1/2017; UPDATED 6/2019 It is with great appreciation that we recognize the following members of the FNSB Standing Orders Committee that contributed countless hours to help make this document as accurate and up to date as possible with current practices in emergency medicine: Original Standing Orders Committee: Dr. Paul Buccigross, Chena Goldstream FR Responder Dr. Marc Dumas, Fairbanks FD Medical Director Scott Learned, MICP Steese FD Doug Loshbaugh, EMT III, Chena Goldstream Fire and Rescue Dr. Maria Mandich, ER Physician, Chena Goldstream FR Medical Director Dr. Brian Tansky, ER Physician, Interior Region EMS Council Medical Director Dr. Carol Timmerman, ER Physician, North Pole FD Medical Director Wilma Vinton, MICP, Steese Volunteer Fire Department and Interior Region EMS Council, Inc Original Proofreaders: Besides the great help of the Committee members, the following are to be thanked for their assistance in proofreading and assisting with ensuring accuracy and consistence; Jenny Brown, MICP, UAF-CTC Paramedic Program Assist Dir. David Daniell, MICP, North Pole FD Ken Mayfield, MICP, Fairbanks FD David Rockney, MICP, Interior Region EMS Council, Inc. Terry Solomon, EMT 3, Chena Goldstream F&R 2019 Update By: Dr. Maria Mandich, IREMSC Regional Medical Director Kimberlee Johnson, IREMSC Training Coordinator 2021 Update By: Dr. Maria Mandich, IREMSC Regional Medical Director Dr. Dumas, FFD Medical Director Dr. Robinson, Steese Fire, NPF, NSFD, and Salcha Fire Medical Director Ashley Christenson, MICP, IREMSC Training Coordinator Ian Longridge, MICP, University FD David Daniell, MICP, Steese FD Racheal Cox, MICP, Chena Goldstream F&R Dan Weatherly, MICP, University FD 0

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Table of Contents Signature Page . 1 Introduction . 5 SCOPE OF PRACTICE . 6 Treatment Protocols . 10 Universal Patient Care. 11 Airway Management Protocol. 12 Venous Access Protocol. 13 Treatment Protocols Medical . 14 Abdominal Pain . 15 Altered Mental Status . 17 Anaphylaxis/Allergic Reaction . 19 Behavioral – Agitated or Combative Patient. 21 Cardiac: Arrest ALS . 23 Cardiac: Arrest w/AED BLS . 24 Cardiac: Arrest- Asystole/PEA-Adult . 25 Cardiac: Arrest -Asystole/PEA-Pediatric . 27 Cardiac Arrest . 29 -V-Fib/Pulseless V-Tach- Adult . 29 Cardiac Arrest . 31 V-Fib/Pulseless V-Tach- Pediatrics . 31 Cardiac: Bradycardia-Adult. 33 Cardiac: Bradycardia-Pediatric . 35 Cardiac: LVAD Patient. 39 Cardiac: Post-Resuscitation-Adult . 41 Cardiac: Tachycardia -Adult . 45 Cardiac: Tachycardia- Pediatric . 47 Cardiac: Ventricular Ectopy-Adult . 49 Dental Problems . 51 Epistaxis (Nosebleed). 53 Frostbite . 55 Hyperkalemia . 57 Hypertensive Crisis. 59 Hyperthermia . 61 Hypotension/Shock - Adult . 63 Hypotension/Shock - Pediatric . 65 Hypothermia with Signs of Life . 67 Hypothermia, No Signs of Life . 69 Near-Drowning/ Drowning . 71 Neonatal Resuscitation. 73 OB: Childbirth/Labor . 75 OB: Obstetrical/Gynecological. 77 Pain Control Protocol. 79 Poisoning/Overdose . 81 Respiratory Distress- Adult: Universal Algorithm . 83 Respiratory Distress: Asthma- Adult . 85 Respiratory Distress: CHF/Pulmonary Edema Adult . 87 Respiratory Distress-Pediatric . 89 Seizures-Adult . 91 Seizures-Pediatric . 93 Stroke . 95 Syncope . 97 Vomiting/Nausea and Diarrhea . 99 Treatment Protocols: Trauma . 102 Trauma: Multiple Trauma Overview . 103 Trauma: Burns . 105 Trauma: Chest . 107 Trauma: Crush Injury . 109 Trauma: Extremity . 111 Trauma: Eye Injuries . 113 Trauma: Face and Neck . 115 Trauma: Head . 117 2

