IMPORTANT

Relevance of County Operating Procedures and Protocols to the different levels of certified EMS providers in Spokane County

All FR, EMT-B, and EMT-I responders are obligated to follow the State of Washington mandated Patient Care Protocols for their level of certification.  A number of additional protocols have been developed within our EMS system that are also relevant to our EMT-B and EMT-I responders (see BLS/ILS Protocols Section below).  They include the following: 

1.  Patients With a Left Ventricular Assist Device (LVAD)

2.  Patients With a Thoratec Ventricular Assist Device (VAD)

3.  Treatment of Patients Exposed to Nerve Agents

State Allowed Discretionary Decisions Within BLS Protocols

In addition, the State of Washington allows some local modification of State BLS and EMT I protocols.  The following modifications are recommended to be applied to the appropriate State protocol.

1.  Cardiovascular Emergencies - Aspirin should be administered without online contact with medical control unless there is a specific reason not to do so such as an allergy to this medicine.*

2.  Anaphylaxis - Epinephrine for anaphylaxis should be administered without online contact with medical control unless the EMS provider is seeking confirmation of the indications for administration by BLS personnel in our county.  The lower weight limit for the use of a pediatric auto-injector for an infant or child is 15 kg (33 lbs).  Medical control should be contacted to consider pediatric auto-injector administration to children <15 kg (33lbs) with appropriate indications.

3.  Diabetic Emergencies - EMT-Bs may assess the blood glucose level provided they have successfully completed a Spokane County approved training program.*

4.  Nitroglycerin should not be given patients who have used erectile dysfunction drugs within the past 24 hours for Viagra or Levitra or 96 hours for Cialis.

All certified EMS providers in Spokane County are obligated to follow Spokane County Operating Procedures to the extent to which implementation is within the scope of practice of the provider's level of certification.  Similarly, Reference material, medications, special situations, and our Mass Casualty Incident Guide represent consensus recommendations within our EMS system that should be applied by all EMS providers within the scope of practice of the providers level of certification.

 

Click Here For Manual Sections

Bulletin January 20, 2009:  See Ipecac Syrup In Drug Section

 

UPDATES-Scroll Down For Latest Updates

All previous updates from July 2004 through August 2010 are below in Miscellaneous   

November 1, 2010: 

Added Drug Protocol Rocuronium, D 188C, in case of a possible shortage of Succinylcholine.  Succinylcholine remains our preferred agent for these indications providing supplies are available.  It is not in the Table of Contents.

December 27, 2010:

  1. The Pediatric Airway Obstruction ALS, P99, has been changed as follows:  Infant 7 and 8 have been removed and a new 7 added.  Child has added a new 7 & 8.

  2. The Reference Needle Cricothyrotomy, R151, added (60 degree for the Quick Trach) at the end of 6).

  3. The COPS Determination of Patient Transportation, G17A, changed nearer hospital to an alternate on the end of the second line in the * at the bottom of the page.

  4. The Medical Anaphylaxis, P65, has been changed the title to Allergic Reactions and Anaphylaxis and Benadryl for Mild and Moderate has been changed to 25-50.

  5. The Medical Toxic Smoke Inhalation, P71D, has inserted a new 10 and added a new 14.

February 11, 2010:

           The COPS, POLST form has been updated to the 2011 Washington State version.

April 5, 2011:

The Medical Protocol, Grand Mal Seizure, P68, has changed 5) and changed ativan to Lorazepam and change the wording  in the * at the end relating to the availability of Lorazepam.

April 13, 2011:

The new April 2011 POLST Form as been added to the Miscellaneous section.  It is front and back and if you print it, use green card stock only.

July 1, 2011:

1.      The COPS, Inter-Facility Transfer, G12, has added the ILS level.

2.      The COPS, Determination of Patient Transport Destination, G17A, added Step 4 to 1b, revised 2, and added 3.

3.      The COPS, Field Resuscitation Guidelines, G30, has changed as follows:  WITHHOLDING OF CPR 1,)A, 1) was  changed and DISCONTINUING OF CPR 1), B), D) was added.

4.      The Cardiac Protocol, Chest Discomfort, C44, has change 2), 5), and 7).

5.      The Cardiac Protocol, General Considerations for Patients with Significant Cardiac Arrythmias or Cardiac Arrest, C45,  has a name change and totally changed the protocol.

6.      The Cardiac Protocol, Ventricular Fibrillation/Pulseless Ventricular Tachycardia, C46, has almost totally changed.

