Spokane County EMS Protocols
Front Matter
Section 1: County Operating Procedures
- Abandoned Babies Newborn Safety Act
- Blood Draws
- Cancellation / Slow Down
- Determination of General Patient Transport Destination
- Dispatch of Medical Personnel
- Documentation
- Emergency Services Supervisory Organization (ESSO)
- Emergency Transports and ALS Rendezvous
- Emergency Transport of the Physically Disabled and their Service Animals
- EMS Communication to Receiving Hospital
- EMS Personnel Endangerment
- EMS Scene Management & Inter-Agency Relations
- Expectations of the EMS Agency, EMS Agency Supervisor and EMS Agency Supervising Physician
- Field Resuscitation
- General Guidelines for All Patients
- Hazardous Materials Response
- Helicopter Triage Guidelines
- Hospital Emergency Response Team (H.E.R.T.)
- Infectious Disease Precautions
- Inter-Facility Transport
- Level of Certification of EMS Personnel to Attend the Patient During Transport
- Mass Casualty, Treatment and Transport
- Medical Control
- Medical Professionals at the Scene
- Interfacility Transfer of Hospice Patients
- Medications and Allergies
- Non-Transport of Patients
- On-Scene Medical Authority and Assistance
- On-Scene Patient Mask Use
- Pandemic Triage Guide (COVID-19)
- Patient Treatment Rights
- Relationship Between EMS Team and Private Physician
- Restraints for Aggressive or Violent Patients
- Schedule II Medications
- Suspected Ebola Virus Disease
- Thank You for Your Offer of Assistance
- Washington State Prehospital Trauma Triage Destination Procedure
- Washington State Prehospital Cardiac Triage Destination Procedure
- Washington State Prehospital Stroke Triage Destination Procedure
Section 2: Procedure Protocols
- AED Defibrillation Protocol
- Bag-Valve-Mask Ventilation
- Blood Specimen Information
- Capnometry / Capnography
- Continuous Positive Airway Pressure (CPAP)
- Endotracheal Intubation
- Estimating Tracheal Tube Size and Depth of Insertion
- Failed Resuscitation: Considerations for Family Support
- Helmet Removal from Injured Patients
- I-Gel Airways
- Intraosseous Infusion - Adults
- Intraosseous Infusion in Children
- Correct Intraosseous Needle Placement
- IV Fluids
- Needle Cricothyrotomy
- Needle Thoracostomy
- Optimal Sequence Intubation (OSI)
- Orogastric Tube Insertion
- Oxygen Administration
- Recommended Indications for Spinal Precautions in Children
- Special Considerations in the Treatment of Patient Recently Immunized Against Smallpox
- Spinal Immobilization
- SQ and IM Injections
- Stimulus Procedure
- Surgical Cricothyrotomy
- Tourniquet
- Use of External Pace Makers
- Vagal Maneuvers
Section 3: Cardiovascular Protocols
- Acute Stroke
- Asystole / PEA
- Bradycardia
- Chest Discomfort Suspected Angina / AMI
- General Assessment of Patients with Significant Cardiac Arrhythmias
- LVAD - HeartMate II
- LVAD - HeartWare
- LVAD - VentrAssist
- Post Resuscitation
- Post Cardiac Arrest Care
- Pulmonary Edema
- Stable Narrow-Complex Tachycardia (HR>150)
- Stable Wide-Complex Tachycardia (HR>150)
- Thoratec Ventricular Assist Devices
- Unstable Narrow-Complex Tachycardia
- Unstable Wide-Complex Tachycardia (HR>150)
- Ventricular Assist Device(s)
- Ventricular Fibrillation / Pulseless Ventricular Tachycardia
Section 4: Medical Protocols
- Acute Epistaxis (Non-Trauma)
- Allergic Reactions and Anaphylaxis
- Adult Seizures
- Coma of Unknown Origin
- Emergency Disconnect of Home Hemodialysis
- Excited Delirium: The Agitated Uncontrolled Patient
- Hypoglycemia
- Mental Health Emergencies
- Poisoning / Overdose
- Renal Failure and Dialysis Patients
- Severe Sepsis
- Toxic Smoke Inhalation
- Treatment of Patients Exposed to Nerve Agents, GB, VX and Organophoshorous Pesticides
- Vascular Emergencies
Section 5: Pediatric and OB/GYN Protocols
- General OB/GYN Considerations
- Complications of Delivery
- Emergency Delivery
- Medications for Neonatal Resuscitation
- Neonatal Resuscitation
- Pre-Eclampsia
- Sexual Assault
- Spontaneous Abortion
- General Pediatric Considerations
- Child Abuse
- Pediatric Airway Obstruction
- Pediatric Allergic Reactions and Anaphylaxis
- Pediatric Asystole / Pulseless Electrical Activity