Trauma: Spinal . 119 Trauma: Traumatic Arrest. 121 Operational Guidelines. 124 Abuse-Child:Recognition and Reporting . 126 Abuse- Domestic Violence:Recognition and Reporting . 127 Abuse- Elder Abuse:. 128 Recognition and Reporting . 128 Air Medevac Transport: Rotor . 129 Cardiac/STEMI Alert Procedure . 131 Care of Minors . 132 Children with . 133 Special Care Needs. 133 Deceased Subjects. 134 Do Not Resuscitate/Physician Orders for Life Sustaining Treatment (POLST) . 135 Infant Abandonment:Safe Haven for Infant Act . 136 Multiple Casualty Incident. 137 Patient Care Report- Written . 139 Patient Care Report: . 142 Radio & Verbal . 142 Physician On Scene . 143 Reportable Conditions . 144 Transport . 145 Termination of Resuscitation (TOR) and . 147 Field Pronouncement . 147 PRE-HOSPITAL TRAUMA TEAM ROLE SUMMARY . 149 Medications . 150 ADENOSINE (Adenocard). 152 ALBUTEROL SULPHATE . 154 AMIODARONE (Cordarone). 155 ASPIRIN (ASA) . 156 ATROPINE SULFATE . 157 DIPHENHYDRAMINE (Benadryl) . 160 EPINEPHRINE (Adrenalin). 161 FENTANYL (Sublimaze). 163 GLUCAGON . 165 GLUCOSE, ORAL GEL (Glutose 15) . 166 IPRATROPIUM BROMIDE (Atrovent) . 167 KETAMINE (KETALAR) . 168 LIDOCAINE 2% SOLUTION. 169 LORAZEPAM (Ativan) . 171 MAGNESIUM SULFATE . 173 METHYLPREDNISOLONE (Solu-Medrol) . 175 MIDAZOLAM (Versed) . 176 MORPHINE SULFATE . 178 NALOXONE (NARCAN) . 179 NITROGLYCERIN (Nitrolingual, Nitrostat) . 180 ONDANSETRON (Zofran) . 181 OXYGEN . 182 SODIUM BICARBONATE . 183 TRANEXAMIC ACID (TXA) . 184 Procedures . 186 Airway Management: . 188 Obstructed Airway . 188 Airway: Cricothyrotomy via Needle . 189 Airway: Cricothyrotomy, Surgical . 190 Airway: Emergent Airway Management . 191 Airway: Intubation-Nasotracheal. 193 Airway: Supra-Glottic Airway Device: . 194 Airway: Suctioning-Tracheal . 195 Airway: Tracheostomy Tube Replacement . 196 Blood Glucose Analysis . 197 3

Capnography . 198 Cardioversion . 199 Chest Decompression . 200 Childbirth. 201 CPAP . 202 ECG Diagnostics- 12 Lead . 204 Med Administration: . 206 Epinephrine Auto-Injector . 206 Med Administration . 207 : Hypodermic Medications . 207 Med Adminstration: IN . 208 Med Administration: . 209 Nebulizer. 209 Medication Administration . 211 : Rectal. 211 Positive End Expiratory Pressure (PEEP) Device . 212 Pulse Oximetry . 213 Restraints- Manual . 214 Restraints- Chemical . 216 Sedation. 217 Spinal Clearance for . 218 Spinal Motion Restriction (SMR) . 218 Spinal Clearance Flowchart. 221 Splinting- Pelvis . 222 Temperature Measurement . 223 Tourniquet Protocol . 224 Transcutaneous Cardiac Pacing . 225 Vagal Maneuvers . 226 Vascular Access: Existing Catheters. 227 Vascular Access: . 228 External Jugular Access . 228 Vascular Access: Extremity . 229 -Saline Lock Only . 229 Vascular Access: . 230 IO Access-EASY-IO . 230 Wound Packing:Uncontrollable Hemorrhage . 232 Appendices . 234 Symbols . 242 Glossary. 243 TRICYCLIC ANTIDEPRESSENTS LIST: . 255 APGAR Scale . 256 Cranial Nerve Assessment . 257 Focused Assessment . 258 Glasgow Coma Scale . 259 Pediatric Assessment Triangle . 260 Poisons - Signs and Symptoms . 261 Pregnancy Categories . 262 Stroke Screening: . 263 Cincinnati Stoke Scale. 263 Section 08.64.369Required Reporting . 265 TITLE 18.66 DOMESTIC VIOLENCE AND SEXUAL ASSAULT . 266 Alaska Statutes. Title 47. Welfare, Social Services and Institutions . 268 TITLE 47 WELFARE, SOCIAL SERVICES AND INSTITUTIONS . 270 AS 09.68.120. Definition of Death. . 272 AS 18.08.089. Authority to Pronounce Death. . 272 Report Of Harm . 273 Protection Of Vulnerable Adults . 273 Fairbanks North Star Borough Rescue Force . 276 4

Introduction These standing orders are the culmination of many hours of work by Interior Alaska EMS medical directors and providers dedicated to providing the highest quality care to people in the communities they serve. It is the intent of this document to provide you, the providers, with sufficient guidance to adequately perform your duties and to allow you to provide the best possible care to your patients, and to establish a uniform standard of care throughout the Fairbanks North Star Borough. It is important that you are familiar with the content of this document and that you are compliant with all training and membership requirements of your department. These orders only apply to members whose certification or license is current, who are in good standing in their department and who have met the training and check-off requirements of their departments. If for any reason a member is no longer in good standing, even though his or her EMT or paramedic certificate may still be current, that member may not operate under these guidelines or the authorization of the department’s physician sponsor. These are multilevel orders that include advanced procedures and drugs not covered in the basic State of Alaska EMT curricula. Before you may exceed the basic level of care for any state certification you hold, you must complete the required training and have written authorization from your department and medical director. Each individual using these orders will be authorized to practice at a particular level, for example, EMT-1, Paramedic or EMT-3. It is imperative that you know your level of authorization and do not exceed it. Just because a drug or procedure is mentioned in this document does not automatically mean you are authorized to perform it. You are to provide care to the standard of your certification and authorization. The drugs and procedures authorized for each level of certification and advanced training are listed in the Scope of Practice section. At no time should you substantially deviate from these standing orders unless you have physician authorization by direct radio, telephone or physician contact. Whenever significant deviation occurs, complete documen

Fairbanks North Star Borough Standing Orders By Regional Standing Orders Committee Fairbanks North Star Borough And Interior Region EMS Council, Inc 2503 18th Ave Fairbanks, Alaska 99701 Revised August 6, 2015 Revised September 2, 2016 Updated January 11, 2017 Updated February 2021 . 0