7.      The Cardiac Protocol, Asystole*/PEA, C47, is totally changed...C 49 PEA removed.

8.      The Cardiac Protocol, Bradycardia, C48, is totally changed.

9.      10.  The Cardiac Protocol, Stable Wide-Complex Tachycardia, C50, has changed everything except 2.

11.  The Cardiac Protocol, Unstable*Wide-Complex Tachycardia, C51, has removed the original 3 and 4 and the * is changed.

12.  The Cardiac Protocol, Unstable Narrow-Complex Tachycardia, C52, reviewed with no changes.

13.  The Cardiac Protocol, Stable Narrow-Complex Tachycardia, C53, has changed 4 to indicate the brand name.

14.  The Cardiac Protocol, Post-Cardiac Arrest Care, C54, has changed the name to Post-Cardiac Arrest Care and has been totally redone.

15.  The Cardiac Protocol, Pulmonary Edema, C55, was reviewed with no changes.

16.  The Cardiac Protocol, LVAD-HeartMate II, C57B, was reviewed with no changes.

17.  The Cardiac Protocol, Thoratec Venticular Assist Device(s), C57D, was reviewed with no changes.

18.  The Cardiac Protocol, LVAD HeartMate (XVE), C57, was reviewed with no changes.

19.  The Cardiac Protocol, LVAD-VentrAssist, C57C, was reviewed with no changes.

20.  The Drug Protocol, Adenocard (Adenosine), D166, added to Indications and Precautions/Side Effects.

21.  The Drug Protocol, Atropine, D168, deleted former indications 2 and 3.

22.  The Drug Protocol, Amiodarone, D166A, revised Adult Dosage Indication 1.

23.  The Drug Protocol, Benadryl (Diphenhydramine), D169,  added to Indication 2.

24.  The Drug Protocol, Magnesium Sulfate, D182, was reviewed with no changes.

25.  The Drug Protocol, Sodium Bicarbonate, D189, deleted former indications 2 and 3.

26.  The Drug Protocol, Fentanyl, D175B, changed the BP <90 in Precautions to <100.

 Every effort is made to insure accuracy and in the event you see an error or omission, please let your EMS Officer know or contact our office by e-mail at ems@spokanecounty.org.  Please update staff within 30 days.

November 18, 2011

These Pediatric Protocol changes are based upon the State’s Pediatric Technical Advisory Committee as well as new AHA guidelines and the input of the Spokane County EMS Protocol Committee:

1.  Pediatric Bradycardia, P101

2.  Pediatric/Stable Narrow-Complex Ped Tachycardia November 2011.doc, P 102 C

3.  Pediatric Pulseless Ventricular Tachycardia or V-FIB, P 103

4.  Pediatric Asystole /Pulseless Electrical Activity, P 104

5.  Unstable Narrow-Complex Pediatric Tachycardia, P 102

6.  Unstable Wide-Complex Pediatric Tachycardia, P 102 A

7.  Stable Wide-Complex Pediatric Tachycardia, P 102 B

Every effort is made to insure accuracy and in the event you see an error or omission, please let your EMS Officer know or contact our office by e-mail at ems@spokanecounty.org.  Please update staff within 30 days.

November 21, 2011

A new Pediatric Protocol, Pediatric Resuscitation Care, P106A has been added.

Every effort is made to insure accuracy and in the event you see an error or omission, please let your EMS Officer know or contact our office by e-mail at ems@spokanecounty.org.  Please update staff within 30 days.

November 23, 2011

  1. Morphine, D 184, is back in the manual and may be substituted for Fentanyl in the event of a Fentanyl drug shortage.

  2. Continuous Positive Airway Pressure, R 149A, has changed Procedure 2.

January 20, 2012

Morphine, D184 added Indication 2:  For the treatment of severe pain when Fentanyl is not available.

Every effort is made to insure accuracy and in the event you see an error or omission, please let your EMS Officer know or contact our office by e-mail at ems@spokanecounty.org.  Please update staff within 30 days.