- Pediatric Bradycardia
- Pediatric Coma / Altered Level of Consciousness
- Pediatric Fever
- Pediatric Hypoglycemia
- Pediatric Post Resuscitation Care
- Pediatric Pulseless Ventricular Tachycardia or V-Fib
- Pediatric Respiratory Arrest
- Pediatric Respiratory Distress with Stridor
- Pediatric Respiratory Distress with Wheezing
- Pediatric Seizures
- Pediatric Shock
- Pediatric Trauma
- Stable Narrow-Complex Pediatric Tachycardia
- Stable Wide-Complex Pediatric Tachycardia
- Sudden Infant Death Syndrome
- Unstable Narrow-Complex Pediatric Tachycardia
- Unstable Wide-Complex Pediatric Tachycardia
- Pediatrics at a Glance
Section 6: Trauma Protocols
- Abdominal Trauma
- Animal Bites
- Burns
- Chemical Burns to the Eye
- Chest Trauma
- Crush Injury Syndrome
- External Hemorrhage Control
- Head Trauma
- Injuries to the Ear
- Injuries to the Nose
- Penetrating and Blunt Injuries to the Eye
- Penetrating and Blunt Injures of the Neck
- Penetrating Trauma from Taser® Weapons
- Pelvic Fracture Stabilization Procedure
- Soft Tissue Avulsions or Amputations
- Spinal Trauma
Section 7: Environmental Protocols
Section 8: Respiratory Protocols
- Airway Obstruction: Adult
- Asthma
- Chronic Obstructive Pulmonary Disease (COPD)
- Tracheostomy / Stoma Emergency Airway Management
Section 9: Special Situation Protocols
- Cardiac Arrest Due to Physical Trauma
- Fatal and Non-Fatal Drowning
- Electrocution
- EMS Response to Meth Lab Related Injuries
- Hypothermia
- Mental Health Emergencies
- Pregnancy and Cardiac Arrest
- Right Ventricular Infarction
Section 10: BLS / ILS and Supplemental Protocols
- Aspirin
- BLS Airway Obstruction: Adult
- BLS Airway Obstruction: Pediatric
- EMT Glucose Testing
- EMT Naloxone Administration for Suspected Opiate Overdoseage
- Mark 1 Kit (Atropine and 2-PAM)
- Treatment of Patients Exposed to Nerve Agents, GB, VX and Organophosphorous Pesticides
Section 11: Drug Protocols
- Introduction
- 10% Dextrose
- 50% Dextrose
- Acetaminophen
- Acetylsalicylic Acid (Aspirin)
- Activated Charcoal (Actidose / Sorbitol)
- Adenosine (Adenocard®)
- Albuterol (Ventolin®)
- Amiodarone
- Atropine
- Calcium Gluconate
- Diazepam (Valium®)
- Diltiazem
- Diphenhydramine (Benadryl®)
- Epinephrine (Adrenalin) - Adult
- Epinephrine (Adrenalin) - Pediatric
- Etomidate
- Fentanyl
- Glucagon
- Heparin
- Hydroxocobalamin
- Ibuprofen
- Ipratropium Bromide (Atrovent®)
- Ketamine (Ketalar™)
- Lidocaine (Xylocaine®)
- Lorazepam (Ativan®)
- Magnesium Sulfate
- Midazolam (Versed®)
- Morphine (MSO₄)
- Naloxone (Narcan®)
- Nitroglycerin
- Norepinephrine (Levophed®)
- Ondansetron (Zofran®)
- Oral Glucose Gel
- Oxygen (O₂)
- Oxymetazoline Hydrochloride
- Pralidoxime Chloride (2-PAM)
- Racemic Epinephrine - Pediatric
- Rocuronium
- Sodium Bicarbonate (N𝖠HCO3)
- Succinylcholine (Anectine®)
- Vecuronium Bromide (Norcuron)
Appendix C: Reference Documents
- Additional Approved Skills and Procedures for Spokane County EMS Providers
- APGAR Scoring
- Certification Made Easy
- Classification of Burns
- Community Resources
- Conditions for which Field Assessment of Temperature may be Beneficial
- Conversion Tables
- Diabetic Coma and Insulin Shock Fact Sheet
- Drug Reference Sheet
- Emergency Departments in Spokane County
- Emergency Laryngectomy Management
- Emergency Support Function #8
- Emergency Tracheostomy Management - Patient upper airway
- Field Operations Guide (FOG)
- Helicopter Safety Reference
- Interpretation of Step 3 of WA Prehospital Trauma Triage Procedure
- Levels of Trauma, Stroke, and Cardiac Hospitals in Spokane County
- Manikin Intubation Credit Requirement for the Airway Component of Recertification
- Oxygen Administration for Suspected or Known COVID-19 Patients
- Policy
- Federal Requirements for Dispensing Physicians
- DEA Registered Reverse Distributors
- P.S. Industries Procedure
- Pandemic Index of Severity for Triage (PIST)
- Paramedic Requirements for Practicing in Spokane County
- Pediatrics at a Glance
- Pit Crew
- Pre / Post Cardiac Arrest Checklist
- Recommended Guidelines for the Scope of AED Training of Site Specific Personnel
- Revised Trauma Score (R.T.S.)
