Spokane County EMS Protocols
Front Matter
Section 1. County Operating Procedures
- 1-01. Abandoned Babies Newborn Safety Act
- 1-02. Blood Draws
- 1-03. Cancellation / Slow Down
- 1-04. Determination of General Patient Transport Destination
- 1-05. Dispatch of Medical Personnel
- 1-06. Documentation
- 1-07. Emergency Services Supervisory Organization (ESSO)
- 1-08. Emergency Transports and ALS Rendezvous
- 1-09. Emergency Transport of the Disabled and their Service Animals
- 1-10. EMS Communication to Receiving Hospital
- 1-11. EMS Personnel Endangerment
- 1-12. EMS Scene Management & Inter-Agency Relations
- 1-13. Expectations of the EMS Agency, Supervisor and Supervising Physician
- 1-14. Field Resuscitation
- 1-15. General Guidelines for All Patients
- 1-16. Hazardous Materials Response
- 1-17. Helicopter Triage Guidelines
- 1-18. Hospital Emergency Response Team
- 1-19. Infectious Disease Precautions
- 1-20. Inter-Facility Transport
- 1-21. Level of Certification of EMS Personnel Attending Patient
- 1-22. Mass Casualty, Treatment and Transport
- 1-23. Medical Control
- 1-24. Medical Professionals at the Scene
- 1-25. Medications and Allergies
- 1-26. Moonlighting
- 1-27. Non-Transport of Patients
- 1-28. On-Scene Medical Authority
- 1-29. Patient Treatment Rights
- 1-30. Patient Refusal of Treatment / Transport
- 1-31. Relationship Between EMS Team and Private Physician
- 1-32. Restraints for Aggressive or Violent Patients
- 1-33. Schedule II Medications
- 1-34. Suspected Ebola Virus Disease
- 1-35. Thank You for Your Offer of Assistance
- 1-36. Washington State Prehospital Trauma Triage Destination Procedure
- 1-37. Washington State Prehospital Cardiac Triage Destination Procedure
- 1-38. Washington State Prehospital Stroke Triage Destination Procedure
Section 2. Procedure Protocols
- 2-01. AED Defibrillation Protocol
- 2-02. Bag-Valve-Mask: Face and Thigh Squeeze Technique
- 2-03. Blood Tube Information
- 2-04. Capnometry / Capnography
- 2-05. Carotid Sinus Massage
- 2-06. Continuous Positive Airway Pressure
- 2-07. Endotracheal Drug Administration
- 2-08. Endotracheal Intubation
- 2-09. Estimating Tracheal Tube Size and Depth of Insertion
- 2-10. Failed Resuscitation: Considerations for Family Support
- 2-11. Helmet Removal from Injured Patients
- 2-12. i-Gel Airways
- 2-13. Intraosseous Infusion - Adults
- 2-14. Intraosseous Infusions - Children
- 2-15. Correct Intraosseous Needle Placement
- 2-16. IV Fluids
- 2-17. King Airways
- 2-18. Needle Cricothyrotomy
- 2-19. Needle Thoracostomy
- 2-20. Optimal Sequence Intubation (OSI)
- 2-21. Oxygen Administration
- 2-22. Recommended Indications for Spinal Precautions in Children
- 2-23. Special Considerations in the Treatment of Patient Recently Immunized Against Smallpox
- 2-24. Spinal Immobilization
- 2-25. SQ and IM Injections
- 2-26. Stimulus Procedure
- 2-27. Surgical Cricothyrotomy
- 2-28. Tourniquet
- 2-29. Use of External Pacemakers
Section 3. Cardiovascular Protocols
- 3-01. Acute Stroke
- 3-02. Asystole / PEA
- 3-03. Bradycardia
- 3-04. Chest Discomfort Suspected Angina / AMI
- 3-05. General Assessment of Patients with significant Cardiac Arrhythmias
- 3-06. LVAD - HeartMate II
- 3-07. LVAD - HeartWare