 

 

Table of Contents January 2012


 

Cardiac Protocols Drug References Environmental Protocols Patient Care Procedures (Guidelines)
MCI Medical Protocols OB-Gyn Protocols Pediatric Protocols
References Respiratory Protocols Special Situations Trauma Protocols

BLS Protocols

Miscellaneous    

Cardiac Protocols Acute Stroke
Asystole
Bradycardia
 
Chest Discomfort-Suspected Angina/AMI
General Considerations for Patients with Significant Cardiac Arrythmias or Cardiac Arrest
LVAD HeartMate (XVE)

LVAD HeartMate II

LVAD VentrAssist

Post-Cardiac Arrest Care
Pulmonary Edema
 
Stable Narrow - Complex Tachycardia
Stable Wide -Complex Tachycardia
Thoratec Venticular Assist Device
Unstable Narrow - Complex Tachycardia
Unstable Wide - Complex Tachycardia
V Fib Pulseless V Tac
 
 

Drug References  50% Dextrose 
Acetylsalicylic
Activated Charcoal
Adenosine
Amiodarone
Ativan
Atropine
Benadryl
Calcium Gluconate
Dopamine
Epinephrine-Adult
Epinephrine-Pediatric
Etomidate

Fentanyl

 
Glucagon
Heparin
Hydroxocobalamin
Ipecac Syrup
Ipratropium
Lasix
Lidocaine
Magnesium Sulfate
Morphine
 
Narcan
Nitroglycerin
Ondansetron
Oxymetazoline
Pralidoxime Chloride (2-PAM)
 
Racemic Epinephrine
Rocuronium Bromide
Sodium Bicarbonate
Succinylcholine
Valium  
Vecuronium  
Ventolin
Versed

Environmental Protocols
Frostbite
Heat Cramps
Heat Stroke
Hypothermia
Drowning

County Operating Procedures

Abandoned Babies (Full Abandoned Babies Act below in Misc)
Blood Draws
 
Cancellation Slow Down
Code 99
Determination of Patient Transport
Direction-Blood Test
Dispatch of Medical Personnel
Documentation
Emergency Transports
 
Emergency Service Animals
EMS-No CPR
EMS Scene Management & Inter-Agency Relations
Field Resuscitation Guidelines
General Guidelines
Hazardous Materials
Helicopter Triage
Infectious Disease
Inter-Facility Transport
Level of Certification
Medical Control
Medical Professionals at the Scene
Medications and Allergies
 
Moonlighting
No CPR Bracelet-Call EMS Office For Copy
Non-Transport of Patients
On-Scene Med Authority
Patient Refusal of Treatment/Transport
Patient Treatment Rights
(POLST) Physician Orders for Life-Sustaining Treatment 2 pages
Prehospital Cardiac Triage Destination Procedures
Prehospital Stroke Triage Destination Procedures
CDC Trauma Triage July 2011
Relationship Between Between EMS and Private Physician
Restraints Aggressive Patients Transport
Schedule 2 Medications
Thank You For Your Offer
Trauma Triage Tool  

MCI
Spokane County MCI-Field Operations Guide (FOG) 2006

Medical Protocols
Acute Epistaxis
Allergic Reactions and Anaphylaxis
Coma of Unknown Origin
Emergency Disconnect of Hemodialysis
Excited Delirium
Grand Mal Seizure
Hypoglycemia
Mental Health Emergencies
 
 
Poisoning Overdose
Renal Failure

Toxic Smoke Inhalation

Treatment of Patients Exposed To Nerve Agents

OB-Gyn Protocols
Complications of Delivery
Emergency Delivery
General Considerations
Medications For Neonatal Resuscitation
Neonatal Resuscitation
Pre-Eclampsia
Spontaneous Abortion

Sexaul Assault


Pediatric Protocols
Airway Obstruction
 
Child Abuse
General Considerations Pediatrics
 
Pediatric Allergic Reactions and Anaphylaxis
Pediatric Asystole/Pulseless Electrical Activity
Pediatric Bradycardia
Pediatric Coma
Pediatric Fever
Pediatric Hypoglycemia
Pediatric Post Resucitation Care
Pediatric Pulseless V-Tach or V-Fib
Pediatric Respiratory Arrest
Pediatric Respiratory Distress
Pediatric Respiratory-Stridor
Pediatric Respiratory-Wheezing
Pediatric Seizures
Pediatric Shock
Pediatric Trauma
Stable Narrow-Complex Ped Tachycardia
Stable Wide-Complex Ped Tachycardia
Sudden Infant Death
Unstable Narrow-Complex Ped Tachycardia
Unstable Wide-Complex Ped Tachycardia

References
AED Defib Protocol
Apgar Scoring
Bag Valve Mask
Blood Tube Information
Burn Chart
Capnometry/Capnography
Carotid Sinus Massage Procedure
Community Resources
Conversion Table
Continuous Positive Airway Pressure (CPAP)
Diabetic Coma and Insulin
Double Lumen Airway
Drugs Commonly Prescribed
Emergency Departments
Endotracheal Drug Admin
Endotracheal Intubation
Estimating Tracheal Tube
Failed Resuscitation
Glossary
Helicopter Safety Reference
 