- Sexual Assault Resources
- Stoma / Tracheostomy Management - Adult & Pediatric
- Tiered Response to EMS Patient Care Concerns and System Issues
- Washington State Department of Health Scope of Practice for EMS Providers
MPD Controlled Substance Management Guidelines
Appendix D: Reference Forms
- Abandoned Babies Act
- Affiliate Intent to Cover
- Blood Draw Directions
- County Field Training Letter
- Infectious Disease Exposure Form
- Non-Transport of Patient Form
- Patient Refusal of Treatment / Transport
- Physician Orders for Life-Sustaining Treatment
- Preliminary Field Medical Report
- Recommendation for Follow-Up to a Possible Infectious Disease Exposure
- Spokane County EMS King Airway Insertion Evaluation
- Thank You for Your Offer of Assistance
- Training, CME, and Skills Maintenance Documentation
Field Operations Guide
- Cover & Preface
- Common Responsibilities
- Multi-Agency Coordination System
- Area Command
- Complex
- Command
- Organization Chart
- Position Checklists
- Air Operations Considerations
- Operations Section Planning Cycle Guide
- Finance/Administration Section
- Organization Chart
- Modular Development
- ICS Organization Guide
- T-Card Colors and Uses
- ICS Forms
- ICS Map Display Symbology
- Resources Unit Functions and Interactions
- Situation Unit Functions and Interactions
- Resource Status Change Reporting
- Strike Team Leader Interactions
- Reassign/Release of Resources
- ICS Camp Organization and Reporting Relationships
- Introduction
- Typing Process
- Fire Suppression Resources
- Emergency Medical Services Resources
- Hazardous Materials Resources
- Search and Rescue Resources
- Hazardous Materials
- Introduction
- Incident Authority
- Command
- On Scene Medical Authority
- Initial "On-Scene" Priorities
- Secondary "On-Scene" Priorities
- Air Ambulance Transportation
- Disaster Medical Coordination Center (DMCC)
- Communications
- Central Collection Point for Names of Victims
- Medical Surge Trailers / Alternative Care Facilities (ACF)
- Modular Development
- Position Checklists
- EMS / Medical Branch Worksheet
- MCI Patient Triage / Destination List
- Multi-Casualty Glossary of Terms
- Urban Search and Rescue
- High Rise Structure Fire
- Law Enforcement Branch
- Evacuation Group
- Security Group
- Investigations Group
- Tactical Group
- Traffic Group
- Resource Types and Minimum Standards
- Terrorism / Weapons of Mass Destruction
- Introduction
- Risk Management Policy
- Risk Management Checklist
- Risk Management Theory
- All Risk Decision Making Checklist
- Utilization of LCES on All Incidents
- Spokane County Fire Agency Mutual Aid Firefighter Accountability
- Rapid Intervention Crews (RIC) and Groups (RIG)
- Modular Development of RIC / RIG
- Accountability Position Checklists
- Rehabilitation at Emergency Incidents
- Water Rescue for Swift Water / Flood
- Appendix A - Communications
- Appendix B - Agency Designators
- Appendix C - Glossary
- Appendix H - Area Coordinator Duty Schedule
Operations Section
Planning Section
Logistics Section
Organizational Guides
Resource Types and Minimum Standards
Multi-Casualty
Law Enforcement
Incident Safety and Accountability Guidelines
Last updated: 2022-09-13