2013 Treatment Protocols - Wake County Government
2013 Treatment Protocols - Wake County Government 2013 Treatment Protocols - Wake County Government
Adult Multiple Trauma History · Time and mechanism of injury · Damage to structure or vehicle · Location in structure or vehicle · Others injured or dead · Speed and details of MVC · Restraints / protective equipment · Past medical history · Medications Signs and Symptoms · Pain, swelling · Deformity, lesions, bleeding · Altered mental status or unconscious · Hypotension or shock · Arrest Differential (Life threatening) · Chest: Tension pneumothorax Flail chest Pericardial tamponade Open chest wound Hemothorax · Intra-abdominal bleeding · Pelvis / Femur fracture · Spine fracture / Cord injury · Head injury (see Head Trauma) · Extremity fracture / Dislocation · HEENT (Airway obstruction) · Hypothermia Assessment of Serious Signs / Symptoms ABC and LOC Airway Protocol(s) if indicated Spinal Immobilization Procedure Normal Repeat Assessment Adult Procedure Splint Suspected Fractures Consider Pelvic Binding Control External Hemorrhage Monitor and Reassess Transport to appropriate destination using Trauma and Burn: EMS Triage and Destination Plan I P IV Procedure P Cardiac Monitor VS / Perfusion / GCS Hypotension / Shock Protocol IO Procedure I P Abnormal Rapid Transport to appropriate destination using Trauma and Burn: EMS Triage and Destination Plan Limit Scene Time ≤ 10 minutes Provide Early Notification Head Injury Protocol if indicated Splint Suspected Fractures Consider Pelvic Binding Control External Hemorrhage Normal Saline Bolus 500 mL IV / IO Repeat to effect SBP ≥ 90 Maximum 2 Liters Chest Decompression-Needle Procedure if indicated Monitor and Reassess Adult Trauma/Environmental Section Protocols Notify Destination or Contact Medical Control Protocol 80 This protocol has been altered from the original 2012 NCCEP Protocol by the Wake EMS Medical Director 2013
Adult Multiple Trauma TRAUMA CENTER CRITERIA Patients with a traumatic injury who meet the following criteria should be transported to a trauma center, as per the Trauma Triage and Destination plan ( as of 2013: WakeMed, WakeMed Peds, Duke Durham, UNC-Chapel Hill): 1. GCS ≤ 13 2. Systolic Blood Pressure < 90 mmHg 3. Respiratory Rate < 10 or > 29 Breaths per minute ( 20 feet (one story is equal to 10 feet) 13. Falls in pediatrics > 10 feet or 2-3 times the height of the child 14. High risk auto crash, including: - Intrusion, including roof, of > 12 inches at the occupant site or > 18 inches at any site - Ejection (partial or complete) from the automobile - Death in the same passenger compartment - Vehicle telemetry data consistent with a high risk of injury 15. Auto vs. pedestrian or bicyclist thrown, run over, or with significant (> 20mph) impact 16. Motorcycle crash > 20 mph 17. PREGNANCY > 20 weeks with even minor blunt trauma should be transported to a trauma center due to the potential need for trauma evaluation and prolonged fetal monitoring. Reference for further info: www.cdc.gov/fieldtriage - The 2011 Guidelines for Field Triage of Injured Patients Adult Trauma/Environmental Section Protocols Pearls · Recommended Exam: Mental Status, Skin, HEENT, Heart, Lung, Abdomen, Extremities, Back, Neuro · Items in Red Text are key performance measures used in the EMS Acute Trauma Care Toolkit · Transport Destination is chosen based on the EMS System Trauma Plan with EMS pre-arrival notification. · Scene times should not be delayed for procedures. These should be performed en route when possible. Rapid transport of the unstable trauma patient to the appropriate facility IS the goal. · Bag valve mask is an acceptable method of managing the airway if pulse oximetry can be maintained ≥ 90% · Geriatric patients should be evaluated with a high index of suspicion. Often occult injuries are more difficult to recognize and patients can decompensate unexpectedly with little warning. · Mechanism is the most reliable indicator of serious injury. · In prolonged extrications or serious trauma, consider air transportation for transport times and the ability to give blood. · Do not overlook the possibility of associated domestic violence or abuse. Protocol 80 This protocol has been altered from the original 2012 NCCEP Protocol by the Wake EMS Medical Director
- Page 189 and 190: Obstetrical Emergency Obstetrical S
- Page 191 and 192: Newly Born Pediatric/Obstetrical Se
- Page 193 and 194: Pediatric Pulseless Arrest Pediatri
- Page 195 and 196: Pediatric Ventricular Fibrillation
- Page 197 and 198: Pediatric Induced Hypothermia Histo
- Page 199 and 200: Pediatric Post Resuscitation Histor
- Page 201 and 202: Pediatric Tachycardia Pediatric Sec