- 3-08. LVAD - VentrAssist
- 3-09. Post Resuscitation
- 3-10. Post Cardiac Arrest Care
- 3-11. Pulmonary Edema
- 3-12. Stable Narrow-Complex Tachycardia
- 3-13. Stable Wide-Complex Tachycardia
- 3-14. Thoratec Ventricular Assist Devices
- 3-15. Unstable Narrow-Complex Tachycardia
- 3-16. Unstable Wide-Complex Tachycardia
- 3-17. Ventricular Assist Device(s)
- 3-18. Ventricular Fibrillation / Pulseless Ventricular Tachycardia
Section 4. Medical Protocols
- 4-01. Acute Epistaxis (Non-Trauma)
- 4-02. Allergic Reactions and Anaphylaxis
- 4-03. Adult Seizures
- 4-04. Coma of Unknown Origin
- 4-05. Emergency Disconnect of Home Hemodialysis
- 4-06. Excited Delirium: The Agitated Uncontrolled Patient
- 4-07. Hypoglycemia
- 4-08. Mental Health Emergencies
- 4-09. Poisoning / Overdose
- 4-10. Renal Failure and Dialysis Patients
- 4-11. Severe Sepsis
- 4-12. Toxic Smoke Inhalation
- 4-13. Treatment of Nerve Agents, GB, VX and OPP
Section 5. Pediatric and OB/GYN Protocols
- 5-01. General OB/GYN Considerations
- 5-02. Complications of Delivery
- 5-03. Emergency Delivery
- 5-04. Medications for Neonatal Resuscitation
- 5-05. Neonatal Resuscitation
- 5-06. Pre-Eclampsia
- 5-07. Sexual Assault
- 5-08. Spontaneous Abortion
- 5-09. General Pediatric Considerations
- 5-10. Child Abuse
- 5-11. Pediatric Airway Obstruction
- 5-12. Pediatric Allergic Reactions and Anaphylaxis
- 5-13. Pediatric Asystole / Pulseless Electrical Activity
- 5-14. Pediatric Bradycardia
- 5-15. Pediatric Coma / Altered Level of Consciousness
- 5-16. Pediatric Fever
- 5-17. Pediatric Hypoglycemia
- 5-18. Pediatric Post Resuscitation Care
- 5-19. Pediatric Pulseless Ventricular Tachycardia or V-Fib
- 5-20. Pediatric Respiratory Arrest
- 5-21. Pediatric Respiratory Distress with Stridor
- 5-22. Pediatric Respiratory Distress with Wheezing
- 5-23. Pediatric Seizures
- 5-24. Pediatric Shock
- 5-25. Pediatric Trauma
- 5-26. Stable Narrow-Complex Pediatric Tachycardia
- 5-27. Stable Wide-Complex Pediatric Tachycardia
- 5-28. Sudden Infant Death Syndrome
- 5-29. Unstable Narrow-Complex Pediatric Tachycardia
- 5-30. Unstable Wide-Complex Pediatric Tachycardia
- C-21. Pediatrics at a Glance
Section 6. Trauma Protocols
- 6-01. Abdominal Trauma
- 6-02. Animal Bites
- 6-03. Burns
- 6-04. Chemical Burns to the Eye
- 6-05. Chest Trauma
- 6-06. Crush Injury Syndrome
- 6-07. External Hemorrhage Control
- 6-08. Head Trauma
- 6-09. Injuries to the Ear
- 6-10. Injuries to the Nose
- 6-11. Penetrating and Blunt Injuries to the Eye
- 6-12. Penetrating and Blunt Injures of the Neck
- 6-13. Penetrating Trauma from Taser Weapons
- 6-14. Pelvic Fracture Stabilization Procedure
- 6-15. Soft Tissue Avulsions or Amputations
- 6-16. Spinal Trauma
Section 7. Environmental Protocols
- 7-01. Drowning
- 7-02. Frostbite
- 7-03. Heat Cramps / Heat Exhaustion
- 7-04. Heat Stroke
- 7-05. Hypothermia
Section 8. Respiratory Protocols
- 8-01. Airway Obstruction: Adult
- 8-02. Asthma
- 8-03. Chronic Obstructive Pulmonary Disease
- 8-04. Tracheostomy / Stoma Emergency Airway Management
Section 9. Special Situation Protocols
- 9-01. Cardiac Arrest Due to Physical Trauma
- 9-02. Fatal and Non-Fatal Drowning
- 9-03. Electrocution
- 9-04. EMS Response to Meth Lab Related Injuries