Intraosseous Infusion In Adults
Intraosseous Infusion In Children Call  office for copy
Intraosseous Needle Placement
 
IV Fluids
King Airway
King Airway Skills Sheet  
Needle Cricothyroitomy
Needle Thoracostomy
Oxygen Administration
Pandemic Index of Severity for Triage  
   
Pediatrics at a Glance
Rapid Sequence Intubation
Revised Trauma Score
Smallpox Vaccination Concerns
Spinal Precautions in Children
SQ & IM Injections
Tiered Response-Patient Care-System Issues
Thermometers
Tourniquet
Helmet Removal From Injured Patients
Use of External Pacemakers

Respiratory Protocols
Asthma
Chronic Obstructive Pulmonaru Disease (COPD)
Airway Obstruction:  Adult
 

Special Situations
Drowning and Near Drowning
Electrocution
Hypothermia
Mental Health Emergencies
Pregnancy and Cardiac Arrest
Traumatic Cardiac Arrest

Trauma Protocols
Abdominal Trauma
Animal Bites
Burns
Chemical Burns to the Eye
Chest Trauma
Crush Injury
Head Trauma
Injuries To Ear and Nose
Penetrating and Blunt Eye
Penetrating and Blunt Neck
Soft Tissue Avulsions
Spinal Trauma
Taser Trauma

BLS/ILS Protocols

and

Supplemental

Protocols

Aspirin
BLS-LVAD
BLS-VAD
BLS-Treatment of Nerve Agent
EMT Glucose Testing
MARK 1 Kit (Atropine & 2-PAM)
BLS Airway Obstruction:  Adult
BLS Airway Obstruction-Pediatric
First Responder Field Protocols http://www.doh.wa.gov/hsqa/emstrauma/download/frprot.pdf
EMT-Basic Field Protocol  http://www.doh.wa.gov/hsqa/emstrauma/download/emtbprot.pdf  
Intravenous Therapy and Airway Technican Field Protocols http://www.doh.wa.gov/hsqa/emstrauma/download/ivawprt.pdf
Intermediate Life Support Technican Field Protocols  http://www.doh.wa.gov/hsqa/emstrauma/download/ilsprt.pdf
Intermediate Life Support and Airway Field Protocols   http://www.doh.wa.gov/hsqa/emstrauma/download/ilsawprt.pdf

Miscellaneous Abandoned Babies Act

Acknowledgments

Affiliate County Operating Procedures

Affiliate Intent to Cover a Special Event

Affiliate Service Update Form

Airway Skills Evaluation Form

BLS-ILS-ALS Education Requirements For Certification

BLS Epi Pilot Power Point

2011 Certification Applications:  http://www.doh.wa.gov/hsqa/emstrauma/initcert.htm#First%20Responder

2011 Reciprocity Application:  http://www.doh.wa.gov/hsqa/emstrauma/download/r-challapp.pdf

2011 Reinstatement App:  http://www.doh.wa.gov/hsqa/emstrauma/download/recertapp.pdf

Certification Made Easy

County Field Training Letter

DOH EMS Contacts

Double Lumen Airway-AED Skills Maintenance

Drug Reference Sheet July 2010

Emergency Support Function #8

EMS Awards Nomination Form

EMS Instructors

EMS Manual Updates July 2004-June 2008

EMS Manual Updates July 2008-November 2008

EMS Manual January 2008-August 2010

EMT Physician Advisor Letter

Infectious Disease Exposure Form (Legal Size)

 
 
 
Interpretation of Step 3 of the State of Washington Prehospital Trauma Triage (Destination) Procedure

Introduction

Manikin Intubation Requirements For Recertification

Medical Abbreviations

Getting Started On Line http://www.doh.wa.gov/hsqa/emstrauma/download/gettingstarted.pdf

 
PAD AED Training Recommendations    
 
PAD Locations-Spokane County August 2010 (Printable)

PM OTEP Random Review Form

PM Requirements For Spokane County

PM Student Advisory Committee Recommendation Process

Physician Advisor Letter

Preliminary Field Medical Report (PFMR)

Pyramid Security Agreement

 

Pyramid Use Instructions
 

POLST Form April 2011 (Print on Green Card Stock)

 
Quick Clot Memo
 
Recommendation for Follow-up to a Possible Infectious Disease Exposure*

Step 3 Additional Information Memo October 2009

Suggested QI Review for Physician Advisors