- Page 203 and 204: Pediatric Pulmonary Edema / CHF His
- Page 205 and 206: Pediatric Respiratory Distress Pedi
- Page 207 and 208: History Past medical history Medica
- Page 209 and 210: Pediatric Overdose / Toxic Ingestio
- Page 211 and 212: Pediatric Hypotension / Shock Histo
- Page 213 and 214: Pediatric Allergic Reaction History
- Page 215 and 216: Pediatric Seizure History · Fever,
- Page 217 and 218: Bites and Envenomations History ·
- Page 219 and 220: Marine Envenomations / Injury Histo
- Page 221 and 222: Blast Injury / Incident History ·
- Page 223 and 224: Adult Thermal Burn History · Type
- Page 225 and 226: Pediatric Thermal Burn History · T
- Page 227 and 228: Chemical and Electrical Burn Histor
- Page 229 and 230: Crush Syndrome Trauma Adult / Pedia
- Page 231 and 232: Extremity Trauma History · Type of
- Page 233 and 234: Adult Head Trauma History · Time o
- Page 235 and 236: Pediatric Head Trauma History · Ti
- Page 237 and 238: Hyperthermia Adult / Pediatric Trau
- Page 239: Hypothermia / Frostbite Pearls · R
- Page 243 and 244: Radiation Incident History · Type
- Page 245 and 246: Selective Spinal Immobilization C-S
- Page 247 and 248: Nerve Agent (includes WMD) Protocol
- Page 249 and 250: Scene Rehabilitation: General May b
- Page 251 and 252: Scene Rehabilitation: Responder Rem
- Page 253 and 254: Cyanide Exposure History · Smoke i
- Page 255 and 256: Medical Clearance for Mental Health
- Page 257 and 258: EMS Triage and Destination Plan Ped
- Page 259 and 260: STEMI Patient (ST Elevation Myocard
- Page 261 and 262: EMS Triage and Destination Plan Tra
- Page 263 and 264: Approved Medical Abbreviations The
- Page 265 and 266: Approved Medical Abbreviations L-SP
- Page 267 and 268: Approved Medical Abbreviations a p
- Page 269: Diagnoses/Past Procedures/Physical
- Page 272 and 273: HIPAA PERMITS DISCLOSURE OF MOST TO
- Page 274 and 275: North Carolina Medical Board Approv
- Page 276 and 277: North Carolina Medical Board Approv
- Page 278 and 279: UNIVERSAL INSTRUCTIONS: Patient Ins
- Page 280 and 281: Burns Resources Fluid Formula Formu
- Page 282 and 283: APPENDIX B.1: WCEMSS PEDIATRIC DRUG
- Page 284 and 285: APPENDIX B.2: WCEMSS ADULT DRUG VOL
- Page 286 and 287: Patient Weight (kg) 30 5 mcg/kg/min
- Page 288 and 289: Appendix C: Wake County EMS System
Adult Multiple Trauma<br />
History<br />
· Time and mechanism of injury<br />
· Damage to structure or vehicle<br />
· Location in structure or vehicle<br />
· Others injured or dead<br />
· Speed and details of MVC<br />
· Restraints / protective equipment<br />
· Past medical history<br />
· Medications<br />
Signs and Symptoms<br />
· Pain, swelling<br />
· Deformity, lesions, bleeding<br />
· Altered mental status or<br />
unconscious<br />
· Hypotension or shock<br />
· Arrest<br />
Differential (Life threatening)<br />
· Chest: Tension pneumothorax<br />
Flail chest<br />
Pericardial tamponade<br />
Open chest wound<br />
Hemothorax<br />
· Intra-abdominal bleeding<br />
· Pelvis / Femur fracture<br />
· Spine fracture / Cord injury<br />
· Head injury (see Head Trauma)<br />
· Extremity fracture / Dislocation<br />
· HEENT (Airway obstruction)<br />
· Hypothermia<br />
Assessment of Serious Signs /<br />
Symptoms<br />
ABC and LOC<br />
Airway Protocol(s)<br />
if indicated<br />
Spinal Immobilization Procedure<br />
Normal<br />
Repeat Assessment Adult Procedure<br />
Splint Suspected Fractures<br />
Consider Pelvic Binding<br />
Control External Hemorrhage<br />
Monitor and Reassess<br />
Transport to appropriate<br />
destination using<br />
Trauma and Burn:<br />
EMS Triage and Destination Plan<br />
I<br />
P<br />
IV Procedure<br />
P<br />
Cardiac Monitor<br />
VS / Perfusion /<br />
GCS<br />
Hypotension /<br />
Shock<br />
Protocol<br />
IO Procedure<br />
I<br />
P<br />
Abnormal<br />
Rapid Transport to appropriate<br />
destination using<br />
Trauma and Burn:<br />
EMS Triage and Destination Plan<br />
Limit Scene Time ≤ 10 minutes<br />
Provide Early Notification<br />
Head Injury Protocol<br />
if indicated<br />
Splint Suspected Fractures<br />
Consider Pelvic Binding<br />
Control External Hemorrhage<br />
Normal Saline Bolus 500 mL IV / IO<br />
Repeat to effect SBP ≥ 90<br />
Maximum 2 Liters<br />
Chest Decompression-Needle<br />
Procedure<br />
if indicated<br />
Monitor and Reassess<br />
Adult Trauma/Environmental Section <strong>Protocols</strong><br />
Notify Destination or<br />
Contact Medical Control<br />
Protocol 80<br />
This protocol has been altered from the original 2012 NCCEP Protocol by the <strong>Wake</strong> EMS Medical Director<br />
<strong>2013</strong>
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