- 9-05. Hypothermia
- 9-06. Mental Health Emergencies
- 9-07. Pregnancy and Cardiac Arrest
- 9-08. Right Ventricular Infarction
Section 10. BLS / ILS and Supplemental Protocols
- 10-01. Aspirin
- 10-02. BLS Airway Obstruction: Adult
- 10-03. BLS Airway Obstruction: Pediatric
- 10-04. EMT Glucose Testing
- 10-05. EMT Naloxone Administration for Suspected Opiate Overdoseage
- 10-06. Mark 1 Kit (Atropine and 2-PAM)
- 10-07. Treatment of Nerve Agents, GB, VX and OPP
Section 11. Drug Protocols
- 11-00. Introduction
- 11-01. 10% Dextrose
- 11-02. 50% Dextrose
- 11-03. Acetylsalicylic Acid
- 11-04. Activated Charcoal
- 11-05. Adenosine
- 11-06. Albuterol
- 11-07. Amiodarone
- 11-08. Atropine
- 11-09. Calcium Gluconate
- 11-10. Diazepam
- 11-11. Diltiazem
- 11-12. Diphenhydramine
- 11-13. Dopamine
- 11-14. Epinephrine - Adult
- 11-15. Epinephrine - Pediatric
- 11-16. Etomidate
- 11-17. Fentanyl
- 11-18. Glucagon
- 11-19. Heparin
- 11-20. Hydroxocobalamin
- 11-21. Ipratropium Bromide
- 11-22. Ketamine
- 11-23. Lidocaine
- 11-24. Lorazepam
- 11-25. Magnesium Sulfate
- 11-26. Midazolam
- 11-27. Morphine
- 11-28. Naloxone
- 11-29. Nitroglycerin
- 11-30. Ondansetron
- 11-31. Oxygen
- 11-32. Oxymetazoline Hydrochloride
- 11-33. Pralidoxime Chloride
- 11-34. Racemic Epinephrine - Pediatric
- 11-35. Sodium Bicarbonate
- 11-36. Succinylcholine
- 11-37. Vecuronium Bromide
Appendix C. Reference Documents
- C-01. APGAR Scoring
- C-02. Certification Made Easy
- C-03. Classification of Burns
- C-04. Community Resources
- C-05. Conditions for Beneficial Assessment of Temperature
- C-06. Conversion Tables
- C-07. Diabetic Coma and Insulin Shock Fact Sheet
- C-08. Drug Reference Sheet
- C-09. Emergency Departments in Spokane County
- C-10. Emergency Laryngectomy Management
- C-11. Emergency Support Function #8
- C-12. Emergency Tracheostomy Management
- C-13. Field Operations Guide (FOG)
- C-14. Helicopter Safety Reference
- C-15. Interpretation of Step 3 of WA Prehospital Trauma Triage Procedure
- C-16. Levels of Trauma, Cardiac and Stroke Hospitals in County
- C-17. Manikin Intubation Credit Requirement for the Airway Component of Recertification
- C-18.1. Policy
- C-18.2. Federal Requirements for Dispensing Physicians
- C-18.3. DEA Registered Reverse Distributors
- C-18.4. P.S. Industries
- C-19. Pandemic Index of Severity for Triage
- C-20. Paramedic Requirements for Practicing in Spokane County
- C-21. Pediatrics at a Glance
- C-22. Pit Crew
- C-23. Pre / Post ROSC Cardiac Arrest Checklist
- C-24. Recommended Guidelines for the Scope of AED Training
- C-25. Revised Trauma Score
- C-26. Stoma / Tracheostomy Management
- C-27. Tiered Response to EMS Patient Care Concerns
- C-28. Department of Health Scope of Practice for EMS Providers
C-18. MPD Controlled Substance Management Guidelines
Appendix D. Reference Forms
- D-01. Abandoned Babies Act
- D-02. Affiliate Intent to Cover
- D-03. Blood Draw Directions
- D-04. County Field Training Letter
- D-05. Infectious Disease Exposure Form
- D-06. Non-Transport of Patient Form
- D-07. Patient Refusal of Treatment / Transport
- D-08. Physician Orders for Life-Sustaining Treatment
- D-09. Preliminary Field Medical Report
- D-10. Recommendation for Follow-Up to a Possible Exposure
- D-11. Spokane County EMS King Airway Insertion Evaluation
- D-12. Thank You for Your Offer of Assistance
- D-13. Training, CME, and Skills Maintenance Documentation
Field Operations Guide
- Cover & Preface
- FOG-1. Common Responsibilities
- FOG-2. Multi-Agency Coordination System
- FOG-3. Area Command
- FOG-4. Complex
- FOG-5. Command
- FOG-6.1. Organization Chart
- FOG-6.2. Position Checklists
- FOG-6.3. Air Operations Considerations
- FOG-6.4. Operations Section Planning Cycle Guide
- FOG-7.1. Organization Chart
- FOG-7.2. Position Checklists
- FOG-7.3. Planning Process
- FOG-7.4. Planning Section Planning Cycle Guide
- FOG-8.1. Organization Chart
- FOG-8.2. Position Checklists
- FOG-8.3. Logistics Guidelines
- FOG-8.4. Logistics Section Planning Cycle Guide
- FOG-9. Finance/Administration Section
- FOG-10.1. Organization Chart
- FOG-10.2. Modular Development
- FOG-10.3. ICS Organization Guide
- FOG-10.4. T-Card Colors and Uses
- FOG-10.5. ICS Forms
- FOG-10.6. ICS Map Display Symbology
- FOG-10.7. Resources Unit Functions and Interactions
- FOG-10.8. Situation Unit Functions and Interactions
- FOG-10.9. Resource Status Change Reporting
- FOG-10.10. Strike Team Leader Interactions
- FOG-10.11. Reassign/Release of Resources
- FOG-10.12. ICS Camp Organization and Reporting Relationships
- FOG-11.1. Introduction
- FOG-11.2. Typing Process
- FOG-11.3. Fire Suppression Resources
- FOG-11.4. Emergency Medical Services Resources
- FOG-11.5. Hazardous Materials Resources
- FOG-11.6. Search and Rescue Resources
- FOG-12. Hazardous Materials
- FOG-13.1. Introduction
- FOG-13.2. Incident Authority
- FOG-13.3. Command
- FOG-13.4. On Scene Medical Authority
- FOG-13.5. Initial "On-Scene" Priorities
- FOG-13.6. Secondary "On-Scene" Priorities
- FOG-13.7. Air Ambulance Transportation
- FOG-13.8. Disaster Medical Coordination Center (DMCC)
- FOG-13.9. Communications
- FOG-13.10. Central Collection Point for Names of Victims
- FOG-13.11. Medical Surge Trailers / Alternative Care Facilities (ACF)
- FOG-13.12. Modular Development
- FOG-13.13. Position Checklists
- FOG-13.14. EMS / Medical Branch Worksheet
- FOG-13.15. MCI Patient Triage / Destination List
- FOG-13.16. Multi-Casualty Glossary of Terms
- FOG-14. Urban Search and Rescue
- FOG-15. High Rise Structure Fire
- FOG-16.1. Law Enforcement Branch
- FOG-16.2. Evacuation Group
- FOG-16.3. Security Group
- FOG-16.4. Investigations Group
- FOG-16.5. Tactical Group
- FOG-16.6. Traffic Group
- FOG-16.7. Resource Types and Minimum Standards
- FOG-17. Terrorism / Weapons of Mass Destruction
- FOG-18.1. Introduction
- FOG-18.2. Risk Management Policy
- FOG-18.3. Risk Management Checklist
- FOG-18.4. Risk Management Theory
- FOG-18.5. All Risk Decision Making Checklist
- FOG-18.6. Utilization of LCES on All Incidents
- FOG-18.7. Spokane County Fire Agency Mutual Aid Firefighter Accountability
- FOG-18.8. Rapid Intervention Crews (RIC) and Groups (RIG)
- FOG-18.9. Modular Development of RIC / RIG
- FOG-18.10. Accountability Position Checklists
- FOG-18.11. Rehabilitation at Emergency Incidents
- FOG-19. Water Rescue for Swift Water / Flood
- Appendix A - Communications
- Appendix B - Agency Designators
- Appendix C - Glossary